Nasal allergen challenge and environmental exposure chamber challenge: A randomized trial comparing clinical and biological responses to cat allergen.
Nasal allergen challenge and environmental exposure chamber challenge: A randomized trial comparing clinical and biological responses to cat allergen.
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DOI：
10.1016/j.jaci.2020.02.024
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发表时间：
2020-06
期刊：
影响因子：
--
通讯作者：
Durham SR
中科院分区：
文献类型：
--
作者：
Larson D;Patel P;Salapatek AM;Couroux P;Whitehouse D;Pina A;Johnson JL;Sever ML;Sanda S;Poyser J;Allio T;Scadding GW;Qin T;Shamji MH;Kwok WW;James EA;French D;Lelic A;Larché M;Altman MC;Togias A;Durham SR
直接滴注鼻变应原激发（NAC）和环境暴露室（EEC）是进行受控变应原激发的2种方法。尚未对这些方法的临床和生物学可比性进行彻底研究。我们试图比较NAC与EEC对猫过敏原的临床和免疫反应。24名受试者随机接受NAC，然后在EEC中进行2天激发，或在EEC中进行2天激发，然后接受NAC。激发间隔28天洗脱期。我们测量了总的鼻部症状评分、鼻吸气流量峰值、鼻（0-8小时）和血清细胞因子、血清抗体、外周血抗原特异性T淋巴细胞和鼻刮片中的基因表达。主要结果是NAC中过敏原暴露后或EEC中开始暴露后前3小时的总鼻症状评分曲线下面积。这两种挑战增加了鼻液和血清中的IL-5和IL-13，并导致与粘膜生物学和转录调控相关的基因模块的鼻细胞表达改变。基因模块的变化，比细胞因子的测量，显示出显着的关联与总的鼻部症状评分和峰值鼻吸气流量。总体而言，EEC暴露产生更大的反应和更多的早期终止与NAC相比。虽然这2种挑战在症状程度或时间上不相关，但在细胞因子水平上观察到显著相关性。虽然NAC和EEC的临床结局在时间上不同，幅度不相等，但免疫反应相似。特定变应原激发方法的选择应取决于研究目的和成本的考虑。
The direct-instillation nasal allergen challenge (NAC) and the environmental exposure chamber (EEC) are 2 methods of conducting controlled allergen provocations. The clinical and biological comparability of these methods has not been thoroughly investigated. We sought to compare clinical and immunologic responses to cat allergen in NAC versus EEC. Twenty-four participants were randomized to receive either NAC followed by a 2-day challenge in an EEC or a 2-day challenge in an EEC followed by NAC. Challenges were separated by 28-day washout periods. We measured total nasal symptom scores, peak nasal inspiratory flow, nasal (0–8 hours) and serum cytokines, serum antibodies, peripheral blood antigen-specific T lymphocytes, and gene expression in nasal scrapings. The primary outcome was the total nasal symptom score area under the curve for the first 3 hours after allergen exposure in NAC or after initiation of exposure in EEC. Both challenges increased IL-5 and IL-13 in nasal fluids and serum and resulted in altered nasal cell expression of gene modules related to mucosal biology and transcriptional regulation. Changes in gene modules, more so than cytokine measurements, showed significant associations with total nasal symptom score and peak nasal inspiratory flow. Overall, EEC exposure generated larger responses and more early terminations compared with NAC. Although the 2 challenges did not correlate in symptom magnitude or temporality, striking correlations were observed in cytokine levels. Although clinical outcomes of NAC and EEC were temporally different and nonequivalent in magnitude, immunologic responses were similar. Selection of a particular allergen challenge method should depend on considerations of study objectives and cost.
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14.2
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通讯作者：
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