Cellular inflammatory responses in human allergic skin reactions

To define better the role of inflammation in the response to pollen antigens, we have used our skin chamber model to study inflammatory cells recovered from the sites of ongoing allergic reactions. In 15 atopic subjects, paired skin blister sites were simultaneously challenged with ragweed- or grass-pollen antigen or buffer for 5 hours. There were 10 times as many cells recovered at antigen (20.7 X 10(5)) than at buffer (2.0 X 10(5)) sites, p less than 0.005; greater than 97% of the cells recovered were neutrophils. The number of cells recovered at the antigen sites correlated with the total amount of histamine released (r = 0.57; p less than 0.05) but not with the extinction dilution skin test reactivity nor with the intensity of the late cutaneous allergic response measured 6 hours after the injection of antigen. Phase-contrast microscopic examination of the cells recovered from the antigen sites demonstrated that 82% to 95% were polarized compared to 0% to 1.5% of autologous blood neutrophils obtained simultaneously from the peripheral blood. Antigen site cells were as capable of serum-dependent phagocytosis as peripheral blood neutrophils. There was no significant difference in the migratory response to buffer, the chemoattractant N-formyl-methionyl-leucyl-phenylalanine, or leukotriene B4, but there was a significantly decreased response to platelet-activating factor when the cells recovered from antigen sites were compared to autologous blood neutrophils.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of histocytological examinations of the nasal mucosa in pollinosis]

Cytogramme analyses have been made on the nasal mucosae of 100 patients affected with pollinosis. Ten of the cases had a histocytological examination during the season and also during winter. In the period of symptom upsurge neutrophil cytogrammes were seen in 31% of patients, 30% had eosinophils and the remainder had eosinophils and neutrophils. Basophils were seen in the cytogrammes from 38 patients (mean 4 to 15%). In those patients where the cytogrammes were eosinophils and neutrophils and the titre of basophils was below 15%, Lomusol, Beconase and hyposensitisation were found to be effective, in contrast to those in whom the cytogrammes had more than 70% of eosinophils or more than 15% basophils.

Mucosal mast cells in the rat and in man

The proteoglycan structure of mucosal mast cells (MMC) of the two species has been analyzed with histochemical in situ techniques. The findings indicate that human MMC, like human mast cells of several other sites, contain a heparin proteoglycan, unlike rat MMC which lack heparin but contain an oversulphated chondroitin sulphate. However, the dye-binding of the human MMC proteoglycan, like that of the rat, is highly susceptible to blocking by formaldehyde. Human MMC also exhibit a lower critical electrolyte concentration (CEC) of dye-binding than mast cells of other connective tissue sites, suggesting a relatively lower charge density and/or molecular weight of the glycosaminoglycan of the MMC. These findings thus suggest that the human MMC like those of the rat have a distinctive proteoglycan structure. Recent findings of another group indicate that the human MMC like those of the rat have also a distinctive proteinase composition. Finally, the mast cell response of the nasal mucosa during birch pollen allergy shows fundamental similarities to the nematode response of the rat intestinal mucosa. During both conditions mast cells are redistributed from the lamina propria into the epithelium, probably as a result of migration of mast cells or mast cell precursors. Taken together, these findings suggest the existence of a distinctive MMC phenotype also in man.

Seasonal variations in in vitro synthesis of rye pollen-specific IgE by human peripheral mononuclear cells. Functional heterogeneity within the IgE-B pool

Peripheral blood mononuclear B cells from 6 rye pollen-allergic patients, with no consistent perennial symptoms, were isolated before (July), during (October) and after (February and May) the pollen season. The T-depleted cells were fractionated on a discontinuous percoll density gradient and the B cell fractions, together with unfractionated B cells, incubated in vitro for quantitation of spontaneous synthesis of rye pollen-specific IgE. Markedly higher levels of IgE were synthesised by the fractions, as opposed to unfractionated B cells. The low-density fraction (B5) contributed most towards synthesis in the pollen season and the denser B6 cells in the pre- and post-pollen season. All low-density B cell fractions (B1-3-B5) and some high-density fractions contained large but variable amounts of preformed specific IgE which was retained, even in the absence of de novo synthesis in vitro, during the post- and pre-pollen season. Since only a fraction of this preformed IgE escaped into culture supernatants the contribution of preformed IgE to in vitro IgE synthesis in general may require reappraisal.

Contribution of basophil/mast cell and eosinophil growth and differentiation to the allergic tissue inflammatory response

The mechanisms underlying allergic tissue basophil/mast cell (BMC) or eosinophil (Eo) accumulation are unclear, especially since chemotaxis or IgE levels do not offer a sufficient explanation. We have found that a formaldehyde-blockable, steroid-responsive nasal metachromatic cell (NMC) population predominates in epithelium and correlates well with symptoms and signs in patients with allergic rhinitis. Circulating BMC and Eo progenitors (colony-forming cells in culture; CFU-c) are increased in atopic patients, inversely related to NMC counts, and fall as NMC numbers rise during seasonal allergen (ragweed pollen) stimulation. The metachromatic cell progeny of these CFU-c are also formaldehyde-blockable in their staining reaction and thus may correspond to NMC. Human nasal polyps yield BMC CFU-c. Nasal polyp epithelial scrapings or mononuclear cells, T lymphocytes or keratinocytes in vitro all produce potent BMC or Eo colony-stimulating activities (CSA) as well as an interleukin-3-like activity, each of which is partially separable from the others. Nasal epithelial cells cultured from scrapings of atopic, as opposed to nonatopic, patients also produce BMC or Eo CSA with an enhanced effect of the former on atopic peripheral blood CFU-c growth. These studies support the hypothesis that BMC and Eo accumulate in allergic inflammation as a result of in situ growth and differentiation of progenitors stimulated by soluble hemopoietic factors derived from mucosal cell populations.

Nasal mucosal mast cells and histamine in hay fever. Effect of topical glucocorticoid treatment

Symptomatic seasonal allergic rhinitis has previously been found to be associated with a redistribution of mast cells from the subepithelial stroma to the epithelial lining and the surface of the nasal mucosa. The present study was designed in order to elucidate the interaction between topical glucocorticosteroids, effective in the treatment of allergic rhinitis, and the migration of mast cells described earlier. Six patients treated prophylactically in the nose with budesonide were studied. Imprints and biopsies from the nasal mucosa were taken 2-3 weeks before and 2-3 weeks into the birch pollen season. The biopsies were used for light microscopy and tissue histamine determination. The morphologic studies showed, also in the actively treated patients, an increased number of metachromatically stained cells on the nasal mucosal surface of the same order of magnitude as previously reported for untreated patients. We did, however, find a decrease in the histamine content of the nasal mucosa, which was not associated with a decrease in the number of mast cells. Together with similar previous findings in the unstimulated allergic nasal mucosa these results suggest that glucocorticosteroids induce a decrease in the mast cell histamine pool, possibly due to an inhibition of the intracellular synthesis of histamine. This effect might contribute to the clinically beneficial effect of topical glucocorticosteroids in the treatment of hay fever.

Changes in nasal mast cell numbers in and out of the pollen season

Mast cells were counted in biopsies of the nasal mucous membrane from 8 patients with allergic rhinitis during (July 1985) and after (October 1985 and January 1986) the grass pollen season in both the superficial epithelium and the deeper lamina propria. There was an eightfold increase in the total number of mast cells in the nasal mucous membrane during the grass pollen season when compared to midwinter. In addition, there was a striking change in the number of mast cells present in the surface epithelial layer from almost total absence in biopsies taken in midwinter to counts of between 2,000 and 28,000/mm3 in all but 1 patient during the summer.

[Ultrastructural changes in the human nasal respiratory epithelium in hypersensitivity reactions]

In immunoallergic syndromes, the structure of normal respiratory nasal mucous membrane is modified. The epithelial lining (which is responsible for the effectiveness of the mucociliary synergy), is secondarily affected. Its modifications depend, generally, on the severity and chronicity of the clinical case. Normal and pathologic material obtained from inferior turbinate bone (of similar structure and response to the rest of the respiratory nasal mucous membrane) were studied through transmission and scanning electron microscopies, employing both methods as complementary analysis. In normal cases, the presence of different kinds of cells was confirmed. Some additional characteristics about intercellular spaces and junctions as well as the possible role of the above mentioned structures in transudation were also described. In pathologic cases, increasing lesion staging grades could be determined. In the first stage, structural alterations could not be observed despite the existence of functional disturbances (i.e. ciliary dyskinesia and non-synergic motility). In an advanced stage, ciliary abnormalities could be observed with abnormalities in the number, morphology, spatial orientation and distortion in the number of different cell types. With cellular linkage affectation, the severity of the lesion increased and the cells were easily desquamated, giving rise to intercellular spaces which communicated freely with the organ lumen. Finally, in the most severe cases, the epithelial lining was diminished to a monolayer, with complete cellular dissociation and lack of differentiation. This cellular disarrangement allowed free passage of substances in both directions through the monolayer.

Basophilic cell progenitors, nasal metachromatic cells, and peripheral blood basophils in ragweed-allergic patients

Circulating hematopoietic progenitor cells giving rise to colonies containing basophilic cells (basophilic cell colony-forming units in culture [CFU-c]), nasal epithelial metachromatic cells (basophils and/or mast cells) (NMC), and blood basophils were enumerated before, during, and after a ragweed-pollen season in patients with ragweed hayfever and patients with perennial allergic rhinitis who were not ragweed allergic. In the patients with seasonal hay fever, the following was observed: basophilic cell CFU-c, measured as basophilic cell or histamine-containing colonies, were significantly reduced during the ragweed season compared to before (p less than 0.005) or after (p less than 0.025) the season in the ragweed-allergic group only. Conversely, peripheral blood basophils were higher during the ragweed season than before or after (p less than 0.001) in the ragweed-allergic group, whereas the number of NMC was higher during the season than before the season in this group (p less than 0.05). There were no such changes during the season in the group of patients with perennial allergic rhinitis. The observed seasonal changes in both NMC and circulating basophilic cell CFU-c are discussed in the context of lineage relationships among metachromatic cell types.

Clinical, rhinomanometric, and cytologic evaluation of seasonal allergic rhinitis treated with beclomethasone dipropionate as aqueous nasal spray or pressurized aerosol

The currently available beclomethasone dipropionate (BDP) metered-dose nasal aerosol spray is considered uncomfortable by some patients because of the force of delivery. It was compared for efficacy and acceptability in a double-blind study with a new aqueous suspension BDP spray for the treatment of seasonal allergic rhinitis in 44 symptomatic patients aged 12 to 43 years. After 7 days of baseline evaluation, every patient was given both an aerosol canister and an aqueous spray bottle each containing either BDP, 42 mcg per spray, or placebo (P). For 15 days the patient sprayed each nostril twice a day with one spray of suspension (BDP or P) followed 5 minutes later by one spray of aerosol (P or BDP). Patients were evaluated before the study medications were started (day 1) and on days 4, 8, and 15 for nasal and eye symptoms. Nasal cytologic specimens were examined on days 1 and 15, and rhinomanometry was performed on days 1, 8, and 15 of the study. Topical BDP by both methods of delivery was rapidly effective in decreasing mean nasal obstruction, rhinorrhea, sneezing, and itching symptoms as well as mean eye symptoms with no statistically significant differences between them. Nasal airflow increased with both treatments; rhinomanometry significantly correlated with subjective nasal obstruction scores. Of 34 patients with nasal eosinophils, 74% had fewer eosinophils after treatment. Most patients (84%) preferred the aqueous spray over the pressurized aerosol.

Intraepithelial migration of nasal mucosal mast cells in hay fever

Mast cells were studied by light microscopy in mucosal imprints and in biopsies of nasal mucosa of 12 birch pollen allergic individuals before and during the pollen season, using techniques optimized for the demonstration of mucosal mast cells. We also measured the histamine content of nasal mucosa, whole blood and plasma, and counted the numbers of circulating blood basophils. Before the pollen season the nasal mucosa was found to contain many mast cells located in the mucosal connective tissue stroma, and very few cells with basophilic and metachromatic granules were found in mucosal imprints. During the pollen season there was a redistribution of mast cells into the epithelium, many such cells now being recovered in mucosal imprints. The total number of mucosal mast cells counted in tissue sections did not change significantly with the onset of the pollen season, suggesting a redistribution of mucosal mast cells by migration. Judged by morphologic appearance and naphthol-AS-D chloroacetate esterase activity, the intraepithelial mast cells found in tissue sections had rather the properties of tissue mast cells than of blood basophils, and only a few of the basophilic cells of the imprints had a morphology compatible with blood basophils. The histamine content of the mucosa, as well as histamine levels of whole blood and plasma, and circulating blood basophil numbers did not change significantly in relation to the pollen season. These findings suggest that an intraepithelial migration of mucosal mast cells is part of the allergic mucosal response.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraepithelial migration of mucosal mast cells in hay fever: ultrastructural observations

Evidence has been presented suggesting that a migration of nasal mast cells from the mucosal connective tissue stroma into the epithelium is part of the mucosal response in birch pollen allergy. In a previous study, the identification of these intraepithelial cells as tissue mast cells rather than blood basophils was based on light microscopical morphology and histochemistry. We have now studied the ultrastructure of these cells in mucosal biopsies taken before and during the birch pollen season. Intraepithelial cells with basophil or metachromatic granules were only observed in biopsies taken during the season. Some of these cells had the ultrastructural appearance of tissue mast cells, including cytoplasmic lipid droplets and a granular substructure composed of multilamellar arrays and scrolls, serving to distinguish human mast cells from blood basophils. The ultrastructural traits of the remaining cells were heterogeneous, some reminiscent of human blood basophils, others of globule leucocytes of other species, but entirely typical blood basophils could not be identified. The results thus support our previous suggestion that a migration of mucosal mast cells from the connective tissue stroma into the epithelium is part of the human allergic mucosal response. It cannot be determined whether the ultrastructural heterogeneity of these cells is the result of an adaptation to the intraepithelial environment of one single mast cell type or to the existence of an ultrastructurally distinct mucosal mast cell.

Culture of human nasal epithelial cells on collagen matrix supports. A comparison of bioelectric properties of normal and cystic fibrosis epithelia

The feasibility of culturing human nasal epithelial cells was tested by plating on permeable collagen matrices primary isolates of epithelial cells from normal (n = 21) and atopic (n = 5) subjects and from subjects with cystic fibrosis (CF) (n = 13). The cells were cultured in serum-free, hormone-supplemented medium for 5 days followed by maintenance in conditioned medium with 1% serum. A transepithelial electric potential difference (PD) exceeding 1.0 mV developed in most preparations (71%). The PD reached a peak by Day 10 and declined slowly thereafter. The maximal PD of CF epithelia (-32.4 +/- 5.8 mV, n = 9) on collagen matrices exceeded that of normal (-11.3 +/- 1.8 mV, n = 15) and atopic (-13.5 +/- 2.5, n = 5) epithelia. The maximal PD for both CF and normal cultures exceeded that of freshly excised preparations. This difference reflected higher transepithelial resistance of cultures as compared with intact preparations. The efficacy of amiloride (10(-4) M) to reduce the PD was greater in cultures of CF epithelia (-85 +/- 4.6%, n = 7) than it was in cultures of normal (-45.5 +/- 5.0%, n = 11) and atopic (-50.5 +/- 2.9%, n = 5) epithelia, whereas the hyperpolarization induced by replacement of Cl- in the apical bath was smaller for CF cultures (5.9 +/- 1.5 mV) than it was for normal (9.3 +/- 0.9 mV) and atopic (8.8 +/- 0.5 mV) cultures. We conclude that nasal epithelial cells will form high resistance barriers when cultured on collagen matrices.(ABSTRACT TRUNCATED AT 250 WORDS)

Failure of Verapamil in inhibiting allergen-induced histamine release in vivo

In order to evaluate the effect of Verapamil on human cutaneous anaphylactic responses, ragweed-sensitive individuals were skin tested with ragweed, ragweed plus Verapamil, and Verapamil alone. In addition, using a skin chamber technique, the effect of Verapamil on antigen-induced histamine release in vivo was investigated. The results suggest that Verapamil, applied locally in non-irritant doses, does not affect Type I hypersensitivity skin reactions.

Methods for bronchoalveolar lavage in asthmatic patients following bronchoprovocation and local antigen challenge

We employed bronchoalveolar lavage (BAL) of subsegmental airways to study the local inflammatory effects of aeroallergen bronchoprovocation (BPC) and local instillation of allergen in allergic asthmatic patients, allergic rhinitis patients, and normal subjects. Two protocols were used: (1) BAL was performed in three subsegments following BPC or during spontaneous seasonal exposure, and (2) 5-ml aliquots of increasing doses of allergen were instilled into a single subsegment until there was at least 30 percent closure of the airway; the airway was then immediately lavaged. A subsegment in the opposite lung was lavaged as a control site. These same two segments were lavaged again two to 14 days later and the cells and fluid analyzed. Fifty-five lavages have been performed without complications. Pulmonary function tests (FEV1) were not significantly disturbed by either local challenge or lavage procedures. Cells were examined using light and electron microscopy and showed inflammatory cells in alveolar airways and dissolution of mast cell and eosinophil granules. Using selected criteria, we were able to use these methods in mildly, seasonally asthmatic patients to obtain safely cells and fluid for analysis. These techniques may permit studies which further our understanding of the mechanisms responsible for allergic asthma.

Clinical findings in patients with allergic rhinitis

Clinical observations, X-ray findings and results of laboratory tests were evaluated in 770 patients with allergic rhinitis. Anamnestic data and results of the allergological examination of these patients have been presented elsewhere (Holopainen et al., 1979b; Binder et al., 1982). Allergic symptoms were seasonal in 54.5% and perennial in 45.5% of the patients. Mucosal changes as seen on rhinoscopy were significantly more common among patients with perennial than among patients with seasonal rhinitis. Watery discharge was the most common nasal finding, observed in 90% of all patients. Nasal smears showed increased numbers of eosinophilic leucocytes in 70% of the cases. Relationships between the cellular population of the nasal secretion, other laboratory test results and clinical findings are described. X-ray examination revealed pathological changes in the paranasal sinuses in 53.4% of the patients.

Diagnosis of allergic conjunctivitis

Itching was cited as a major symptom of their ocular disease by 49 (80%) of the 61 patients with allergic conjunctivitis. Conjunctival scrapings from 51 patients (84%) demonstrated intact eosinophils or eosinophil granules. Eosinophil granules were a useful and recognizable cytologic feature of allergic conjunctivitis even in the absence of intact eosinophils. We believe that a history of itching and the presence of eosinophils or eosinophil granules in conjunctival scrapings are helpful in diagnosing allergic conjunctivitis.

[Electron microscopy findings in allergic reactions of the nasal mucosa]

The fundamental morphologic aspects of acute and chronic allergic reactions, as well as endonasal polyps in allergic patients and disturbances of the autonomic nervous system were studied by means of electron microscopy. Characteristic changes are described which differ according to the stage of the allergic reactions; they are discussed in relation to the altered function of the allergic nasal mucosa.

Effect of topical glucocorticoid treatment on nasal mucosal mast cells in allergic rhinitis

Glucocorticoids were previously considered not to affect the immediate allergic reaction. However, in a nasal allergen challenge, an inhibitory effect on the nasal symptoms induced at the challenge has been shown to occur in patients treated with a recently developed glucocorticoid, budesonide, for 1 week prior to the challenge. This treatment was also found to reduce tissue histamine levels in the nasal mucosa. Mast cells in the mucosa were therefore studied with a view to finding out whether this reduction could be due to a reduction of mast cells. A double-blind study was performed in 14 asymptomatic patients. Nasal biopsies were made before and after 1 week's treatment with either budesonide or placebo. The number of mast cells was counted in two Epon sections after the specimens had undergone specific staining with toluidine blue. No quantitative or qualitative morphological changes in the mast cells were found as a result of treatment.

Digestion of the fifth component of complement by eosinophil lysosomal enzymes. Production of eosinophil specific chemotactic activity

Recently our laboratory has shown that neutrophils contain enzymatic activity within their lysosomal granules which will generate chemotactic activity for neutrophils and tumor cells from the fifth component of complement (C5). We have now expanded this initial observation and have demonstrated that eosinophils can release enzymatic activity from their lysosomal granules upon stimulation with immune complexes or opsoninized zymosan, but not with C5a or synthetic chemotactic peptides. Furthermore, the enzymatic activity released from the eosinophil lysosomal granules can cleave C5 into eosinophil-specific chemotactic activity. The generation of the eosinophil chemotactic activities from C5 is blocked by prior treatment of the eosinophil preparations with a number of protease inhibitors. The eosinophil-derived C5 cleaving activity possesses a pH optimum of 7.2, thus suggesting the enzymatic activity is a neutral protease. The demonstration that enzyme activities derived from eosinophils have the ability to generate eosinophil chemotactic factor(s) from C5 may explain why eosinophils are the predominant inflammatory cell in both nasal polyps and in the nasopharynx and bronchi of patients with allergic conditions such as hay fever and asthma.