Basophilic cells in allergic nasal secretions

[T-cell immune responses in chronic inflammatory diseases of the nasal mucosa]

Acute rhinosinusitis and chronic rhinosinusitis are inflammatory diseases of the mucosal membranes due to mislead immunological reactions to aeroallergens. T‑cells are divided into different groups based on their cytokine secretion: T‑helper type 1 (Th1) and type 2 (Th2) cells. The allergic immune response is caused by activation of specific Th2 cells. With specific immunotherapy, the mislead hyperactivated "allergic" immune response is reduced to a reaction within the normal range. The inflammatory forms of chronic rhinosinusitis are called endotypes, and, in the future, could enable a targeted, pathomechanistic therapy. These endotype-based treatment approaches target specific signaling pathways that have already shown good effects for chronic rhinosinusitis with nasal polyps using monoclonal antibodies. However, so far, only selected patients with non-rhinologic indications, off-label treatments, or in clinical trials have benefited from these treatments.

Allergic and Nonallergic Rhinitis: Classification and Pathogenesis Part I. Allergic Rhinitis

Chronic rhinitis, although not life-threatening, substantially interferes with one's quality of life. Associated symptoms of nasal obstruction, sneezing, rhinorrhea, and anosmia afflict an estimated 40 million Americans. Directed clinical history and physical examination combined with noninvasive and routine procedures permit physicians to diagnose the myriad conditions causing rhinitis. Although the precise etiology of many of these conditions is only partially known, a practical diagnostic classification can be formulated based on clinical and laboratory findings. An understanding of the pathophysiology of allergic rhinitis as well as the other less understood entities provides the clinician with a integral foundation to implement preventative and therapeutic measures. This comprehensive review should provide the reader an opportunity to better understand and appreciate the causes and pathophysiology of chronic rhinitis. Part I of this article concentrates on IgE-mediated reactions, mediators, and drugs involved in allergic rhinitis. Part II focuses on the recent advances gained in understanding the nonallergic (non-IgE) causes of chronic rhinitis.

Nasal Cytology in Clinical Practice

Analysis of the nasal cytology provides information regarding the pathophysiology and response to therapy of the airway. This paper reviews the techniques for obtaining and interpreting specimens. The discussion focuses on the epithelial and inflammatory cells and the patterns seen in allergic, infectious and structural nasal disorders.

Assessment of Upper Respiratory Tract and Ocular Irritative Effects of Volatile Chemicals in Humans

Accurate assessment of upper respiratory tract and ocular irritation is critical for identifying and remedying problems related to overexposure to volatile chemicals, as well as for establishing parameters of irritation useful for regulatory purposes. This article (a) describes the basic anatomy and physiology of the human upper respiratory tract and ocular mucosae, (b) discusses how airborne chemicals induce irritative sensations, and (c) reviews practical means employed for assessing such phenomena, including psychophysical (e.g., threshold and suprathreshold perceptual measures), physiological (e.g., cardiovascular responses), electrophysiological (e.g., event-related potentials), and imaging (e.g., magnetic resonance imaging) techniques. Although traditionally animal models have been used as the first step in assessing such irritation, they are not addressed here since (a) there are numerous reviews available on this topic and (b) many rodents and rabbits are obligate nose breathers whose nasal passages differ considerably from those of humans, potentially limiting generalization of animal-based data to humans. A major goal of this compendium is to inform the reader of procedures for assessing irritation in humans and to provide information of value in the continued interpretation and development of empirical databases upon which future reasoned regulatory health decisions can be made.

The sensitivity of nasal eosinophilia in allergic rhinitis

Evaluation of nasal epithelial samples is a part of clinical allergy practice. The aim of this study is to reveal the sensitivity of the nasal eosinophilia using Rhino-probe and Wright-Giemsa staining by means of all available nasal eosinophilia scoring systems. In 30 patients (12 males, 18 females; mean age = 31.6 years) with clinical diagnosis of allergic rhinitis, both sides of the nose were sampled. The content of the cupped tip of the probe has been prepared and stained for nasal cytological examination under oil immersion by light microscopy. Nasal eosinophilia has been assessed by scoring systems. The sensitivity of nasal eosinophilia has been revealed. The nasal eosinophilia scores have been compared between nasal sides (right or left nose) and also between the examiners' observations for the same sample. Sensitivity values of nasal eosinophilia according to previously described criteria in the literature have been found to be between 13.33 and 80%. As the agreements for the nasal eosinophilia diagnosis between the sides of the nasal cavity and between the blinded examiners, the criteria of nasal eosinophilia such as the ratio of eosinophils to neutrophils or to all inflammatory cells rendered different diagnoses between the examiners (P < 0.01). The results of nasal cavity sides and Meltzer-scoring yielded no differences (P > 0.05). The substantial intraindividual variations when comparing the results obtained from the nasal sides and low sensitivity reveal that the nasal cytology needs more objective and standardized methods for a better differential diagnosis of chronic rhinitis.

The inferior turbinate mast cell population of patients with perennial allergic and nonallergic rhinitis

The number of mast cells in the inferior turbinates of patients with perennial allergic rhinitis and perennial nonallergic rhinitis was compared with normal controls. Mast cell counts expressed as the mean number in 100 high-power fields, assessed after Carnoy's fixation and toluidine blue staining were 1.84 in normal controls (n = 11), 4.39 in patients with perennial allergic rhinitis (n = 13), and 4.00 in those with perennial nonallergic rhinitis (n = 26). Statistical analysis confirmed that the density of mast cells in allergic as well as in nonallergic patients was significantly higher than in normal controls, whereas no significant difference was found between the number of mast cells in allergic and nonallergic patients. It is concluded that the number of mast cells in the inferior turbinate mucosa of patients with perennial rhinitis is increased compared with normal controls, and the increased number is not necessarily allergy-dependent.

Implicating adhesion molecules in nasal allergic inflammation

Allergic rhinitis is now considered an inflammatory disorder where many leukocyte types, including eosinophils and T-lymphocytes, accumulate in increased numbers. Along with mast cells and other cells, they release a wide variety of mediators, cytokines, and granule constituents that can directly cause inflammation or activate the local vascular endothelium to further enhance the recruitment of leukocytes through the expression and function of adhesion molecules. While the understanding of the importance of leukocyte and endothelial adhesion molecules is still at a very early stage, recent evidence has already begun to implicate these cell surface molecules in the pathogenesis of allergic diseases such as rhinitis and asthma. Additional studies, including the use of adhesion molecule antagonists when available, will clarify the importance of these structures in the pathophysiology of these disorders.

Proteinase content of mast cells of nasal mucosa; effects of natural allergen exposure and of local corticosteroid treatment

The distribution and density of metachromatic cells (MCC) and mast cells containing chymase plus tryptase (MCTC) or tryptase alone (MCT) were studied in the nasal mucosa by dye-binding methods and immunohistochemical analysis. Biopsies were obtained from 17 subjects with birch pollen allergy before and during the peak season and from nine healthy controls. Six patients were treated with an intranasal glucocorticosteroid before and during the season in an open study. Hay fever patients, even when asymptomatic, showed signs of mast cell system activation, exhibiting an increased number of mast cells in the nasal epithelium. Basophils, lacking immunohistochemically detectable tryptase, were not a major component of the mast cell response. MCT, most conspicuous in the epithelium, were found to be the most frequent mast-cell type in the nasal mucosa of allergic, but not of normal, subjects. Only 33% of the epithelial, but 90% of the stromal, immunopositive cells in the atopic mucosa before as well as during the season were MCC. Intraepithelial MCT thus displayed a low capacity to stain metachromatically, indicating a relative deficiency of the glycosaminoglycan (heparin) component of the granules. Intraepithelial mast cells also appeared to be markedly sensitive to steroid treatment and aldehyde fixation. The findings suggest that the lack of chymase, the characteristic feature of MCT, may reflect a functional activation of the mast cells, rather than a stable phenotypic differentiation related to anatomic site.

Nasal cytology in patients with allergic rhinitis: effects of intranasal fluticasone propionate

BACKGROUND

Nasal cytograms of patients with allergic rhinitis contain increased numbers of eosinophils and basophilic cells. Neutrophils are also more numerous in cytograms of allergic persons. Topical intranasal corticosteroid therapy for allergic rhinitis has been shown to decrease the numbers of some inflammatory cell types. Fluticasone propionate aqueous nasal spray, a potent synthetic corticosteroid preparation, is effective therapy for seasonal and perennial allergic rhinitis.

METHODS

Nasal mucosal scrapings were obtained with a Rhinoprobe (Apotex Scientific, Inc. Arlington, Texas) before and after therapy with fluticasone propionate aqueous nasal spray at several doses in patients with either seasonal allergic rhinitis (2 to 4 weeks' therapy) or perennial allergic rhinitis (24 weeks' therapy). More than 1000 paired nasal cytograms obtained from patients participating in five multicenter studies were evaluated.

RESULTS

The percentage of patients with nasal eosinophils (p < 0.01, most studies) and basophilic cells (p < 0.05, most studies) decreased significantly after treatment with fluticasone propionate compared with placebo-treated patients. Similar findings were observed with beclomethasone dipropionate in one study. The number of neutrophils remained relatively unchanged after treatment with the intranasal corticosteroids or placebo.

CONCLUSIONS

These findings suggest that the therapeutic benefits of topical intranasal fluticasone propionate and beclomethasone dipropionate for the therapy of seasonal and perennial allergic rhinitis are reflected by the decrease in inflammatory cells in the nasal mucosa.

Mast cell quantitation in nasal polyps, sinus mucosa and nasal turbinate mucosa

The distribution and abundance of mast cells in nasal polyps, the maxillary sinus mucosa of patients with sinusitis and the turbinate mucosa of allergic rhinitis was microscopically examined using different methods of fixation. In the epithelium of the surface and the ducts of nasal polyps (n = 8), the mean number of mast cells was over 20,000 per mm3 using Mota's fixation and the increase was correlated with the epithelial thickness (P < 0.05). On the other hand those of the maxillary sinus mucosa (n = 6) and the nasal turbinate mucosa (n = 7) were less than 6,000 per mm3. In the subepithelial layer or areas deeper than the area with the glands, however, mast cell counts were less than 3,200 per mm3 in all diseases. More than 70-90 per cent of all mast cells in the epithelium of the mucosal surface and the ducts of the polyp, the maxillary sinus mucosa and nasal turbinates were formalin sensitive. Most of the mast cells in the subepithelial and deeper areas were formalin resistant in all diseases. These results suggest that conditions for mast cell growth differ between polyps and the other diseases, and that the conditions which affect mast cells may contribute to polyp development.

Clinical and pathophysiological evaluation of tranilast in patients with pollinosis: the effects of pre-seasonal treatment

Tranilast is an orally effective anti-allergic agent evaluated for clinical activity in prevention of symptoms of allergic rhinitis. It was investigated in a randomized, pre-seasonal, and in-seasonal treatment of tranilast to test the clinical efficacy and pathophysiological changes on the onset of nasal symptoms in season. Thirty-eight patients with a history of Sugi pollinosis and positive allergic tests were treated with tranilast 300 mg daily 6 to 7 weeks before the onset of the pollen season and continuously during the season or no medication including tranilast until the onset of clinical symptoms in season. The number of sneezing and the grade of stuffiness at the onset of pollen season were inhibited significantly in pre-seasonal treatment. The number of mast cells and eosinophils in season increased compared with off-season and the threshold of nasal hypersensitivity in season decreased compared with off-season in inseasonal treatment, but not in pre-seasonal treatment. This study indicates that tranilast may have the prophylactic effect for Sugi pollinosis.

Dynamics of mast cells in the nasal mucosa of patients with allergic rhinitis and non-allergic controls: a biopsy study

Mast cell degranulation is thought to be an important component of the pathogenesis of allergic rhinitis. Quantitative studies on mast cells in nasal mucosa after allergen exposure have given widely divergent results, ranging from an overall decrease via redistribution to an overall increase. We investigated this problem by employing a combination of anti-IgE and toluidine blue staining of biopsy specimens. In allergic patients anti-IgE was found to identify all mast cells and toluidine blue to detect mast cells that were not (totally) degranulated. The study was composed of two parts done in different patient groups. In the first part of the study biopsies were performed in 23 patients with isolated grass-pollen allergy, once during natural provocation in the summer and once in the winter. Biopsies were also performed in 12 controls. Non-allergic controls were found to have the same number of mast cells in the lamina propria as asymptomatic allergic patients. The controls seldom have mast cells in the epithelium. The patients with isolated grass-pollen allergy showed an increase in the numbers of mast cells in the lamina propria during natural provocation and the same seemed to occur in the epithelium as well. During natural provocation almost all of the mast cells in the epithelium and half of those in the lamina propria were degranulated. In the second part of the study 17 patients with isolated grass-pollen allergy and four controls were challenged daily with allergen extract during a 2-week period in the winter. During this period biopsies were performed at eight different occasions, i.e. once before, six occasions during and once after the provocation period. The results of this part of the study showed that during provocation mast cells migrate to the surface of the nasal mucosa, where they become degranulated, and that the pool of mast cells in the lamina propria was apparently replenished by migration of mast cells from the vessels in the lamina propria. The total number of mast cells in the lamina propria remained approximately the same while the mast cells residing in an increasingly thick layer measured from the basal membrane into the lamina propria became degranulated. After 2 weeks, 82% of the mast cells in the lamina propria was degranulated and it was only in the deepest layers that some toluidine blue positive cells were found.(ABSTRACT TRUNCATED AT 400 WORDS)

A technique for quantitative cytology of nasal secretions

To quantitatively analyze cellular elements in mucopurulent nasal secretions from patients with chronic paranasal sinusitis, we studied five mucus-liquefying agents--dithiothreitol (DTT), ethylenediaminetetraacetic acid tetrasodium salt, propylene glycol, serratio peptidase and urea--with Hanks' balanced salt solution used as a control. Agents were compared for the number of cells, the mucus-liquefying effect and the staining characteristic of cells in cytocentrifuge-prepared smears. The results indicated that the treatment of nasal secretions with 10 mM DTT provides more clear and detailed cytological preparations for quantitative cytology of nasal secretions.

[Allergic rhinitis nasal epithelial cell conditioned medium stimulates growth and differentiation of basophil/mast cell and eosinophil progenitors from atopic blood]

We examined the conditions, kinetics and cell sources for basophil/mast cell and eosinophil colony stimulating activity (CSA) production by nasal epithelial cells taken from house dust (HD) nasal allergic patients. Epithelial scrapings removed from HD nasal allergic patients were grown to confluence over 7 days as a monolayer of epithelial cells in medium supplemented with fetal calf serum (FCS) on collagen coated microwell plates. CSA in nasal epithelial cells conditioned medium (CM) was assessed with density-gradient separated, nonadherent peripheral blood mononuclear cells in 14-day and 21-day methylcellulose assays. In the 14-day methylcellulose assays, the number of Eo-type colonies in the presence of either 10% or 5% CM was significantly higher than the background number of Eo-type colonies (negative control). Comparison of Gm CSA among 1%, 5% and 10% CM with negative, revealed no significant differences. We also compared the Eo-type CSA in the presence of 10% significant differences. We also compared the Eo-type CSA in the presence of 10% CM in the 14-day methylcellulose assay with 21-day methylcellulose assay. There was no significant difference in the number of Eo-type colony between the 14-day and 21-day methylcellulose assays. We also examined the composition of the cells in the colonies in the 14-day and 21-day methylcellulose cultures. The percentage of metachromatic granule containing cells in a Eo-type colony in 14-day methylcellulose assay was significantly higher than in a Eo-type colony in 21-day methylcellulose assay.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of basophils in asthma

The characteristics of the acute and late human response to antigen in the upper and lower airways and in the skin is summarized in TABLE 2. This table makes it clear that while mast cells are responsible for the mediator release of the acute phase, eosinophils and basophils are the cells involved in the mediator release which occurs during the experimental late phase reaction. The pattern of mediators observed during the acute response is quite characteristic of the mast cell. Thus, in the nose, skin, and lungs, the acute response is characterized by significant increases in histamine, PGD2, tryptase, and sometimes LTC4. In the late phase reaction, the pattern of mediator release is characteristic of basophils and eosinophils, and includes histamine, LTC4 (where measurable), and eosinophil-derived proteins, without PGD2 or tryptase. Basophils have been identified at appropriate time-points in each model using morphologic and phenotypic criteria, and their numbers relate to the histamine levels. Finally, treatment with glucocorticosteroids, the most potent drugs available for treating chronic allergic inflammation, obliterates the late phase reaction and decreases both mediator release and the infiltration of eosinophils and basophils. Chronic allergic inflammation is now taken by both the pulmonary and immunologic community as a hallmark of asthma, and it can be stated without equivocation that the basophils are responsible for the mediator release observed in that response.

Changes in nasal metachromatic cells during allergen immunotherapy

We have investigated changes of nasal metachromatic cell number, nasal symptoms and nasal provocation at the third and sixth month during allergen immunotherapy. Twenty-five subjects with perennial allergic rhinitis (house dust (23), Alternaria (2) were divided into two groups: an immunotherapy-treated group (n = 14) and a control group (n = 11). At the first visit nasal symptom scores, nasal provocation reactions and the number of metachromatic cells in nasal mucosal epithelial scrapings were not significantly different between groups. At the third and sixth month after immunotherapy nasal symptom scores, nasal provocation and the metachromatic cells in epithelial scrapings were significantly reduced (P less than 0.05) compared with the pretreatment values in the immunotherapy group, but unchanged in the control group. These results suggest that the reduction in metachromatic cell number at the nasal mucosal surface may be one of the mechanisms which could explain the improvement of nasal allergic symptoms by immunotherapy.

Metachromatic cells in nasal mucosa after allergen challenge

Metachromatic cells in the nasal mucosa were studied in relation to symptoms in 16 schoolchildren and 11 adults with hay fever who were challenged with pollen outside the pollen season, using either a gentle scraping-cytocentrifugation method for collection of mucosal specimens or biopsies. There was a temporary redistribution of metachromatic cells towards the mucosal surface appearing 5-24 h after challenge, with a correlation between the quantity of metachromatic cells and symptom scores. Thus, a single exposure to high doses of allergen may contribute to priming in susceptible individuals.

Cytologic changes in the nasal secretions during the late nasal response

One hundred sixty-four patients with allergic rhinitis (104 patients with positive late nasal responses (LNRs) and 60 patients with negative nasal responses to allergen challenge), correlating with history and skin tests, were randomly selected for this study. Nasal challenges were repeated and supplemented by cytologic examination of the nasal secretions (NSs). The cytologic examination of NS was also performed during 164 control challenges with phosphate-buffered saline. The positive LNR was accompanied by significant changes in the count of neutrophils in 84% of the cases (increase immediately before and decrease during appearance of LNR, with increase again during resolving of late nasal response), of eosinophils in 58% (increase immediately before and decrease during appearance of LNR), of epithelial cells in 73% (increase followed by decrease, running parallel with LNR), of goblet cells in 63% (increase followed by decrease), of basophils in 8%, and of lymphocytes in 6% (both of these cells demonstrated a slight increase during LNR) in the NS. No significant changes in the count of other types of cells in the NS during most of the LNR cases were recorded. Most cases of negative response were not accompanied by significant changes in the count of individual cell types. No significant changes in the count of any cell type in the NS were recorded in any patient during the phosphate-buffered saline-control challenges. The cytologic examination of NS, accompanying the nasal challenge with allergen, appears therefore to be a valuable supplementary diagnostic parameter for the LNR and a promising model for further immunologic and clinical studies of the LNR.

Hematopoietic growth factor production by cultured cells of human nasal polyp epithelial scrapings: kinetics, cell source, and relationship to clinical status

The conditions and cell sources for colony stimulating activity (CSA) production by nasal polyp epithelial scrapings were examined. Epithelial scrapings removed from patients were grown to confluence during 7 days as monolayers of epithelial cells in media supplemented with fetal calf serum (FCS) on collagen-coated microwell plates. Growth kinetics of nasal polyp epithelial cells (NPECs) were determined, and CSA in NPEC conditioned medium (CM) was assessed with density-gradient separated, nonadherent peripheral blood mononuclear cells in standard 14-day methylcellulose assays. Nasal polyp cultures in the presence of 5% or 15% FCS (vol/vol) demonstrated significantly more epithelial cell proliferation than cultures at 0% and 1% FCS. There were comparable metachromatic cell counts in polyp epithelial scrappings from allergic and nonallergic donors. Similarly, NPEC CM from allergic and nonallergic donors had equivalent CSA for basophil/mast cell (BMC) and eosinophil (EO) lineages, respectively. CSA production was enhanced under conditions of higher FCS concentration and NPEC proliferation. These studies confirm an epithelial cell origin of BMC and EO growth and differentiation factors derived from nasal polyps and point to the existence of a unique microenvironment for BMC and EO development provided by polyp epithelium that appears to be independent of the presence of an allergic diathesis.

Cytologic changes in the nasal secretions during the immediate nasal response

In 102 randomly selected patients with allergic rhinitis caused by immediate hypersensitivity, nasal provocation tests (NPTs) with allergens were evaluated by means of rhinomanometry, and cytologic examination of the nasal secretions (NSs) was performed. The cells in NS of 117 positive immediate nasal responses (INRs) and in 68 negative INRs, correlating with history and skin tests, and in 102 control challenges with phosphate-buffered saline were stained by modified May-Grünwald-Giemsa, toluidine blue, and Hansel's method. The positive INR was accompanied by significant changes in the count of eosinophils (increase followed by decrease) in 67% of neutrophils (decrease followed by increase) in 40%, goblet cells (increase followed by decrease) in 41%, and basophils (decrease) in 13% of the NSs. No significant changes in the count of other types of cells in the NSs were recorded during most of the cases of INR. No significant changes in the count of individual cell types in NSs were found during most cases of negative INR. During the phosphate-buffered saline control challenges, the individual cell types appeared irregularly, and no significant changes in their count were recorded in any patient. The cytologic examination of NS, evoked by allergen, appears therefore to be a valuable supplementary diagnostic parameter for nasal allergy. The repeated counting of eosinophils in NS, before and after allergen challenge, appears to be the best way to discriminate between positive and negative nasal responses, since the eosinophils demonstrated significant changes in their count during 67% of the positive and only 11% of the negative INRs.

The cellular response of the human allergic mucosa to natural allergen exposure

It has been suggested that the IgE-dependent late-phase reaction to allergen exposure, with the features of an inflammatory cellular infiltration and airway hyperreactivity, is a link between anaphylaxis and continuous allergic airway disease. Our main knowledge of the cellular response to allergen in sensitized individuals has been derived from allergen-challenge models. To explore the dynamics of the cellular response during the actual disease, patients with a strictly seasonal allergic rhinitis were studied during natural allergen exposure. Ten patients suffering from an isolated birch-pollen allergy were followed from a symptom-free state before, during, and to the height of the birch-pollen season. Repeated parallel cell samplings from the nasal mucosa were performed with cytologic imprints on plastic strips, nasal lavages with the recovery of the cells in the lavage fluid with cytocentrifugation on object slides for cytologic study, and scrapings from the nasal surface with a curette for histologic and ultrastructural evaluation. The histamine content was determined in lavage fluid and cell pellets. The tosyl-alpha-tosyl-L-arginine methyl esterase activity of the nasal lavage fluid was also determined as a biochemical marker of the allergic inflammatory reaction. The birch-pollen season was moderate in terms of pollen counts, and this resulted in mild to moderate nasal symptoms that ran parallel to the birch-pollen counts. The total number of cells recovered in the lavage fluid was 1.2 +/- 0.4 (SEM) x 10(6) before and 3.2 +/- 2.0 per 10(6) cells (not significant) during pollen exposure. Most cells were neutrophils and mononuclear cells.(ABSTRACT TRUNCATED AT 250 WORDS)

A new rhinitis model using chemical mediators in rats

No good experimental model for studying rhinitis, has been hitherto available. In the present study, development of a new rhinitis model using chemical mediators was attempted, especially to establish an index of nasal congestion. Male Wistar rats were anesthetized with pentobarbital-Na. Nasal cavities were ventilated between both cannulae inserted into the nasopharynx and bilateral nostrils, with an artificial respirator. Intranasal resistance was recorded with a modification of a Konzett-Rössler apparatus as a change in ventilation overflow (VO). To provoke rhinitis, some mediators were inhaled into the nasal cavities with an ultrasonic nebulizer for 5 min. To assess the capillary permeability of the nasal mucosa, exudation of Evans blue was determined by injecting the dye before inhalations of mediators. Inhalation of histamine (0.01, 0.1, 0.3%), bradykinin (0.01, 0.1%) and ACh (0.3%) markedly increased VO, while inhalation of serotonin (0.01, 0.1, 0.3%) did not increase VO. Histamine, bradykinin and high concentration of ACh significantly increased the dye exudation in the nasal cavities, although serotonin did not. From the above results, it is concluded that 1) a new rhinitis model in which symptoms of nasal blockage and increased capillary permeability in nasal mucosa are quantitatively determined, was established, and 2) histamine- and bradykinin-inhalations can cause rhinitis-like symptoms, although serotonin-inhalation can not.

A brush method to harvest cells from the nasal mucosa for microscopic and biochemical analysis

A method is described for the sampling of epithelial cells and other effector cells from the human airway mucosa for structural and biochemical analysis. The cell samples are obtained from the nasal mucosa using a small nylon brush which is rotated over the epithelium and soaked and shaken in a small volume of a balanced salt solution. Morphological evaluation using light microscopy and transmission electron microscopy revealed excellently preserved cytological detail. In asymptomatic individuals the cells harvested were as follows: 45 +/- 5.9% (mean +/- SEM) epithelial cells, 38 +/- 7.1% granulocytes, 16 +/- 2.3% large mononuclear cells (monocytes), and 1.3 +/- 2.3% eosinophils. Repeated measurements in the same individual revealed a coefficient of variation of the order of 40% for the proportions of cells harvested. In comparison with nasal airway lavage, a higher proportion of epithelial cells and monocytes were obtained with the brush method. The cells harvested could also be used for biochemical analysis. The histamine content of the cell pellets was found to be strongly correlated with the mast cell count (r = 0.93) and was estimated to about 10 pg/cell, which is higher than previously reported for mast cells obtained from human lung tissue dispersed by an enzymatic method. The present method appears to be appropriate for the study of cellular events in the nasal mucosal epithelium.

Low dose sublingual therapy in patients with allergic rhinitis due to house dust mite

In a double-blind placebo-controlled cross-over trial, low dose sublingual therapy with house dust mite was effective in relieving symptoms in 72% of the group of patients with perennial rhinitis due to house dust mite (P less than 0.03). Following active treatment, there was a significant increase in morning peak nasal inspiratory flow rate (P less than 0.01) in those who improved (thirteen out of eighteen) and resistance to nasal provocation with house dust mite also increased, in some cases up to 1000-fold (P less than 0.05). Oral therapy is safe and avoids the side effects of desensitizing injections which can be serious. The potential for oral desensitization is great and further studies on this form of treatment are needed.

Lymphocyte transformation by grass pollen allergens. A study of atopic patients receiving immunotherapy

Peripheral blood lymphocyte (PBL) transformation by allergens, PPD antigen and PHA mitogen, was followed in 20 allergic patients with grass pollen rhinitis, during and after a preseasonal immunotherapy. Ten patients were treated with Allpyral and 10 with Conjuvac two-grass mixture. Lymphocyte proliferative responses to grass antigens decreased during therapy for most of the patients. Higher values than before treatment were seen in August. Three patients had increased values during the preseasonal treatment. One stopped treatment because of discomfort, the other two got urticaria during the ensuing winter seasons. No effect of immunotherapy was seen on the PPD or PHA response of cells. Cellular changes in relation to changes in specific IgE and IgG antibodies are discussed.

Basophils in human disease

Hypersensitivity reactions containing significant infiltrates of basophils occur in a large proportion of allergic diseases such as contact dermatitis, atopic dermatitis, and allergic rhinitis, and are quite deleterious. However, the potential usefulness of such responses can be recognized in similar reactions in guinea pigs responding to tissue invasion by complex multicellular parasites in which interactions occur between thymic-derived T lymphocytes, antibodies, and basophils in immune resistance responses. Perhaps inappropriate and deleterious allergic responses to pollens, chemicals, and insects is the price that we must pay for the ability to reject complex parasites.

The significance of nasal eosinophils and mast cells in children with nasal symptoms

Nasal smears from children with symptoms of nasal obstruction and/or discharge were examined for the presence of eosinophils, mucus-containing cells and mast cells. The presence of more than one eosinophil or any mast cells was significantly associated with atopy as determined by immediate hypersensitivity on skin prick testing. Twelve children with markedly increased numbers of nasal smear mast cells are described. In these children symptoms frequently commenced in the first 6 months of life. Nasal eosinophilia was not noted in any of the cases. Nasal smear mastocytosis was associated with significant perennial symptoms and would be missed if nasal smears are examined only for eosinophilia.

Seasonal variation of sensitivity of nasal mucosa in pollinosis

The purpose of the present paper is to examine whether hypersensitivity of nasal mucosa observed in nasal allergy is cause or result of allergic reaction using the subjects with pollinosis in which the exposure period can be clearly distinguished. Subjects are 30 cases of Japanese cedar pollinosis and orchard grass pollinosis and 25 normal controls. Inferior turbinate of unilateral nasal cavity was stimulated by a piece of filter paper soaked with 0.02 ml of 0.1% and 0.5% histamine hydrochloride. Frequency of sneezing and amount of nasal secretion were measured quantatively and were compared among the subjects with pollinosis in season, off season, and normal controls. In subjects with pollinosis when stimulated with extrinsic histamine, frequency of sneezing and amount of nasal secretion were markedly enhanced in season, but during off season no apparent difference was observed compared with normal subjects. Relationship between frequency of sneezing and amount of nasal secretion indicated positive correlation (alpha less than 0.01). Positive correlation was also observed in amount of nasal secretion in ipsilateral and contralateral nasal cavity when unilateral nasal cavity was stimulated with histamine (alpha less than 0.01). Hyperrhinorrhea was closely related with hypersensitivity of nasal mucosa. The present study showed that hypersensitivity of nasal mucosa characteristic of nasal allergy is nonspecific and that it is largely a result of antigen antibody reaction, which in turn works in causing exaggeration of the allergic symptoms and allergic reaction through vicious cycle.

Children's atopy and mastocytosis in the nasal smear

Nasal secretion samples from 473 children aged 0--15 years were studied in order to evaluate the role of mast cells in the nasal smear in different types of atopy and food allergy. The occurrence of eosinophils in the nasal secretion and in the blood, and susceptibility to upper respiratory infection were recorded. A mast cell count of more than 20 cells per slide was indicative of atopy and there was a clear correlation between eosinophilia and mastocytosis in the nasal smear. No type of allergy seemed to be significantly predominant in the total material, but in young children aged 0--3 years mastocytosis was clearly related to food allergy. The examination of nasal smears for mast cells is a valuable test in diagnosing atopy in children and especially food allergy among young children. However, the test is not reliable enough to be used as a single screening test.

Evaluation of laboratory tests in childhood allergy. Total serum IgE, blood eosinophilia and eosinophil and mast cells in nasal mucosa of 178 children aged 3 years

The diagnosis of atopic disease is often difficult in small children because of differences in symptoms and lack of specific and reliable laboratory tests. We evaluated the significance of four commonly used laboratory tests--blood eosinophil count, total serum IgE, and eosinophil and mast cells in the nasal smear--as indicators of atopy in 178 children aged 3 years. The children were followed from birth and examined at the age of 3 years. Symptoms of immediate hypersensitivity including atopic dermatitis, food allergy and pollen or animal allergy were recorded. Severe or obvious atopy correlated with the highest levels of serum IgE. A total serum IgE level higher than 150 U/ml was found to be strongly suggestive of atopic disease. A blood eosinophil count higher than 600 X 10(9)/l as well as an increased number of eosinophil and mast cells in the nasal smear were associated with atopy. On the other hand, normal levels of these laboratory tests did not exclude atopic disease. In other words, all of the tests were high in specificity, but low in sensitivity. Consequently, when small children's atopic disease is being diagnosed, emphasis can be laid on the elevated levels of serum total IgE, blood eosinophil count and eosinophil and mast cells in the nasal smear, all of which separately, but especially together, give valuable information on atopy.

Effects of beclomethasone dipropionate nasal spray on subjective and objective findings in perennial allergic rhinitis

It was the aim of this trial to study the effect of intranasal beclomethasone dipropionate on symptoms and signs of perennial allergic rhinitis in Japanese patients. In a multicenter trial 183 patients, children and adults, were treated with placebo or with 400 microgram beclomethasone dipropionate a day for 2 weeks. The active treatment had an effect on all nasal symptoms: sneezing, nose blowing, and blockage being reduced to 34%, 44% and 63% (P < 0.01) of the values in the placebo group. A considerable carry-over effect was found, suggesting a group comparative design to be preferable for a cross over trial for the study of intranasal steroids. The beclomethasone dipropionate therapy had a significant inhibitory effect on the immediate response to nasal allergen provocation. The number of secretion eosinophils was reduced during treatment, and the appearance of the mucous membrane tended to normalize. Local side effects were few and insignificant. It is concluded that beclomethasone dipropionate is a valuable drug for the treatment of perennial allergic rhinitis.

Electron microscope study of basophilic cells in allergic nasal secretions

In order to elucidate whether basophilic cells in nasal secretion belong to blood basophil or tissue mast cell, basophilic cells in the blood, nasal secretion, and nasal mucous membrane were electron microscopically observed in patients with house dust nasal allergy. The majority of basophilic cells in the nasal secretion was identical with the blood basophil in structure. The blood basophils pass through the vessels and emigrate in the mucous blanket in allergy.