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Brattmo M, Lindberg S, Wihl JÅ, Petersson G, Malm L. Allergic Rhinitis and Atopy in 18-Year-Old Students. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240201600608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The aim of this study was to investigate the prevalence of allergic rhinitis and atopy in adolescents and whether air pollution in their schools contributed to allergic sensitization. Methods Analyses were performed in 1992–1994 on 511 18-year-old students at four schools and on the indoor air and floor dust of their classrooms. The students underwent skin-prick tests (SPTs) and a nasal lavage and answered a computer-based questionnaire containing questions on allergy and nasal symptoms. Results Atopy, defined as at least one positive SPT response, was found among 37% of the students, with no difference between students of the four schools, regardless of whether the data were adjusted for gender, hereditary disposition to allergy, and smoking habits. The number of students who had positive SPT and reported nasal symptoms when exposed to possible allergens, which were found among 35%, did not differ between the schools. No correlation was found between the prevalence of atopic individuals and the levels of different indoor air pollutants in the schools. Conclusion The prevalence of allergic rhinitis among adolescents is very high and suggests that it is, at least at the time of our study and in comparison with other studies, still increasing. Our results indicate that the indoor air and floor dust at the schools of the students do not contribute to allergic sensitization.
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Affiliation(s)
- Marianne Brattmo
- Department of Otorhinolaryngology, University Hospital, Malmö, Sweden
| | - Sven Lindberg
- Department of Otorhinolaryngology, University Hospital, Lund, Sweden
| | - Jan-åke Wihl
- Department of Otorhinolaryngology, University Hospital, Malmö, Sweden
| | - Göran Petersson
- Department of Otorhinolaryngology, University Hospital, Malmö, Sweden
| | - Lars Malm
- Department of Otorhinolaryngology, University Hospital, Malmö, Sweden
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Barck C, Lundahl J, Holmström M, Bylin G. Does Nitrogen Dioxide Affect Inflammatory Markers after Nasal Allergen Challenge? ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240501900605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Exposure to high ambient levels of nitrogen dioxide (NO2) enhances the bronchial inflammatory reaction to allergen in humans. We tested whether this NO2 effect occurs also in the upper airways. Methods Sixteen allergic subjects with rhinitis and mild asthma were exposed at rest to either purified air or 500 μg/m3 NO2 for 30 minutes, followed 4 hours later by a nasal allergen challenge. Nasal lavage was performed before air/NO2 exposure, before allergen challenge, and 1, 4 and 18 hours after allergen challenge. Symptoms were recorded. Results The percentage of eosinophils and neutrophils, eosinophil cationic protein, and myeloperoxidase were similar after exposure to air + allergen and to NO2 + allergen. We noticed a tendency to increased sneezing the day after exposure to NO2 + allergen. Conclusion The priming effect of an ambient brief NO2 exposure on subsequent allergic response was not noticeable in activation of inflammatory cells and mediators in the upper airways.
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Affiliation(s)
- Charlotte Barck
- Division of Respiratory Medicine and Allergology, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Joachim Lundahl
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Holmström
- Department of Otorhinolaryngology, Uppsala University Hospital, Uppsala, Sweden
| | - Gunnar Bylin
- Division of Respiratory Medicine and Allergology, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Subramaniyam D, Hollander C, Westin U, Erjefält J, Stevens T, Janciauskiene S. Secretory leukocyte protease inhibitor inhibits neutrophil apoptosis. Respirology 2011; 16:300-7. [PMID: 21077989 DOI: 10.1111/j.1440-1843.2010.01901.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The secretory leukocyte protease inhibitor (SLPI) is a major anti-elastase barrier at the epithelial surfaces of upper respiratory tract. In addition to its anti-protease activity, SLPI has been shown to express anti-bacterial, anti-viral and anti-inflammatory properties. METHODS We measured SLPI concentration in nasal lavage fluid of healthy volunteers after challenge with endotoxin (LPS) and evaluated SLPI effects in vitro on neutrophil chemotaxis, adhesion, cytokine (IL-8) release and apoptosis. RESULTS SLPI concentration in nasal lavage (n = 9) 2, 6 and 24 h after the challenge with LPS (25 µg) increased from 32% to 238% compared with baseline (226 ± 71 ng/mL). In vitro, SLPI (20-80 µg/mL) induced neutrophil chemotaxis (sixfold, P < 0.001) and decreased neutrophil apoptosis by 73% (P = 0.006), relative to controls. However, SLPI had no affect on IL-8 release or neutrophil adhesion to fibronectin. SLPI-positive immunoreactivity was co-localized with neutrophils in lung specimens from patients with COPD. CONCLUSIONS Our findings indicate upregulation of SLPI in response to LPS in nasal secretions and show anti-apoptotic effects of SLPI in primary human neutrophils suggesting a new role of SLPI during neutrophilic inflammation.
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Beijer L, Rylander R. (1-->3)-beta-D-glucan does not induce acute inflammation after nasal deposition. Mediators Inflamm 2005; 2005:50-2. [PMID: 15770066 PMCID: PMC1150332 DOI: 10.1155/mi.2005.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To assess if (1→3)-β-D-glucan, a microbial
cell wall agent normally present in pollen, has the ability to
produce pollenlike response, sensitive persons received a nasal
deposition of two doses of (1→3)-β-D-glucan.
The percentage of eosinophils and amount of eotaxin were measured
in nasal lavage 30 minutes and 24 hours after challenge. No
effect could be demonstrated. The absence of an inflammatory
response after (1→3)-β-D-glucan application
confirms earlier findings in inhalation studies.
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Affiliation(s)
- L. Beijer
- Department of Environmental Medicine, Sahlgrenska Academy, Göteborg University, 405 30 Göteborg, Sweden
| | - R. Rylander
- Department of Environmental Medicine, Sahlgrenska Academy, Göteborg University, 405 30 Göteborg, Sweden
- * R. Rylander;
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Sheahan P, Walsh RM, Walsh MA, Costello RW. Induction of nasal hyper-responsiveness by allergen challenge in allergic rhinitis: the role of afferent and efferent nerves. Clin Exp Allergy 2005; 35:45-51. [PMID: 15649265 DOI: 10.1111/j.1365-2222.2004.02131.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hyper-responsiveness of nasal secretory function and volume changes are features of allergic rhinitis (AR) that are mediated in part by neural mechanisms. The finding of nasal hyper-responsiveness in subjects with AR who are currently symptomatic, but not in those who are currently out of season and asymptomatic, suggests that induction of neural reflexes in allergic subjects occurs as a result of allergic inflammation. OBJECTIVES To investigate whether allergen exposure in subjects with asymptomatic seasonal allergic rhinitis (SAR) may lead to induction of neural reflexes, and to investigate the components of the reflexes involved in this induction. METHODS Asymptomatic subjects with (out-of-season) SAR underwent a nasal bradykinin challenge, before and 24 h after preceding ipsilateral (n = 11) and contralateral (n = 11) antigen challenge. Challenges were performed and nasal secretions collected using filter paper disks, and changes in nasal minimal cross-sectional area (A(min)) were measured using acoustic rhinometry. RESULTS Preceding ipsilateral antigen challenge led to the induction of a contralateral secretory reflex (P = 0.01), which was absent in control experiments (P = 0.34). Ipsilateral secretion weights were also enhanced. Preceding contralateral antigen challenge also induced a contralateral secretory reflex (P = 0.03). Enhancement of the reduction in contralateral A(min) was also seen (P = 0.02). Ipsilateral responses were unchanged. CONCLUSIONS Allergen exposure in asymptomatic allergic subjects leads to induction of neural reflexes, resulting in nasal hyper-responsiveness, which persists beyond the resolution of the acute allergic response. Our data suggest that the mechanisms of allergen-induced hyper-responsiveness involve both afferent and efferent components.
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Affiliation(s)
- P Sheahan
- Department of Otolaryngology, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Nita I, Hollander C, Westin U, Janciauskiene SM. Prolastin, a pharmaceutical preparation of purified human alpha1-antitrypsin, blocks endotoxin-mediated cytokine release. Respir Res 2005; 6:12. [PMID: 15683545 PMCID: PMC549028 DOI: 10.1186/1465-9921-6-12] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2004] [Accepted: 01/31/2005] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Alpha1-antitrypsin (AAT) serves primarily as an inhibitor of the elastin degrading proteases, neutrophil elastase and proteinase 3. There is ample clinical evidence that inherited severe AAT deficiency predisposes to chronic obstructive pulmonary disease. Augmentation therapy for AAT deficiency has been available for many years, but to date no sufficient data exist to demonstrate its efficacy. There is increasing evidence that AAT is able to exert effects other than protease inhibition. We investigated whether Prolastin, a preparation of purified pooled human AAT used for augmentation therapy, exhibits anti-bacterial effects. METHODS Human monocytes and neutrophils were isolated from buffy coats or whole peripheral blood by the Ficoll-Hypaque procedure. Cells were stimulated with lipopolysaccharide (LPS) or zymosan, either alone or in combination with Prolastin, native AAT or polymerised AAT for 18 h, and analysed to determine the release of TNFalpha, IL-1beta and IL-8. At 2-week intervals, seven subjects were submitted to a nasal challenge with sterile saline, LPS (25 microg) and LPS-Prolastin combination. The concentration of IL-8 was analysed in nasal lavages performed before, and 2, 6 and 24 h after the challenge. RESULTS In vitro, Prolastin showed a concentration-dependent (0.5 to 16 mg/ml) inhibition of endotoxin-stimulated TNFalpha and IL-1beta release from monocytes and IL-8 release from neutrophils. At 8 and 16 mg/ml the inhibitory effects of Prolastin appeared to be maximal for neutrophil IL-8 release (5.3-fold, p < 0.001 compared to zymosan treated cells) and monocyte TNFalpha and IL-1beta release (10.7- and 7.3-fold, p < 0.001, respectively, compared to LPS treated cells). Furthermore, Prolastin (2.5 mg per nostril) significantly inhibited nasal IL-8 release in response to pure LPS challenge. CONCLUSION Our data demonstrate for the first time that Prolastin inhibits bacterial endotoxin-induced pro-inflammatory responses in vitro and in vivo, and provide scientific bases to explore new Prolastin-based therapies for individuals with inherited AAT deficiency, but also for other clinical conditions.
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Affiliation(s)
- Izabela Nita
- Department of Medicine, Lund University, University Hospital Malmö, 20502 Malmö, Sweden
| | - Camilla Hollander
- Department of Otolaryngology and Head and Neck Surgery, Lund University, University Hospital Malmö, 20502 Malmö, Sweden
| | - Ulla Westin
- Department of Otolaryngology and Head and Neck Surgery, Lund University, University Hospital Malmö, 20502 Malmö, Sweden
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Thorn J, Beijer L. Work-related symptoms and inflammation among sewage plant operatives. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2004; 10:84-9. [PMID: 15070030 DOI: 10.1179/oeh.2004.10.1.84] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Sewage operatives at five sewage treatment plants (n = 59) and controls not exposed to sewage (n = 55) were examined to determine work-related symptoms and inflammatory responses. Symptoms were elicited using a questionnaire, and spirometry was performed. Inflammatory markers were determined in blood and nasal lavage. Workplace endotoxin and hydrogen sulfide were measured and adeno- and enterovirus antibodies were evaluated in blood. Gastrointestinal and airway symptoms, joint pains, unusual tiredness, and toxic pneumonitis were more common among operatives, and the proportion of blood neutrophils was higher among operatives as compared with controls. A relationship was found between several reported symptoms and the inflammatory markers. Hydrogen sulfide levels were very low. Endotoxin levels were generally low, but high at some work sites.
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Affiliation(s)
- Jörgen Thorn
- Department of Environmental Medicine, Göteborg University, Göteborg, Sweden.
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Lönnkvist K, Anderson M, Hedlin G, Svartengren M. Exhaled NO and eosinophil markers in blood, nasal lavage and sputum in children with asthma after withdrawal of budesonide. Pediatr Allergy Immunol 2004; 15:351-8. [PMID: 15305945 DOI: 10.1111/j.1399-3038.2004.00165.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a need for controlled trials among children with asthma to evaluate and compare different markers of inflammation. OBJECTIVE Our goal was to investigate the effect of withdrawal of inhaled budesonide on repeated measurements of exhaled NO (ENO), peripheral blood eosinophils (PBE), sputum/NAL/serum-eosinophil cationic protein (ECP), bronchial hyperresponsiveness (BHR) and forced expiratory volume in 1 s (FEV(1)) in children with allergic asthma. METHODS Eighteen asthmatic children were randomly allocated to continue or discontinue use of inhaled budesonide. They were followed up, at six visits for 4 months with regular blood, serum, sputum, and NAL samples. Sixteen age-matched healthy children served as controls. RESULTS ENO, PBE, and S-ECP increased significantly in the withdrawal group (p < 0.05) but not in the continuous treatment group. No trend could be observed during the study for markers in sputum or in NAL in either group. CONCLUSION The present data provide evidence for the clinical usefulness of measuring ENO, PBE, and S-ECP and when combined they could help to avoid over- and undertreatment with corticosteroids in the growing child.
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Affiliation(s)
- Karin Lönnkvist
- Astrid Lindgren Children's Hospital, Karolinska Hospital, Stockholm, Sweden.
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Nikasinovic-Fournier L, Just J, Seta N, Callais F, Sahraoui F, Grimfeld A, Momas I. Nasal lavage as a tool for the assessment of upper-airway inflammation in adults and children. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 2002; 139:173-80. [PMID: 11944028 DOI: 10.1067/mlc.2002.121661] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The prevalence of respiratory allergies has increased over the last 20 years, highlighting the need for a simple and noninvasive tool to investigate, in a clinical and epidemiological context, airway-inflammation mechanisms encountered in allergic and inflammatory processes. The nose, as the first region of the respiratory tract to come in contact with airborne pollutants, is easily explored with the use of nasal lavage (NL). We evaluated an NL method for adults and children, along with its reproducibility and capacity to separate different subgroups. NL reproducibility, assessed in 10 healthy, nonsmoking adults on three different occasions, was determined with the use of the intraclass coefficient of correlation for such inflammatory markers as total cell count, albumin, urea, neutrophil elastase, alpha(1)-antitrypsin, interleukin-6, and interleukin-8. Using this NL method, we analyzed nasal markers of 50 healthy adults (smokers and nonsmokers) and 12 healthy children. Our NL method demonstrated high reproducibility with regard to total cell count, albumin, urea, and alpha(1)-antitrypsin (intraclass correlation coefficient > 0.75). Compared with NL results in nonsmokers, NL in heavy smokers revealed significant increased concentrations of total cell counts and interleukin-8 and significant decreased concentrations of interleukin-6. These findings suggest that NL can be used as a tool in the assessment of inflammation because it has the correct reproducibility and can discriminate between heavy smokers and nonsmokers. Moreover, the use of this standardized method in children is feasible.
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Affiliation(s)
- Lydia Nikasinovic-Fournier
- Laboratoire d'Hygiène et de Santé Publique, Faculté de Pharmacie, Université René Descartes, 4 avenue de l'Observatoire, 75270 Paris cedex 06, France
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Turner PJ, Dear JW, Foreman JC. Involvement of kinins in hyperresponsiveness induced by platelet activating factor in the human nasal airway. Br J Pharmacol 2000; 129:525-32. [PMID: 10711351 PMCID: PMC1571872 DOI: 10.1038/sj.bjp.0703095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
1. The aim of this study was to investigate the role of kinins in the development of nasal hyperresponsiveness induced by platelet activating factor (PAF) in normal human subjects. 2. Intranasal administration of PAF, 60 micrograms, induced an increased responsiveness to histamine, 200 micrograms per nostril, 6 h later. This effect was abolished by pretreatment with the bradykinin B2 receptor antagonists icatibant and [1-adamantaneacetyl-D-Arg0,Hyp3,beta-(2-thienyl)-Al a5,8,D-Phe7]-bradykinin ([Ad]-BK), both at 200 micrograms, every 2 h following PAF administration. 3. In a separate experiment, utilizing the same protocol, nasal lavage was used to measure the release of mediators into the nasal cavity following treatment with PAF. PAF increased the levels of eosinophil cationic protein (ECP) and kinin detected in the lavage samples, compared with a saline control. The levels of these mediators were reduced by pretreatment with either icatibant or [Ad]-BK. 4. Administration of lyso-PAF, 60 micrograms intranasally, did not cause a rise in kinin or ECP levels in nasal lavage fluid. 5. Exogenous bradykinin, 500 micrograms, or a saline control, applied topically to the nasal mucosa every 30 min for 2 h, failed to cause hyperresponsiveness to histamine. 6. We conclude that bradykinin itself does not cause hyperresponsiveness, but is involved in the hyperresponsiveness induced by PAF in the human nasal airway.
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Affiliation(s)
- P J Turner
- Department of Pharmacology, University College London, Gower Street, London WC1E 6BT
| | - J W Dear
- Department of Pharmacology, University College London, Gower Street, London WC1E 6BT
| | - J C Foreman
- Department of Pharmacology, University College London, Gower Street, London WC1E 6BT
- Author for correspondence:
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Hirvonen MR, Ruotsalainen M, Roponen M, Hyvärinen A, Husman T, Kosma VM, Komulainen H, Savolainen K, Nevalainen A. Nitric oxide and proinflammatory cytokines in nasal lavage fluid associated with symptoms and exposure to moldy building microbes. Am J Respir Crit Care Med 1999; 160:1943-6. [PMID: 10588610 DOI: 10.1164/ajrccm.160.6.9903023] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Epidemiological data indicate that living or working in a moldy building is associated with increased risk of respiratory symptoms and disease related to inflammatory reactions, but biochemical evidence linking cause and effect is still scarce. The staff working in a mold-contaminated school, and a reference group without such exposure, were studied. Nasal lavage was performed and health data were collected with a questionnaire at the end of the spring term, after a 2.5-mo summer vacation, and at the end of the fall term. Here we show that concentrations of tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), and nitric oxide (NO) in nasal lavage fluid were significantly higher in the exposed than in the control subjects at the end of the first exposure period. These inflammatory mediators decreased to reference group concentrations during the period when there was no exposure and the production of NO and IL-6 increased again during the reexposure in the fall term. Reports of cough, phlegm, rhinitis, eye irritation, and fatigue paralleled the changes in the measured inflammatory markers. These results point to an association between inflammatory markers in the nasal lavage fluid, the high prevalence of respiratory symptoms among the occupants, and chronic exposure to molds in the indoor environment.
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Affiliation(s)
- M R Hirvonen
- Division of Environmental Health, National Public Health Institute, Kuopio, Finland.
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Affiliation(s)
- J Y Westcott
- National Jewish Medical and Research Center, Department of Medicine, Denver, CO 80206, USA.
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Westin U, Lundberg E, Wihl JA, Ohlsson K. The effect of immediate-hypersensitivity reactions on the level of SLPI, granulocyte elastase, alpha1-antitrypsin, and albumin in nasal secretions, by the method of unilateral antigen challenge. Allergy 1999; 54:857-64. [PMID: 10485390 DOI: 10.1034/j.1398-9995.1999.00938.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this paper was to investigate the role of SLPI in patients with allergic rhinitis. From this point of view, we also examined leukocyte elastase, alpha1-antitrypsin, and albumin. SLPI is an inhibitor of serine proteases such as leukocyte elastase, cathepsin G, and mast-cell chymase. Since chymase is considered to participate in mast-cell degranulation and histamine release, SLPI might act as a regulator of allergic reactions. Recent interest has been focused on leukocytes and allergy. Since SLPI is a strong inhibitor of leukocyte elastase, we also focused on the function of elastase in allergic rhinitis. METHODS We used the method of nasal lavage after unilateral nasal antigen challenge in atopic and healthy subjects. The ELISA quantified SLPI and elastase. Albumin and alpha1-antitrypsin were quantified by electroimmunoassay. Gel filtration was used to separate native SLPI from its complex with elastase. RESULTS There was a higher level of SLPI in lavage fluid from healthy subjects than from atopic patients. SLPI was increased on the contralateral side in atopic subjects after allergen challenge. The absence of increase in SLPI on the challenged side may be attributed to the increase in elastase and its binding to SLPI, which might have an effect on the immunoreactivity and interfere with the ELISA. It may then be assumed that there is an augmentation of SLPI on the challenged side as well. No increase was seen in healthy subjects. There was a higher concentration of elastase, alpha1-antitrypsin, and albumin before antigen challenge in atopic patients outside the pollen season than in healthy subjects. As expected, an increase was also seen in the challenged side exclusively in atopic subjects. CONCLUSIONS The lower concentration of SLPI in nasal lavage fluid among the atopic patients than the healthy subjects indicates damaged mucosa. Neural reflexes are involved in SLPI release since there was an increase even in the contralateral nostril. A higher level of elastase and albumin before allergen challenge suggests chronic inflammation in nasal mucosa outside the pollen season. Leukocyte recruitment takes place in response to IgE-mediated reactions, which are reflected in an increase in elastase in response to allergen challenge.
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Affiliation(s)
- U Westin
- Department of Otorhinolaryngology, University Hospital of Malmö, Sweden
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