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Rhinitis Phenotypes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1492-1503. [PMID: 32389274 DOI: 10.1016/j.jaip.2020.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 02/08/2023]
Abstract
Rhinitis is an umbrella term of a group of upper airway diseases with nasal symptoms and signs with different etiologies and various clinical features or traits. It can be classified into different "phenotypes," based on these observable traits. A proper differential diagnosis is necessary to adequately manage the disease. The objective of this review is to clarify the concept of rhinitis phenotypes while analyzing the clinical features and/or traits of each in order to determine a proper differential diagnosis and appropriate treatment.
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Pal I, Sinha Babu A, Halder I, Kumar S. Nasal smear eosinophils and allergic rhinitis. EAR, NOSE & THROAT JOURNAL 2018; 96:E17-E22. [PMID: 29121381 DOI: 10.1177/0145561317096010-1105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Our aim was to find out the association between nasal smear eosinophil count and allergic rhinitis (AR) and to determine a cutoff value that is significant for a diagnosis of AR. We also wanted to determine whether this count is related to the predominant symptoms, duration, or type and severity of AR, or to the presence of coexisting asthma. We selected 100 patients with a clinical diagnosis of allergic rhinitis across all age groups and an equal number of age- and sex-matched controls for the study. Their nasal smear eosinophil counts were recorded in terms of the number of eosinophils per high-power field (HPF). All patients were then clinically assessed for asthma and underwent spirometry. The data were recorded and appropriate statistical analysis done. The difference in the mean eosinophil counts of patients with AR and controls was found to be statistically significant (p = 0.000). A nasal smear eosinophil count of >0.3 per HPF had a 100% specificity and a 100% positive predictive value for AR. Asthma was associated with allergic rhinitis in 40% of patients; an association was not found between nasal smear eosinophil count and the symptoms, duration, type, and severity of allergic rhinitis or coexistent asthma. We conclude that an eosinophil count of >0.3 per HPF in nasal smears is a highly specific criterion for the diagnosis of AR. However, nasal smear eosinophil counts are poor indicators of the degree, duration, or type of upper or associated lower airway inflammation due to allergy.
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Affiliation(s)
- Indranil Pal
- Department of Otorhinolaryngology, College of Medicine and Jawaharlal Nehru Memorial Hospital, West Bengal University of Health Sciences, Kalyani, Nadia, West Bengal, India
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Park KI, Jang TY, Yang SC, Hong HS, Kim YH. Correlation of Nasal Eosinophilia and Response after Nasal Provocation Test in Patients with Nonallergic Rhinitis. Otolaryngol Head Neck Surg 2018; 159:231-237. [DOI: 10.1177/0194599818768806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives We aimed to evaluate the relationship between nasal eosinophilia and nasal hyperresponsiveness to allergen extract. Study Design Retrospective chart review. Setting Academic tertiary rhinologic practice. Subjects and Methods We performed allergy tests (skin prick test and multiple allergosorbent test) and nasal cytology for 194 patients with rhinitis symptoms (76 males and 118 females; age, 11-69 years). According to the results, they were classified into 4 groups: group A (allergic rhinitis with eosinophilia, n = 26), group B (allergic rhinitis without eosinophilia, n = 77), group C (nonallergic rhinitis with eosinophilia syndrome, n = 20), and group D (nonallergic rhinitis without eosinophilia, n = 71). We performed a nasal provocation test (NPT) using house dust mite extract and assessed the changes in symptoms and the decrease in acoustic parameters (total nasal volume and minimal cross-sectional area [MCA]). Results Patients in group C were more likely to have severe rhinorrhea and sneezing than those in group D ( P < .001). After NPT, group C had greater aggravation of nasal obstruction than group D ( P < .001). Group C also showed markedly greater MCA changes as compared with group D 15 minutes after the antigen challenge ( P = .002). There was significant correlation between the number of eosinophils and an increase in nasal obstruction ( r = 0.319, P = .0009), rhinorrhea ( r = 0.302, P = .0017), sneezing ( r = 0.219, P = .0241), change in the total nasal volume 15 minutes after NPT ( r = 0.287, P = .0028), and change in the MCA 15 minutes ( r = 0.322, P = .0008) and 30 minutes ( r = 0.250, P = .0098) after NPT. Conclusion In patients with NAR, nasal eosinophilia is associated with provocative response after NPT. Further research should be performed to elucidate the mechanisms that underlie this phenomenon.
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Affiliation(s)
- Ki-Ik Park
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Tae Young Jang
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Seung-Chan Yang
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Hyung Sun Hong
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Young Hyo Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea
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Wang W, Xian M, Xie Y, Zheng J, Li J. Aggravation of airway inflammation and hyper-responsiveness following nasal challenge with Dermatophagoides pteronyssinus in perennial allergic rhinitis without symptoms of asthma. Allergy 2016; 71:378-86. [PMID: 26595454 DOI: 10.1111/all.12808] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND House dust mites are the most prevalent allergen causing sensitizations in patients with rhinitis and asthma in China. We aimed to investigate the changes in both upper and lower airway inflammation and responsiveness following Dermatophagoides pteronyssinus (Der-p) nasal provocation test (NPT) in rhinitis patients. METHODS Study subjects included 15 nonasthmatic Der-p-sensitized rhinitis (AR) patients with airway hyper-responsiveness (AHR) (AR+AHR+), 15 AR patients without AHR (AR+AHR-), 15 healthy controls (HCs) with Der-p sensitization (HC+DP+), and 15 HC without Der-p sensitization (HC+DP-). All subjects underwent Der-p NPT. Visual analogue scale (VAS) scores of nasal symptoms, nasal lavage and nasal airway resistance (NAR) measurement, sputum induction, and forced expiratory volume in 1 second (FEV1 ) were performed. Airway responsiveness to histamine bronchoprovocation (PD20 -FEV1 ) and exhaled nitric oxide (FeNO) was determined. RESULTS NAR increased significantly in all subjects with the greatest effect seen in AR+AHR+ individuals. VAS increased in all subjects at 30 min and returned to baseline at 6 h, with significantly higher levels in AR+AHR+ and AR+AHR- subjects (P < 0.05). Eosinophils in nasal lavage fluid and sputum increased significantly after NPT in AR+AHR+ and AR+AHR- subjects (P < 0.001). FEV1 % and PD20 -FEV1 decreased and FeNO increased significantly after NPT only in AR+AHR+ subjects (P < 0.05). Nasal lavage eosinophil count was positively correlated with sputum eosinophil count and the level of FeNO and negatively correlated with FEV1 and PD20 . CONCLUSIONS House dust mite nasal provocation test induces and aggravates both upper and lower airway inflammation and hyper-responsiveness in patients with persistent allergic rhinitis without asthmatic symptoms.
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Affiliation(s)
- W. Wang
- State Key Laboratory of Respiratory Disease; Department of Allergy and Clinical Immunology; The First Affiliated Hospital; Guangzhou Medical University; Guangzhou China
| | - M. Xian
- State Key Laboratory of Respiratory Disease; Department of Allergy and Clinical Immunology; The First Affiliated Hospital; Guangzhou Medical University; Guangzhou China
| | - Y. Xie
- State Key Laboratory of Respiratory Disease; Department of Allergy and Clinical Immunology; The First Affiliated Hospital; Guangzhou Medical University; Guangzhou China
| | - J. Zheng
- State Key Laboratory of Respiratory Disease; Department of Allergy and Clinical Immunology; The First Affiliated Hospital; Guangzhou Medical University; Guangzhou China
| | - J. Li
- State Key Laboratory of Respiratory Disease; Department of Allergy and Clinical Immunology; The First Affiliated Hospital; Guangzhou Medical University; Guangzhou China
- Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology; Guangzhou Medical University; Guangzhou China
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Yılmaz I, Bayraktar N, Ceyhan K, Seçil D, Yüksel S, Mısırlıgil Z, Bavbek S. Evaluation of vascular endothelial growth factor-A and Endostatin levels in induced sputum and relationship to bronchial hyperreactivity in patients with persistent allergic rhinitis monosensitized to house dust. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:S2173-5115(15)00094-9. [PMID: 26051834 DOI: 10.1016/j.rppnen.2015.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 03/11/2015] [Accepted: 04/30/2015] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Studies about the pathogenesis of bronchial hyperreactivity (BHR) in patients with persistent allergic rhinitis (PAR) and its relationship with lower airway remodeling are extremely limited. OBJECTIVE This study evaluated bronchial vascular remodeling via the measurement of angiogenic factor, vascular endothelial growth factor-A (VEGF-A), and anti-angiogenic factor, Endostatin, and evaluated their relationship with BHR in patients with PAR. METHODS The study group consisted of 30 patients with PAR monosensitized to house dust mites and 14 non-allergic healthy controls. All subjects underwent induced sputum and methacholine (M) bronchial provocation tests. VEGF-A and Endostatin levels were measured by ELISA in induced sputum supernatants. RESULTS The percentages of eosinophils in induced sputum were significantly increased in patients with PAR compared with healthy controls. There were no significant differences between patients with PAR and healthy controls in terms of levels of VEGF (37.9pg/ml, min-max: 5-373pg/ml vs. 24.9, min-max: 8-67pg/ml, p=0.8 respectively), Endostatin (532.5pg/ml, min-max: 150-2125pg/ml vs. 644, min-max: 223-1123pg/ml, p=0.2 respectively) and VEGF/Endostatin ratio (0.057 vs. 0.045, p=0.8 respectively). In addition, there were no significant differences between patients who are BHR positive (n=8), or negative to M (n=22) in terms of levels of VEGF, Endostatin and VEGF/Endostatin ratio and no correlations among value of PD20 to M and levels of VEGF, Endostatin and VEGF/Endostatin ratio. CONCLUSION We conclude that VEGF-A and Endostatin did not differ between patients with PAR and healthy controls regardless of BHR to M.
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Affiliation(s)
- I Yılmaz
- Ankara University, School of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara, Turkey.
| | - N Bayraktar
- Baskent University, Department of Biochemistry, Ankara, Turkey
| | - K Ceyhan
- Ankara University, School of Medicine, Department of Pathology, Division of Clinical Cytology, Ankara, Turkey
| | - D Seçil
- Ankara University, School of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara, Turkey
| | - S Yüksel
- Ankara University, Department of Biostatistics, Ankara, Turkey
| | - Z Mısırlıgil
- Ankara University, School of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara, Turkey
| | - S Bavbek
- Ankara University, School of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara, Turkey
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Luo H, Zhang JB, Yu Y, Liu J, Jiang Y, Yan NB, Wang PJ. Clinical value of the high expression of corticosteroid receptor-beta mRNA in the nasal mucosa of steroid-resistant patients with allergic rhinitis. ORL J Otorhinolaryngol Relat Spec 2014; 76:1-7. [PMID: 24525713 DOI: 10.1159/000357738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 12/02/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE This study investigated clinical values of corticosteroid (CS) receptor α and β in the nasal mucosa of patients with allergic rhinitis (AR) by determining CS receptor α and β mRNA expression following steroid treatment. PROCEDURES Among 120 outpatients, 65 had persistent AR, including 36 being sensitive to steroid treatment (steroid-sensitive group) and 29 being resistant to steroid treatment (steroid-resistant group). In addition, 30 patients with deflection of the nasal septum alone, which was corrected by surgery, were recruited as controls. Fluorescent quantitative reverse transcription-PCR was used to quantify CS receptor α and β mRNA expression in the nasal mucosa of patients. RESULTS Results showed that CS receptor β mRNA expression in the nasal mucosa was significantly higher in the steroid-resistant group [(5.62 ± 1.28) × 102 copies/µg] compared with the steroid-sensitive [(4.62 ± 0.48) × 102 copies/µg, t = -6.67, p < 0.01] and control [(5.32 ± 0.55) × 102 copies/µg, t = -8.29, p < 0.01] groups. There were significant differences in the mRNA expression ratio of CS receptor α to β between the steroid-sensitive (658.32 ± 65.16) and steroid-resistant (525.70 ± 68.10) groups (t = 10.16, p < 0.01). CONCLUSION A high level of CS receptor β mRNA but a low level of CS receptor α mRNA expression in patients with steroid-resistant AR indicates steroid resistance. CS receptor β plays a role in evaluating the effects of steroid therapy for AR.
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Affiliation(s)
- Hong Luo
- Department of Otorhinolaryngology, Hospital Affiliated to Hubei University of Arts and Science, Xiangyang Central Hospital, Xiangyang, China
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Abstract
Allergic rhinitis affects 60 million of the U.S. population, 1.4 billion of the global population, and its prevalence appears to be increasing. The duration and severity of allergic rhinitis symptoms place a substantial burden on patient's quality of life, sleep, work productivity, and activity. The health impact of allergic rhinitis is compounded by associated complications and comorbidities including asthma, otitis media, sinusitis, and nasal polyps. Allergic rhinitis symptoms result from a complex, allergen-driven mucosal inflammatory process, modulated by immunoglobulin E (IgE), and caused by interplay between resident and infiltrating inflammatory cells and a number of vasoactive and proinflammatory mediators, including cytokines. This allergic response may be characterized as three phases: IgE sensitization, allergen challenge, and elicitation of symptoms. A thorough allergic history is the best tool for the diagnosis of allergic rhinitis, the establishment of which is achieved by correlating the patient's history and physical exam with an assessment for the presence of specific IgE antibodies to relevant aeroallergens determined by skin testing or by in vitro assay. Management of allergic rhinitis includes modifying environmental exposures, implementing pharmacotherapy, and, in select cases, administering allergen-specific immunotherapy. Intranasal therapeutic options include antihistamines, anticholinergic agents, corticosteroids (aqueous or aerosol), mast cell stabilizers, saline, and brief courses of decongestants. Selection of pharmacotherapy is based on the severity and chronicity of symptoms with the most effective medications being intranasal corticosteroids and intranasal antihistamines, which can be used in combination (separately or in fixed dose) for more difficult to control allergic rhinitis.
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Affiliation(s)
- Russell A Settipane
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Kim SW, Han DH, Lee SJ, Lee CH, Rhee CS. Bronchial hyperresponsiveness in pediatric rhinitis patients: the difference between allergic and nonallergic rhinitis. Am J Rhinol Allergy 2013; 27:e63-8. [PMID: 23710946 DOI: 10.2500/ajra.2013.27.3877] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Numerous studies have examined the relationship of bronchial hyperresponsiveness (BHR) to asthma or allergic rhinitis (AR). However, little is known regarding the association between BHR and nonallergic rhinitis (NAR). This study investigated the prevalence and risk factors of BHR in pediatric patients with rhinitis and analyzed the difference between patients with AR and those with NAR. METHODS A total of 227 subjects with rhinitis aged 6-15 years underwent a parental survey and laboratory tests, including skin-prick test and methacholine challenge test. Outcome variables were analyzed in relation to BHR. RESULTS The prevalence of BHR was 55.7 and 25.5% in patients with AR and those with NAR, respectively. The persistency of rhinitis, blood eosinophil count, and baseline lung function were significantly associated with BHR in patients with AR, whereas individual or familial medical history, environmental factors, the serum immunoglobulin E level, the number of sensitized allergens, and the wheal size ratio of allergen to histamine did not affect the BHR rate. In multivariate analysis, the persistency of rhinitis was the only significant predictor of BHR in AR patients. However, persistent rhinitis symptoms did not increase the risk of BHR in NAR patients. CONCLUSION BHR occurs over two times more frequently in children with AR than in those with NAR. In addition, persistent nasal inflammation appears to increase the risk of BHR only in the presence of atopy.
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Affiliation(s)
- Sang-Wook Kim
- Department of Otorhinolaryngology, Gyeongsang National University Hospital, Jinju, South Korea
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Yılmaz İ, Bayraktar N, Ceyhan K, Seçil D, Yüksel S, Mısırlıgil Z, Bavbek S. Evaluation of Vascular Endothelial Growth Factor A and Endostatin Levels in Induced Sputum and Relationship to Bronchial Hyperreactivity in Patients with Seasonal Allergic Rhinitis. Am J Rhinol Allergy 2013; 27:181-6. [DOI: 10.2500/ajra.2013.27.3867] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Studies about the pathogenesis of bronchial hyperreactivity (BHR) in patients with allergic rhinitis (AR) and its relationship with lower airway remodeling are extremely limited. In this study, bronchial vascular remodeling and its relationship with BHR were evaluated by measurement of vascular endothelial growth factor A (VEGF-A) and endostatin in patients with seasonal AR (SAR). Methods The study group consisted of 30 patients with SAR (positive skin test to grass pollens) and 14 healthy controls. Induced sputum and bronchial provocation test (BPT) to methacholine (M) were performed in season. VEGF-A and endostatin levels were measured by ELISA in induced sputum supernatant. Results The percentages of eosinophils in induced sputum were significantly increased in BHR+ patients (n = 10) with SAR compared with BHR– patients (n = 20) with SAR (p < 0.001). There was no correlation between eosinophils and provocative concentration of M required to produce a 20% decrease in forced expiratory volume in 1 second. The levels of VEGF-A were significantly higher in SAR patients with BHR than in SAR patients without BHR and healthy controls (respectively, p = 0.014 and p = 0.04). The levels of endostatin were significantly lower in SAR patients with BHR than in SAR patients without BHR and healthy controls (respectively, p = 0.020 and p = 0.014). The ratio of VEGF-A/endostatin was significantly higher in SAR patients with BHR than in SAR patients without BHR and healthy controls (respectively, p = 0.009 and p = 0.019). Conclusion In this first study comparing the VEGF-A and endostatin levels of patients with SAR in sputum supernatant, the presence of BHR was shown to be associated with the vascular component of remodeling “angiogenesis.”
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Affiliation(s)
- İnsu Yılmaz
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey
| | | | - Koray Ceyhan
- Division of Clinical Cytology, Department of Pathology
| | - Derya Seçil
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey
| | - Selcen Yüksel
- Department of Biostatistics, Ankara University, Ankara, Turkey
| | - Zeynep Mısırlıgil
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey
| | - Sevim Bavbek
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey
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Expression of eotaxins in the material from nasal brushing in asthma, allergic rhinitis and COPD patients. Cytokine 2012; 60:393-9. [PMID: 22846146 DOI: 10.1016/j.cyto.2012.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 05/23/2012] [Accepted: 07/02/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Asthma and COPD are non-infectious inflammatory diseases of the respiratory tract. Allergic rhinitis can be assumed as an intermediate condition between healthy and asthmatic state. Eotaxins are important indicators of allergic reaction. They are strong chemoattractants mainly for eosinophils but also for other cells. OBJECTIVE We measured the level of eotaxin expression and inflammatory cell count in the material from nasal brushing in healthy controls and in patients with allergic rhinitis, asthma, and COPD. We studied the correlation between the eotaxin gene expression level in the material from nasal brushing and respiratory tests in asthma and COPD patients. METHODS Expression of eotaxins was measured using quantitative RT-PCR. Number of eotaxin transcript copies was evaluated using real time PCR standard curve method. RESULTS Of all eotaxins CCL24 had the highest expression in the material from nasal brushing, and its level was increased in allergic asthma. CCL11 was significantly increased in the material from nasal brushing of COPD patients. Increased levels of all three eotaxins were observed in the material from nasal brushing of patients with allergic rhinitis in season. The levels of CCL26 expression and FEV1/FVC factor were correlated negatively in the asthma group and positively in the COPD group. CONCLUSIONS Eotaxins are crucial factors of allergic, asthmatic and also COPD inflammatory reactions. Our results suggest a dual role of CCL26 - it can act as a negative regulator for neutrophils in COPD, while in asthma it may act as a chemoatractant of eosinophils and other cells into the lung.
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