Histamine levels in middle ear effusions

Role of innate immunity in the pathogenesis of otitis media

Otitis media (OM) is a public health problem in both developed and developing countries. It is the leading cause of hearing loss and represents a significant healthcare burden. In some cases, acute OM progresses to chronic suppurative OM (CSOM), characterized by effusion and discharge, despite antimicrobial therapy. The emergence of antibiotic resistance and potential ototoxicity of antibiotics has created an urgent need to design non-conventional therapeutic strategies against OM based on modern insights into its pathophysiology. In this article, we review the role of innate immunity as it pertains to OM and discuss recent advances in understanding the role of innate immune cells in protecting the middle ear. We also discuss the mechanisms utilized by pathogens to subvert innate immunity and thereby overcome defensive responses. A better knowledge about bacterial virulence and host resistance promises to reveal novel targets to design effective treatment strategies against OM. The identification and characterization of small natural compounds that can boost innate immunity may provide new avenues for the treatment of OM. There is also a need to design novel methods for targeted delivery of these compounds into the middle ear, allowing higher therapeutic doses and minimizing systemic side effects.

The role of vascular endothelial growth factor in pediatric otitis media with effusion

OBJECTIVES

Vascular endothelial growth factor (VEGF) is a potent and critical inducer of angiogenesis and vascular permeability, and has been shown to play an important role in inflammatory events, together with hypoxia and inflammatory cytokines. VEGF messenger ribonucleic acid (mRNA) is expressed in the middle ear in an experimental animal model of otitis media with effusion (OME) and in patients with OME. However, the protein levels of VEGF in middle ear effusions (MEEs) are unknown and the role of VEGF in the pathogenesis of OME is unclear. The goals of this study were to determine the VEGF levels in MEEs and to investigate the role of VEGF in production of MEEs by comparing these levels with those of interleukin-8 (IL-8), endotoxin, and albumin.

METHODS

Forty-six MEEs obtained from 33 children (24 boys, 9 girls) were used in the study. The mean age of the subjects was 6.3 years old (range, 1-12 years old). The patients underwent myringotomy and/or insertion of a ventilation tube for treatment of OME. After myringotomy, MEEs were collected with a Juhn Tym-Tap. The samples were divided into serous and mucoid types based on observation by the naked eye. After measuring the weight of the MEE, the sample was diluted with phosphate-buffered saline and frozen until use. The concentrations of VEGF and IL-8 in the MEEs were determined by enzyme-linked immunosorbent assays, endotoxin concentrations were measured by the Limulus Amebocyte Lysate test, and albumin levels were determined using an immunoturbidimetric assay.

RESULTS

VEGF, endotoxin, IL-8, and albumin were detected in 100%, 89%, 98%, and 100% of the 46 MEEs, respectively. The concentrations of VEGF, endotoxin, and IL-8 were significantly higher in mucoid MEEs than in serous MEEs (p<0.01), whereas there was no significant difference in the albumin concentration between mucoid and serous MEEs. The VEGF levels were positively correlated with those of endotoxin (R(2)=0.17, p<0.05) and albumin (R(2)=0.65, p<0.01) in mucoid MEEs, but not in serous MEEs.

CONCLUSIONS

Our results suggest that VEGF is produced in response to bacterial components such as endotoxin in the middle ear cavity and is associated with production of mucoid MEEs by increasing serum exudation and mucosal secretion.

The role of inflammatory mediators in the pathogenesis of otitis media and sequelae

This review deals with the characteristics of various inflammatory mediators identified in the middle ear during otitis media and in cholesteatoma. The role of each inflammatory mediator in the pathogenesis of otitis media and cholesteatoma has been discussed. Further, the relation of each inflammatory mediator to the pathophysiology of the middle and inner ear along with its mechanisms of pathological change has been described. The mechanisms of hearing loss including sensorineural hearing loss (SNHL) as a sequela of otitis media are also discussed. The passage of inflammatory mediators through the round window membrane into the scala tympani is indicated. In an experimental animal model, an application of cytokines and lipopolysaccharide (LPS), a bacterial toxin, on the round window membrane induced sensorineural hearing loss as identified through auditory brainstem response threshold shifts. An increase in permeability of the blood-labyrinth barrier (BLB) was observed following application of these inflammatory mediators and LPS. The leakage of the blood components into the lateral wall of the cochlea through an increase in BLB permeability appears to be related to the sensorineural hearing loss by hindering K⁺ recycling through the lateral wall disrupting the ion homeostasis of the endolymph. Further studies on the roles of various inflammatory mediators and bacterial toxins in inducing the sensorineumral hearing loss in otitis media should be pursued.

Ketotifen induced inhibition of histamine release in a non-IgE model of middle ear effusion

The inhibitory effects of ketotifen, a histamine H1-receptor antagonist and mast cell stabilizer, were examined on a non-IgE experimental model of middle ear effusion. Thirty rats were divided into three groups. Group A (n = 9) was subjected to mechanical stimulation of the external auditory canal (EAC); group B (n = 11) was pre-treated with intraperitoneal administration of 0.2 mg ketotifen, 90 min before mechanical stimulation of the EAC; and group C (n = 10), the control group, was neither exposed to mechanical stimulation nor given ketotifen. Thirty minutes after completion of the experiment, the eardrums were inspected, histamine levels were determined by a fluorometric assay, and the pars flaccida underwent histological assessment. An attic effusion was observed in group A; a similar phenomenon but to a lesser extent was also seen in group B. Statistical analysis confirmed that the mean histamine concentration of the rinsing fluid obtained from group A was significantly higher than that of group C (p = 0.004) or group B (p = 0.008). No significant difference was found between the mean histamine concentration of groups C and group B (p = 0.311). Histological assessment revealed that the thickness of the pars flaccida of group A was considerably greater than that of groups C and B and was characterized by marked edema. Furthermore, the pars flaccida mast cell population was significantly depleted compared with groups C and B. The data indicate that mechanical stimulation of the EAC triggered the pars flaccida mast cells to degranulate in a non-mediated IgE fashion and that histamine is implicated in most of these histological changes. It is concluded that administration of ketotifen before mechanical stimulation of the EAC had a stabilizing effect and abolished mast cell degranulation, therefore, may be considered as a potential therapeutic agent for the treatment of middle ear disease in the pediatric population.

Role of mast cells in otitis media

BACKGROUND

New pathophysiologic concepts are needed to explain the clinically observed connection between the allergic diathesis and otitis media. Although mast cells, unlike lymphocytes, are common in the normal middle ear mucosa, their potential role in innate immunity of the middle ear and in the expression of inflammatory responses in that space to bacterial challenge, as opposed to allergy, has received relatively little attention.

OBJECTIVE

In the current study, we examine the contributions of mast cells to the pathogenesis of bacterially induced inflammation in the middle ear and thus to otitis media.

METHODS

Wild-type mice, mast cell-deficient mice, and mast cell-deficient mice whose mast cell populations were restored by transplantation of bone marrow-derived mast cells were challenged by using models of bacterial and allergic middle ear inflammation.

RESULTS

Our results indicate that mast cells account for a substantial proportion of the innate immune response to bacteria in the middle ear.

CONCLUSION

This mechanism may link responses to allergy and infection in the middle ear mucosa, and thus the mast cell may be a critical control element in the pathogenesis of otitis media.

Importance of respiratory viruses in acute otitis media

Acute otitis media is usually considered a simple bacterial infection that is treated with antibiotics. However, ample evidence derived from studies ranging from animal experiments to extensive clinical trials supports a crucial role for respiratory viruses in the etiology and pathogenesis of acute otitis media. Viral infection of the upper respiratory mucosa initiates the whole cascade of events that finally leads to the development of acute otitis media as a complication. The pathogenesis of acute otitis media involves a complex interplay between viruses, bacteria, and the host's inflammatory response. In a substantial number of children, viruses can be found in the middle-ear fluid either alone or together with bacteria, and recent studies indicate that at least some viruses actively invade the middle ear. Viruses appear to enhance the inflammatory process in the middle ear, and they may significantly impair the resolution of otitis media. Prevention of the predisposing viral infection by vaccination against the major viruses would probably be the most effective way to prevent acute otitis media. Alternatively, early treatment of the viral infection with specific antiviral agents would also be effective in reducing the occurrence of acute otitis media.

Experimental otitis media with effusion induced by leukotriene D4

OBJECTIVE

inflammatory mediators such as prostaglandins (PGs), leukotrienes (LTs), and platelet-activating factor (PAF) have been identified in human middle ear effusions (MEEs), as well as in the experimentally induced MEEs of animals. However, the exact function of LTs in the middle ear cavity is still unknown. In this study, the role of LTs was investigated using an experimental model in which OME was induced by LTD4.

METHODS

to examine whether leukotrienes (LTs) induce otitis media with effusion (OME), 2x10(-6), 2x10(-5), 1x10(-4) and 2x10(-4) M of LTD4 was injected into the rat ear. The severity of OME was assessed based on the histological findings. The concentrations of IL1-beta, TNF-alpha, and GRO/CINC-1 in MEE were also measured. Additionally the therapeutic efficacy of a specific LTs antagonist, pranlukast on experimental OME was investigated.

RESULTS

all ears developed middle ear effusion (MEE) within 24 h and about 50% of the animals continued to demonstrate MEE for 14 days in the 1x10(-4) and 2x10(-4) M groups. The cytokine levels seemed to correspond well with the persistence of OME. The oral administration of a specific LTs antagonist, pranlukast, was found to alleviate the experimental OME.

CONCLUSION

these findings suggest that LTs appear to plays an important role in the pathogenesis of OME.

Degranulation of mast cells provokes a massive inflammatory reaction in the tympanic membrane

OBJECTIVE

The pars flaccida is extremely rich in mast cells. On stimulation the mast cells release preformed and de novo synthesized inflammatory substances. The purpose of this study was to examine how these mast cell substances provoke inflammatory changes in the tympanic membrane.

STUDY DESIGN

In vivo, murine model.

METHODS

In a rat model, the mast cell secretagogue compound 48/80 was applied locally to the tympanic membrane on 4 consecutive days and the ensuing inflammatory changes were evaluated by otological, light, and electron microscopy 3, 6, 9, 12, 18, 24, 36, and 48 hours and 4, 6, and 8 days later.

RESULTS

Degranulation of the mast cells occurred within 3 hours of applying compound 48/80. Release of the mast cell substances coincided with an inflammatory event characterized by a two-stage reaction: an edema stage, peaking 6 hours after application, followed by a massive invasion of inflammatory cells, peaking at 24 and 48 hours. Pars flaccida and pars tensa were both involved, pars flaccida showing the earliest changes. Pars tensa exhibited the same biphasic reaction as pars flaccida, but approximately 6 hours later.

CONCLUSIONS

The mast cells of the pars flaccida have the capacity to elicit an intense inflammation of the tympanic membrane. The biphasic reaction pattern resembles that observed in experimental otitis media, suggesting involvement of the mast cells in this inflammatory condition of the middle ear.

Kinin and histamine stimulate Cl- secretion in gerbil middle ear epithelium: connection to otitis media

The effects of bradykinin (BK) and histamine on transepithelial ion transport in primary cultures of gerbil middle ear epithelium were investigated. Lysyl-bradykinin (lys-BK) elicited a transient increase in short-circuit current (I(sc)) when added to apical or basolateral surfaces. Lys-BK had a larger effect than BK or des-arg9-BK on both epithelial surfaces. Histamine induced a transient increase in I(sc) only when added to the basolateral surface. Mepyramine, an H1 histamine antagonist, greatly reduced the histamine-induced I(sc). The H2 and H3 histamine antagonists were both ineffective for inhibiting the I(sc) responses to histamine. Diphenylamine-2-carboxylate or 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid, Cl- channel blockers, significantly blocked the I(sc) responses to lys-BK or histamine. The Ca2+-mobilizing action of lys-BK and histamine was also investigated in single middle ear epithelial cells. BK and histamine induced an increase in the intracellular Ca2+ concentration. 1,2-Bis-(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid-acetoxymethyl ester, a calcium chelator, greatly reduced the increase in the I(sc) responses to lys-BK or histamine. These data indicate that BK and histamine activate intracellular Ca2+-dependent mechanisms, leading to apical Cl- secretion in the cultured gerbil middle ear epithelium via B2 BK receptors and H1 histamine receptors.

Role of viruses in middle-ear disease

Taken together, there is ample evidence suggesting a role for viruses in the pathogenesis of OM. This evidence comes from numerous studies performed in animals and in vitro cell cultures, as well as in adults and children with URI and OM. Viruses induce host immune and inflammatory responses that result in pathology of the ET and the middle ear, and predispose the host in various ways to secondary bacterial infection. A suggested mechanism for the pathogenesis of OM following respiratory viral infection is presented in Figure 1.

Effects of platelet activating factor on mucociliary clearance of the eustachian tube

The effects of platelet activating factor (PAF) on mucociliary clearance of the eustachian tube were investigated both in vitro and in vivo. Normal ciliated epithelium was obtained from the eustachian tube of guinea pigs and incubated with PAF at concentrations ranging from 10(-10) to 10(-6) mol/L. Ciliary activity was observed under an inverted microscope and quantified photoelectrically. The PAF dose-dependently inhibited ciliary activity. One milliliter each of 10(-5) mol/LPAF, 10(-5) mol/L prostaglandin E2 (PGE2), 10(-5) mol/LPAF and PGE2, or the control solution (0.1 v/v% methanol-phosphate-buffered saline) was directly injected into the tympanic bullae of anesthetized chinchillas. The middle ear was examined by otomicroscopy, tympanometry, and auditory brain stem response in relation to time. The PAF delayed middle ear clearance, and the PGE2 augmented its delay. These findings suggest that PAF inhibits mucociliary clearance of the eustachian tube from the middle ear, and that PGE2 plays an important role in the augmentation of inflammatory disorders.

Comparison of the proteins of middle ear effusion with human mast cell proteins

In order to clarify the role of mast cells in the aetiology of secretory otitis media (SOM), we compared the protein components of middle ear effusion (MEE) with human mast cells using acrylamide gradient gel electrophoresis and electrofocusing methods. This first direct comparison between the proteins of MEE and human mast cells has been made possible by a method developed in our laboratory for cultivation of human mast cells in tissue culture. On electrophoresis, we found that out of 12 bands of MEE proteins that were different from the serum, seven (58 per cent) had a similar electrophoretic migration rate (Rx) to mast cells. On electrofocusing, three of the four bands of MEE had a similar Rx to the mast cells. We have shown that proteins of mast cells and MEE had similar Rxs. Therefore, our study supports previous studies which suggests that mast cells play an important role in the aetiology of SOM.

Effect of oxatomide on otitis media with effusion--an experimental study

The therapeutic effect of oxatomide on experimental otitis media with effusion (OME) induced by secondary immune response was investigated in chinchillas. Oxatomide was administered daily in three different doses (5, 10, 30 mg/kg b.w.t.) for a period of 2 weeks, starting 2 days after the instillation of keyhole limpet hemocyanin (KLH) into the tympanic cavity. The severity of OME was assessed by observing the eardrum under a surgical microscope, by tympanography, and by histological findings. The concentrations of leukotriene C4 and LTD4 in middle ear effusion (MEE) were also measured, 7 days after the KLH instillation. It was found that oral administration of oxatomide in dosages of 10 and 30 mg/kg alleviated the experimental OME. The mean LTD4 concentration measured in MEE from chinchillas given 30 mg oxatomide was significantly lower than that measured in the control group. The radioactivity of 14C-labelled oxatomide in MEE and the autoradiographic findings revealed that orally administered oxatomide was rapidly absorbed from the digestive tract and transported to the middle ear via blood circulation. The findings suggest that the effect of oxatomide can be anticipated in patients with OME.

Biochemical evidence of platelet-activating factor (PAF) in human middle ear effusions

Platelet-activating factor (PAF) is one of the most potent biological lipid mediators. This is especially true in relation to inflammation. In order to characterize the biochemical features of otitis media with effusion, the authors characterized and determined the concentration of the PAF present in human middle ear effusions obtained from 23 patients with otitis media with effusion. Each sample of middle ear effusion was divided into two groups: serous (n = 12) and mucoid effusions (n = 11). The platelet-activating factor activity was found mainly in mucoid middle ear effusions, and the amounts of PAF were higher in mucoid type (3.55 +/- 1.19 ng/g, mean +/- standard deviation [SD]) than in the serous type (0.44 +/- 0.19 ng/g). Phospholipids obtained from the middle ear effusions contained a large amount of lyso-platelet-activating factor, the biologically inactive precursor or breakdown product of platelet-activating factor. Based on these findings, it is suggested that platelet-activating factor may play an important role as a mediator of the inflammatory responses in the pathogenesis of otitis media with effusion.

Effects of human middle ear effusions on the mucociliary system of the tubotympanum in the guinea pig

Effusion fluid resulting from otitis media contains a variety of inflammatory substances. This middle ear effusion (MEE) may be itself affect the mucosa of the tubotympanum and contribute to chronicity of the condition. The present study was designed to elucidate in vitro and in vivo effects of MEEs on the mucosa of the guinea pig tubotympanum. The results obtained demonstrated that the ciliary activity of the eustachian tube was reduced in the presence of human MEEs. This activity decreased to approximately 80% in the presence of serous MEE at 48 h and was 60% after exposure to mucoid MEE. Intratympanic inoculation of human MEEs resulted in accumulation of a serous effusion in the tympanic cavity. Histologic study of the tubotympanum in inoculated animals demonstrated mucociliary dysfunction as well as a general inflammatory process and increased vascular permeability. This damage was more prominent following inoculation with the mucoid MEEs. The ciliary depression and inflammation found in the tubotympanum suggest that the pathologic nature of MEEs may be, at least partially, responsible for the chronicity of otitis media.

Effect of S-carboxymethylcysteine on the clearance of middle ear effusion. An experimental study

The therapeutic effect of S-carboxymethylcysteine (S-CMC) on otitis media with effusion was investigated by use of immune-mediated otitis media with effusion (OME) induced in chinchillas. The S-CMC was administered daily to individuals in two different doses (100 mg/kg and 200 mg/kg) for 2 weeks after the induction of immune-mediated otitis media. The severity of OME was evaluated by observation of the tympanic membrane under a surgical microscope, by tympanogram, and by histologic findings of the middle ear mucosa. Results of the study showed that the oral administration of S-CMC at a dose of 200 mg/kg of body weight is more effective than at a dose of 100 mg/kg in the clearance of middle ear effusions in experimental OME. An autoradiographic study using 14C-S-CMC revealed that orally administered S-CMC is rapidly absorbed by the digestive tract and transported to the tubotympanum via the circulation. The uptake and excretion by secretory cells were apparently greater in activated secretory cells. However, S-CMC does not act on the infiltrating cells to prevent the release of chemical mediators such as histamine and prostaglandin E2. This finding suggests that prophylactic use of S-CMC may not be anticipated.

Regional blood flow volume in the eustachian tube

Measurements of regional blood flow around the pharyngeal orifice of the Eustachian tube were carried out after topical administration of various inflammatory mediators in 14 mongrel dogs by the hydrogen clearance method. Histamine and platelet-activating factor (PAF) resulted in a significant alteration of blood flow volume. Histamine was found to induce a dose-response related increase, whereas blood flow volume tended to decrease in each concentration range in the series of PAF administration. There was no significant difference in blood flow between topical application of leukotriene C4 and leukotriene D4. It is likely that in upper respiratory tract inflammation, such as in otitis media and in nasal allergy, activated histamine and PAF affect the microcirculation of the tubal orifice. These results suggest that disturbance of the microcirculatory system in the Eustachian tube mucosa could be involved in the pathogenesis of chronic otitis media with effusion.

Effects of various inflammatory mediators on eustachian tube patency

The effects of several inflammatory mediators on the patency of the Eustachian tube were evaluated in 15 mongrel dogs. Histamine, leukotriene C4(LTC4) and D4(LTD4), and platelet activating factor (PAF) were perfused through the Eustachian tube of anesthetized dogs at concentrations detected in human middle ear effusion of patients with otitis media. The patency of the Eustachian tube was then evaluated by perfusion pressure and opening pressure. Histamine at concentrations of more than 10(-5) M caused increased tubal resistance and opening pressure rapidly. LTC4 and LTD4 caused a rapid increase of tubal resistance and opening pressure at far lower concentrations, i.e. 10(-12) M. Doses of PAF over 10(-9) M may cause an increase in the opening pressure. These results indicate that various inflammatory mediators are capable of affecting the Eustachian tube function.

Distribution of mast cells in the tubotympanum of guinea pigs

The distribution pattern of mast cells in the middle ear mucosa and eustachian tube was examined histologically in adult and developing guinea pigs. The aim was to better understand the role of mast cells in the middle ear defense mechanism. The density of mast cells was highest in the pharyngeal orifice of the eustachian tube, and decreased in the direction of the tympanic orifice. The density was higher in adults than in developing animals. Mast cells were also found in the tubotympanic membrane of the fetal guinea pig. Mast cells in the middle ear mucosa appeared in areas covered by ciliated epithelia or areas richly vascularized. Almost all mast cells found in the middle ear and eustachian tube mucosa were the connective tissue type. The results of this investigation suggest that mast cells distribute in the tubotympanum in response to continuous stimuli to the tubotympanic cavity.

Histamine-induced mucociliary dysfunction and otitis media with effusion

Histamine, which has been found in middle ear effusions, is a potent pharmacological mediator released at an early stage of allergic reactions or general inflammatory process, increasing permeability of small blood vessels. Histamine might be involved in the origin and chronicity of middle ear effusions. In this study we studied the effect of histamine on the mucociliary function. First we examined the effect of histamine and its H1 and H2 blockers on the ciliary activity in the middle ear. 10(-2) M of histamine deteriorated ciliary activity; however, at lower concentrations ciliostimulatory effects were demonstrated for histamine (between 10(-8) M and 10(-4) M). Such ciliostimulatory effects were not affected by diphenhydramine (H1-blocker) but were reduced by cimetidine (H2-blocker). Thus histamine stimulates ciliary activity by combining with H2-receptor. Intratympanic injection of 10(-4) M of histamine induced accumulation of middle ear effusions (MEEs). The volume of MEEs was largest at 1 day postinjection when its mucociliary clearance time was longest. Then the mucociliary clearance time became shorter, but it was still significantly longer than that of the control animal. Ciliary activity in the tubotympanum showed no recovery through the observation period. On the other hand, intratympanic injection of 10(-6) M of histamine produced MEEs at 1 and 3 days postinjection when the mucociliary clearance time was longer than that of the control group. At 8 days, when most ears did not demonstrate MEEs, the mucociliary clearance time and ciliary activity in the Eustachian tube and tympanic orifice reached the level of the control group. Our present study demonstrates that histamine can induce mucociliary dysfunction of the tubotympanum resulting in middle ear effusions, and that cilia, especially those present in the tube and the tympanic orifice, have a significant role in eliminating middle ear effusions.

Current concepts of mucociliary dysfunction in otitis media with effusion

From a survey of the literature on mucociliary function in the tubotympanum, it is clear that mucociliary activity and ciliary activity are deeply involved in the pathogenesis, pathology, and prognosis of otitis media with effusion. Ciliary function in the middle ear, especially in the tympanic orifice and the Eustachian tube, has an important role in the mucociliary clearance of surplus secretion to the pharynx. Our review demonstrates that ciliary activity in the tubotympanum is sensitive to a variety of pathological agents including bacteria, bacterial endotoxin, irritant gases, and irradiation, resulting in mucociliary dysfunction of the tubotympanum.

Immune-mediated otitis media with effusion

This study was designed to clarify the role of immune reaction in otitis media with effusion (OME). Immune-mediated OME was induced in chinchillas, and characteristics of the disease were evaluated biochemically, cytologically, and histologically. OME was induced by a single intratympanic inoculation of keyhole limpet hemocyanin (KLH) in animals which had a high serum anti-KLH IgG titer. In addition, OME was maintained for 3 weeks in seven of 17 chinchillas, boosted by intradermal and intratympanic injections at 1-week intervals. Cells in the middle ear effusion (MEE) consisted substantially of neutrophils, a few macrophages, and other cells. The mean histamine and prostaglandin E2 levels in the MEE significantly exceeded the levels in corresponding sera. The lining membrane of the bullae was edematous and thickened due to dilatation and rupture of blood capillaries and cell infiltration. Next, the animals were inoculated with immune complex into the tympanic cavity. MEE appeared in all treated ears within three days after injection. Biochemical, cytologic, and histologic findings of the immune complex-induced OME resembled those of immune-mediated OME. An immune peroxidase method demonstrated that neutrophils in MEE phagocytose immune complexes. Our findings suggest that a perpetual cycle of inflammatory substances may maintain an inflammatory condition in the middle ear.

Histamine concentrations in nasal secretion and secretory activity in allergic rhinitis

The prerequisites for using the assayed histamine concentration in nasal secretion as an objective measure of disease activity in allergic rhinitis were investigated. It was demonstrated that in histamine determination procedures the presence of quenching substances in the nasal secretion could lead to underestimation of the histamine concentration. This bias was eliminated in a modified spectrofluorometric assay. Only an insignificant fraction of the histamine in samples collected by nasal spray washing was bound to unfiltrable particles or cells. The mean histamine concentration in nasal secretions from 15 healthy subjects was 11.2 micrograms/ml and in a group of nine patients with allergic rhinitis out of season 3.36 micrograms/ml. The histamine concentration in the latter group decreased during the pollen season and after positive allergen challenge. It is suggested that this decrease is caused by the increase in volume of the secretion during the allergic response. The use of lithium as an exogenous marker permitted quantitation of the increase in the relative amount of nasal secretion recovered by washing in the symptomatic subjects.

An overlooked site of tissue mast cells--the human tympanic membrane. Implications for middle ear affections

The tympanic membranes of 14 deceased, with no record of ear disease in their medical files, were investigated with respect to the presence of mast cells. The Shrapnell membrane (pars flaccida) had a rich content of mast cells, whereas the pars tensa had none except for a few located close to blood vessels along the handle of the malleus. The volume density of the pars flaccida mast cells was calculated as 3.9% and the number of mast cells/mm2 as 299 +/- 35 (mean +/- SE; n = 14). The possible role of these mast cells under both healthy and diseased middle ear conditions is discussed.