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Bentabol-Ramos G, Saenz de Santa Maria-Garcia R, Vidal-Diaz M, Eguiluz-Gracia I, Testera-Montes A. The Utility of Nasal Challenges to Phenotype Asthma Patients. Int J Mol Sci 2022; 23:ijms23094838. [PMID: 35563226 PMCID: PMC9104030 DOI: 10.3390/ijms23094838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 12/10/2022] Open
Abstract
Asthma is a heterogeneous disease in terms of both phenotype and response to therapy. Therefore, there is a great need for clinically applicable tools allowing for improved patient classification, and selection for specific management approaches. Some interventions are highly helpful in selected patients (e.g., allergen immunotherapy or aspirin desensitization), but they are costly and/or difficult to implement. Currently available biomarkers measurable in peripheral blood or exhaled air display many limitations for asthma phenotyping and cannot identify properly the specific triggers of the disease (e.g., aeroallergens or NSAID). The united airway concept illustrates the relevant epidemiological and pathophysiological links between the upper and lower airways. This concept has been largely applied to patient management and treatment, but its diagnostic implications have been less often explored. Of note, a recent document by the European Academy of Allergy and Clinical Immunology proposes the use of nasal allergen challenge to confirm the diagnosis of allergic asthma. Similarly, the nasal challenge with lysine acetylsalicylate (L-ASA) can be used to identify aspirin-sensitive asthma patients. In this review, we will summarize the main features of allergic asthma and aspirin-exacerbated respiratory disease and will discuss the methodology of nasal allergen and L-ASA challenges with a focus on their capacity to phenotype the inflammatory disease affecting both the upper and lower airways.
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Affiliation(s)
- Guillermo Bentabol-Ramos
- Pulmonology Unit, Hospital Regional Universitario de Malaga, 29010 Malaga, Spain; (G.B.-R.); (M.V.-D.)
| | | | - Monica Vidal-Diaz
- Pulmonology Unit, Hospital Regional Universitario de Malaga, 29010 Malaga, Spain; (G.B.-R.); (M.V.-D.)
| | - Ibon Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malaga, 29010 Malaga, Spain; (R.S.d.S.M.-G.); (I.E.-G.)
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga (IBIMA) and RICORS “Enfermedades Inflamatorias”, 29010 Malaga, Spain
| | - Almudena Testera-Montes
- Allergy Unit, Hospital Regional Universitario de Malaga, 29010 Malaga, Spain; (R.S.d.S.M.-G.); (I.E.-G.)
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga (IBIMA) and RICORS “Enfermedades Inflamatorias”, 29010 Malaga, Spain
- Correspondence: ; Tel.: +34-951-290-313; Fax: +34-951-290-302
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Xie Y, Ju X, Beaudin S, Wiltshire L, Oliveria JP, MacLean J, Sommer DD, Cusack R, Li O, Banerjee P, Keith PK, O'Byrne PM, Bauer RN, Staton T, Gauvreau GM, Sehmi R. Effect of intranasal corticosteroid treatment on allergen-induced changes in group 2 innate lymphoid cells in allergic rhinitis with mild asthma. Allergy 2021; 76:2797-2808. [PMID: 33784411 DOI: 10.1111/all.14835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Allergic rhinitis is characterized by rhinorrhea, nasal congestion, sneezing and nasal pruritus. Group 2 innate lymphoid cells (ILC2s), CD4+ T cells and eosinophils in nasal mucosa are increased significantly after nasal allergen challenge (NAC). Effects of intranasal corticosteroids (INCS) on ILC2s remain to be investigated. METHODS Subjects (n = 10) with allergic rhinitis and mild asthma were enrolled in a single-blind, placebo-controlled, sequential treatment study and treated twice daily with intranasal triamcinolone acetonide (220 µg) or placebo for 14 days, separated by a 7-day washout period. Following treatment, subjects underwent NAC and upper airway function was assessed. Cells from the nasal mucosa and blood, sampled 24 h post-NAC, underwent flow cytometric enumeration for ILC2s, CD4+ T and eosinophil progenitor (EoPs) levels. Cell differentials and cytokine levels were assessed in nasal lavage. RESULTS Treatment with INCS significantly attenuated ILC2s, IL-5+ /IL-13+ ILC2s, HLA-DR+ ILC2s and CD4+ T cells in the nasal mucosa, 24 h post-NAC. EoP in nasal mucosa was significantly increased, while mature eosinophils were significantly decreased, 24 h post-NAC in INCS versus placebo treatment arm. Following INCS treatment, IL-2, IL-4, IL-5 and IL-13 were significantly attenuated 24 h post-NAC accompanied by significant improvement in upper airway function. CONCLUSION Pre-treatment with INCS attenuates allergen-induced increases in ILC2s, CD4+ T cells and terminal differentiation of EoPs in the nasal mucosa of allergic rhinitis patients with mild asthma, with little systemic effect. Attenuation of HLA-DR expression by ILC2s may be an additional mechanism by which steroids modulate adaptive immune responses in the upper airways.
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Affiliation(s)
- Yanqing Xie
- Department of Medicine McMaster University Hamilton ON Canada
- State Key Laboratory of Respiratory Disease National Clinical Research Center for Respiratory Disease Guangzhou Institute of Respiratory Health the First Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong China
| | - Xiaotian Ju
- Department of Medicine McMaster University Hamilton ON Canada
| | - Suzanne Beaudin
- Department of Medicine McMaster University Hamilton ON Canada
| | | | - John Paul Oliveria
- Department of Medicine McMaster University Hamilton ON Canada
- Department of Pathology Stanford University Palo Alto CA USA
| | - Jonathan MacLean
- Department of Surgery Otolaryngology, Head & Neck Surgery Division McMaster University Hamilton ON Canada
| | - Doron D. Sommer
- Department of Surgery Otolaryngology, Head & Neck Surgery Division McMaster University Hamilton ON Canada
| | - Ruth Cusack
- Department of Medicine McMaster University Hamilton ON Canada
| | - Olga Li
- Genentech Inc South San Francisco CA USA
| | | | - Paul K. Keith
- Department of Medicine McMaster University Hamilton ON Canada
| | - Paul M. O'Byrne
- Department of Medicine McMaster University Hamilton ON Canada
| | | | | | | | - Roma Sehmi
- Department of Medicine McMaster University Hamilton ON Canada
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Teixeira MS, Alper CM, Martin BS, Cetin S, El-Wagaa JA, Doyle WJ. Histamine Applied Topically to the Nasal Mucosa Increases the Transmucosal Nitrous Oxide Exchange for the Middle Ear. Ann Otol Rhinol Laryngol 2017; 126:284-289. [PMID: 28103698 DOI: 10.1177/0003489416689470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Determine if the middle ear transmucosal nitrous oxide (N2O) exchange rate is affected by nasal inflammation caused by topical application of histamine. METHODS In a randomized, double-blind, crossover study, 20 adults were challenged intranasally with histamine (5 mg) and placebo on separate occasions. At each session, the subjects were fitted with a non-rebreathing mask and breathed room air for 20 minutes, 50% N2O:50% O2 for 20 minutes, and 100% O2 for 10 minutes. Throughout, heart rate, blood pressure, and blood O2 saturation were monitored, and bilateral middle ear pressure was recorded by tympanometry every minute. The primary outcome measure was the slope of the middle ear pressure-time function for the 50% N2O:50% O2 breathing period, which is a measure of the transmucosal N2O exchange-constant. The effects of challenge substance, session, and period on the measured vital signs and of treatment, session, ear disease history, and test ear on the pressure-time slopes were evaluated using repeated measures ANOVAs. RESULTS The post-challenge total symptom score and the slope of the middle ear pressure-time function were greater after histamine when compared to placebo challenge. Of the signs, only heart rate was affected, responding to challenge substance and study period. CONCLUSION The transmucosal N2O exchange rate for the middle ear is increased during inflammation caused by nasal histamine exposure.
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Affiliation(s)
- Miriam S Teixeira
- 1 Department of Otolaryngology, School of Medicine of the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cuneyt M Alper
- 1 Department of Otolaryngology, School of Medicine of the University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,2 Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Brian S Martin
- 3 Division of Pediatric Dentistry, School of Dental Medicine of the University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,4 Department of Dentistry, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Selma Cetin
- 1 Department of Otolaryngology, School of Medicine of the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jenna A El-Wagaa
- 1 Department of Otolaryngology, School of Medicine of the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William J Doyle
- 1 Department of Otolaryngology, School of Medicine of the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Gilles-Stein S, Beck I, Chaker A, Bas M, McIntyre M, Cifuentes L, Petersen A, Gutermuth J, Schmidt-Weber C, Behrendt H, Traidl-Hoffmann C. Pollen derived low molecular compounds enhance the human allergen specific immune response in vivo. Clin Exp Allergy 2016; 46:1355-65. [PMID: 27061126 DOI: 10.1111/cea.12739] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/25/2016] [Accepted: 03/19/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Besides allergens, pollen release bioactive, low molecular weight compounds that modulate and stimulate allergic reactions. Clinical relevance of these substances has not been investigated to date. OBJECTIVE To elucidate the effect of a non-allergenic, low molecular weight factors from aqueous birch pollen extracts (Bet-APE < 3 kDa) on the human allergic immune response in vivo. METHODS Birch and grass pollen allergic individuals underwent skin prick testing with allergen alone, allergen plus Bet-APE < 3 kDa, or allergen plus pre-identified candidate substances from low molecular pollen fraction. Nasal allergen challenges were performed in non-atopic and pollen allergic individuals using a 3 day repeated threshold challenge battery. Subjects were either exposed to allergen alone or to allergen plus Bet-APE< 3 kDa. Local cytokine levels, nasal secretion weights, nasal congestion and symptom scores were determined. RESULTS Skin prick test reactions to pollen elicited larger weals when allergens were tested together with the low molecular weight compounds from pollen. Similar results were obtained with candidate pollen-associated lipid mediators. In nasal lining fluids of allergic patients challenged with allergen plus Bet-APE < 3 kDa, IL-8 and IgE was significantly increased as compared to allergen-only challenged patients. These patients also produced increased amounts of total nasal secretion and reported more severe rhinorrhea than the allergen-only challenged group. CONCLUSIONS Low molecular compounds from pollen enhance the allergen specific immune response in the skin and nose. They are therefore of potential clinical relevance in allergic patients.
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Affiliation(s)
- S Gilles-Stein
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University Munich and Helmholtz Center Munich, Augsburg, Germany. .,ZAUM - Center of Allergy & Environment, Technical University Munich and Helmholtz Center Munich, Munich, Germany. .,Christine-Kühne-Center for Allergy Research and Education (CK Care), Davos, Switzerland.
| | - I Beck
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University Munich and Helmholtz Center Munich, Augsburg, Germany.,ZAUM - Center of Allergy & Environment, Technical University Munich and Helmholtz Center Munich, Munich, Germany
| | - A Chaker
- ZAUM - Center of Allergy & Environment, Technical University Munich and Helmholtz Center Munich, Munich, Germany.,ENT Department, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - M Bas
- ENT Department, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - M McIntyre
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
| | - L Cifuentes
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany.,Molecular Immunology, Department of Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College, London, UK
| | - A Petersen
- Division of Clinical and Molecular Allergology, Research Center Borstel, Airway Research Center North (ARCN), Borstel, Germany
| | - J Gutermuth
- ZAUM - Center of Allergy & Environment, Technical University Munich and Helmholtz Center Munich, Munich, Germany.,Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - C Schmidt-Weber
- ZAUM - Center of Allergy & Environment, Technical University Munich and Helmholtz Center Munich, Munich, Germany
| | - H Behrendt
- ZAUM - Center of Allergy & Environment, Technical University Munich and Helmholtz Center Munich, Munich, Germany
| | - C Traidl-Hoffmann
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University Munich and Helmholtz Center Munich, Augsburg, Germany.,ZAUM - Center of Allergy & Environment, Technical University Munich and Helmholtz Center Munich, Munich, Germany.,Christine-Kühne-Center for Allergy Research and Education (CK Care), Davos, Switzerland
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Abstract
Exposure to welding fumes is a recognized respiratory hazard. Occupational asthma but not occupational rhinitis has been documented in workers exposed to steel welding fumes. We report a 26-year-old male with work-related rhinitis symptoms as well as lower airways symptoms suggestive of occupational asthma and metal fume fever associated with exposure to steel welding fumes. The diagnosis of occupational rhinitis was confirmed by specific inhalation challenge.
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Affiliation(s)
- Roberto Castano
- Division of Otolaryngology- Head and Neck Surgery; University of Montreal; Montreal Canada
- Chronic Disease Research Division; Hôpital du Sacré-Coeur de Montréal; Montreal Canada
| | - Eva Suarthana
- Chronic Disease Research Division; Hôpital du Sacré-Coeur de Montréal; Montreal Canada
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Abstract
Allergic rhinitis is a common disorder and involves the reaction to environmental allergens with resultant nasal and eye symptoms. The pathophysiologic mechanisms of the eye symptoms in allergic conjunctivitis include a direct effect on the eye by deposited allergen and indirect effects related to the deposition of allergen in the nasal mucosa. One of these proposed mechanisms is the existence of a nasal-ocular reflex whereby the nasal allergic reaction leads to an afferent reflex response, the efferent limb of which results in eye symptoms. Among the treatments available for allergic rhinitis, intranasal steroids are most efficacious for nasal symptoms and have also shown sizeable efficacy related to eye symptoms. We speculated that the effect of intranasal steroids on eye symptoms in allergic rhinitis was related to their inhibition of the nasal-ocular reflex and present data previously generated from our laboratory to support this assumption in a nasal challenge model.
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Affiliation(s)
- Fuad M Baroody
- Department of Surgery, Section of Otolaryngology-Head and
Neck Surgery, The University of Chicago Medical Center, Chicago, IL
| | - Robert M Naclerio
- Department of Surgery, Section of Otolaryngology-Head and
Neck Surgery, The University of Chicago Medical Center, Chicago, IL
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Deutschle T, Reiter R, Butte W, Heinzow B, Keck T, Riechelmann H. A controlled challenge study on di(2-ethylhexyl) phthalate (DEHP) in house dust and the immune response in human nasal mucosa of allergic subjects. Environ Health Perspect 2008; 116:1487-93. [PMID: 19057701 PMCID: PMC2592268 DOI: 10.1289/ehp.11474] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 07/03/2008] [Indexed: 05/02/2023]
Abstract
BACKGROUND Few studies have yet addressed the effects of di(2-ethylhexyl) phthalate (DEHP) in house dust on human nasal mucosa. OBJECTIVES We investigated the effects of house dust containing DEHP on nasal mucosa of healthy and house dust mite (HDM)-allergic subjects in a short-term exposure setting. METHODS We challenged 16 healthy and 16 HDM-allergic subjects for 3 hr with house dust at a concentration of 300 microg/m(3) containing either low (0.41 mg/g) or high (2.09 mg/g) levels of DEHP. Exposure to filtered air served as control. After exposure, we measured proteins and performed a DNA microarray analysis. RESULTS Nasal exposure to house dust with low or high DEHP had no effect on symptom scores. Healthy subjects had almost no response to inhaled dust, but HDM-allergic subjects showed varied responses: DEHP(low) house dust increased eosinophil cationic protein, granulocyte-colony-stimulating factor (G-CSF), interleukin (IL)-5, and IL-6, whereas DEHP(high) house dust decreased G-CSF and IL-6. Furthermore, in healthy subjects, DEHP concentration resulted in 10 differentially expressed genes, whereas 16 genes were differentially expressed in HDM-allergic subjects, among them anti-Müllerian hormone, which was significantly up-regulated after exposure to DEHP(high) house dust compared with exposure to DEHP(low) house dust, and fibroblast growth factor 9, IL-6, and transforming growth factor-beta1, which were down-regulated. CONCLUSIONS Short-term exposure to house dust with high concentrations of DEHP has attenuating effects on human nasal immune response in HDM-allergic subjects, concerning both gene expression and cytokines.
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Affiliation(s)
- Tom Deutschle
- Department of Otorhinolaryngology, University of Ulm, Medical School, Ulm, Germany.
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Wilson AM, Sims EJ, Orr LC, Robb F, Lipworth BJ. An evaluation of short-term corticosteroid response in perennial allergic rhinitis using histamine and adenosine monophosphate nasal challenge. Br J Clin Pharmacol 2003; 55:354-9. [PMID: 12680883 PMCID: PMC1884241 DOI: 10.1046/j.1365-2125.2003.01776.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AIMS To evaluate the role of AMP nasal challenge as a measure of short-term treatment response in patients receiving intranasal corticosteroids. Adenosine monophosphate (AMP) challenge has been shown to be a good inflammatory surrogate in the lower airways, but it has not been properly evaluated as a nasal challenge test. METHODS Fourteen patients with perennial allergic rhinitis (PAR) were randomized to receive 2 weeks treatment with placebo (PL) or 200 microg intranasal mometasone furoate (MF) once daily in a randomized single-blind crossover study. AMP (25-800 mg ml-1) and histamine (0.25-8 mg ml-1) nasal challenge testing were performed after each treatment period with 30% decrease in minimal cross-sectional area (MCA). Domiciliary symptom data were collected. RESULTS There was a significant (P < 0.05) improvement in PC30 MCA and nasal volume with AMP but not with histamine comparing MF vs PL. This amounted to a 2.8 (95% CI 1.5, 4.0) and 0.7 (95% CI -0.5, 1.9) doubling-dose change for AMP and histamine challenges, respectively. There were significant (P < 0.05) improvements in nasal symptoms and quality of life. CONCLUSIONS AMP nasal challenge using acoustic rhinometry may be a useful test to assess short-term treatment response in patient with PAR.
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Affiliation(s)
- Andrew M Wilson
- Asthma & Allergy Research Group, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, Scotland, UK
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