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Methodological aspects of subjective symptom ratings were investigated in 103 symptomatic rhinitis patients. The patient's own overall rating registered on a visual analogue scale was compared with a summed symptom score calculated from ratings of sneezing, rhinorrhea and congestion. A significant correlation, but not complete correspondence, was found in patients with untreated rhinitis during the birch pollen season and after challenges with birch pollen or histamine. Comparisons between the overall rating and scores for individual symptoms gave lower degrees of correlation or non-significant correlations. When twenty-five patients were treated with an intranasal corticosteroid during the pollen season, both the overall rating and the summed symptom score decreased significantly. The changes in the two ratings for eich" jjatient showed a moderate correlation. The patients' ratings of rhinorrhea correlated with an approximate measure ofthe volume of secretion after pollen challenge but not during the pollen season or after histamine challenge. It is recommended on the basis of these findings that, for measuring the severity of rhinitis, scores indicating the course of individual symptoms should not be combined into a summed score, but that the patient's overall rating of the condition should be used. Scores for individual symptoms can be used to draw more detailed conclusions about nasal pathophysiological features and about qualitative disimilarities between different modes of therapy.

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The inflammatory component of allergic rhinitis was studied by measuring the concentration and content of eosinophil cationic protein (ECP, specific for eosinophils) and myeloperoxidase (MPO, specific for neutrophils) in samples of nasal secretion from 20 pollen-allergic subjects. All secretion samples contained measurable concentrations of both proteins. The mean ECP concentrations on two occasions without pollen exposure were 950 and 1170 micrograms/l. The ECP concentration during the pollen season without any therapy (mean 1160 micrograms/l) did not differ significantly from the baseline values, but intranasal corticosteroid therapy resulted in a significant decrease (mean 530 micrograms/l). The concentration of MPO was about 10 times higher than that of ECP, but the changes in MPO were nonsignificant throughout the observation period. An inverse correlation was found between the threshold dose in histamine challenges and the ECP level expressed either as concentration or as content. Furthermore, the ECP concentration and content 1 day after a positive allergen challenge were both significantly correlated with the strength of the challenge reaction. Measurements of ECP in nasal secretions are useful for studying the presence and activity of eosinophils in the nasal mucosa, and may prove of value in clinical investigations on patients with allergic rhinitis.