Monitoring of seasonal variability in bronchial hyper‐responsiveness and sputum cell counts in non‐asthmatic subjects with rhinitis and effect of specific immunotherapy

Abstract

Bronchial hyper-responsiveness (BHR) is documented in a proportion of non-asthmatic individuals with allergic rhinitis (NAAR) and reflects inflammatory events in the lower airways. Natural exposure to allergens is known to modulate BHR and the level of airway inflammation in asthma, but less consistently in NAAR. Specific immunotherapy (SIT) attenuates symptoms possibly by reducing BHR and airway inflammation. The influence of natural exposure to Parietaria pollen on BHR and sputum cell counts of NAAR was investigated and the effect of Parietaria SIT examined. Thirty NAAR, monosensitized to Parietaria judaica, participated in a randomized, double-blind, placebo-controlled, parallel group study of the effects of a Parietaria pollen vaccine on symptoms/medication score, BHR to inhaled methacholine and adenosine 5'-monophosphate (AMP), and cell counts in the sputum collected out of and during the pollen seasons for 36 months. Seasonal variation in BHR to inhaled methacholine and AMP and changes in sputum cell counts were documented. Changes were consistent for AMP, but not methacholine, and invariably associated with modifications in sputum eosinophils and epithelial cells. The clinical efficacy of Parietaria SIT was associated with a decline in the seasonal deterioration of BHR to AMP, whereas no significant effect was observed on BHR to methacholine or sputum cell differentials. Between-groups comparison of the seasonal changes in PC15 methacholine values and sputum cell differentials calculated as the AUC were not statistically significant, whereas a significant difference in PC15 AMP was demonstrated throughout the study (P=0.029), the median (inter-quartile range) AUC values being 2478.5 (1153.3-3600.0) and 1545.5 (755.3-1797.9) for the SIT- and placebo-treated group, respectively. Bronchial airways of NAAR exhibit features of active inflammation that deteriorate during natural allergen exposure, particularly with regard to BHR to AMP. The clinical efficacy of Parietaria SIT was exclusively associated with attenuation in seasonal worsening of PC15 AMP, suggesting that AMP may be useful in monitoring changes in allergic inflammation of the airways.

Effects of ciclesonide and fluticasone on cortisol secretion in patients with persistent asthma

“…Adenosine-induced bronchoconstriction has been shown to be a sensitive marker of airway inflammation by promoting the release of a variety of inflammatory mediators [41], correlating with both exhaled nitric oxide and sputum, blood and bronchial tissue eosinophilia [42] and appears to be better suited to assess the anti-inflammatory effects of ICS than methacholine [43,44]. In the present study, the room for Base PLA CIC320 CIC640 FP500 FP1000 PC20 methacholine mg·mL -1 FIGURE 5.…”

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…Clinical efficacy (reduction of symptoms and/or need for medications) has been confirmed with grass (1102,1104,(1650)(1651)(1652)(1653)(1654)(1655), birch (1650,1651,(1656)(1657)(1658)(1659), ragweed (1660), Russian thistle (1661), Parietaria pollen (1662,1663), mites (1664)(1665)(1666)(1667)(1668)(1669) and cat (1670). It should be noted that three of the studies (1104,1660,1670) clearly demonstrated that the clinical effect is dose dependent.…”

Cypress pollen allergy is responsible for two distinct phenotypes of allergic rhinitis different from other pollinosis

“…Nevertheless, these differences did not reach the statistical significance. Patients were considered to be mono- (17). This may underestimate the actual bronchial hyperresponsivness in this subgroup.…”