Am. J. Respir. Crit. Care Med., Volume 161, Number 6, June 2000, 2051-2057

Segmental Bronchial Provocation Induces Nasal Inflammation in Allergic Rhinitis Patients

GERT-JAN BRAUNSTAHL, ALEX KLEINJAN, SHELLEY E. OVERBEEK, JAN-BAS PRINS, HENK C. HOOGSTEDEN, and WYTSKE J. FOKKENS

Departments of Pulmonary Medicine and Otorhinolaryngology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

Allergic rhinitis and asthma often coexist and share a genetic background. Pathophysiologic connections between the nose and lungs are still not entirely understood. This study was undertaken to compare allergic inflammation and clinical findings in the upper and lower airways after segmental bronchial provocation (SBP) in nonasthmatic allergic rhinitis patients. Eight nonasthmatic, grass pollen-sensitive patients with allergic rhinitis and eight healthy controls were included. Bronchial biopsies and blood samples were taken before (T₀) and 24 h (T₂₄) after SBP. Nasal biopsies were obtained at T₀, 1 h after SBP (T₁), and T₂₄. Immunohistochemical staining was performed for eosinophils (BMK13), interleukin (IL)-5, and eotaxin. The number of eosinophils increased in the challenged and unchallenged bronchial mucosa (p < 0.05) and in the blood (p = 0.03) of atopic subjects at T₂₄. We detected an increase of BMK13-positive and eotaxin-positive cells in the nasal lamina propria and enhanced expression of IL-5 in the nasal epithelium of atopic subjects only at T₂₄ (p < 0.05). SBP induced nasal and bronchial symptoms as well as reductions in pulmonary and nasal function in the allergic group. No significant changes could be observed in healthy controls. The study shows that SBP in nonasthmatic allergic rhinitis patients results in peripheral blood eosinophilia, and that SBP can induce allergic inflammation in the nose.

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