title: Demonstration of bronchial eosinophil activity in seasonal allergic rhinitis by induced plasma exudation combined with induced sputum.
abstract: BACKGROUND
  Patients with seasonal allergic rhinitis may develop bronchial hyperresponsiveness during the active disease period. Eosinophil activation may occur in the bronchial mucosa and may be reflected by increased sputum levels of eosinophil cationic protein (ECP), especially when ECP binding proteins such as alpha 2-macroglobulin pass through the lamina propria and across the epithelium into the airway lumen. A study was therefore undertaken to determine histamine airway responsiveness (FEV1) and bronchovascular responsiveness (exudation of alpha 2-macroglobulin) to histamine in subjects with seasonal allergic rhinitis, and to explore whether sputum ECP levels are increased by the use of induced exudation followed by induced sputum.
  
  
  METHODS
  Eleven patients with seasonal allergic rhinitis were examined before and during a birch pollen season. Sputum was induced by inhalation of 4.5% saline twice before and twice during the pollen season. Histamine inhalations were given before the second of each pair of sputum inductions at increasing concentrations until FEV1 was reduced by 20%. Sputum levels of alpha 2-macroglobulin and ECP were determined as indices of bronchial exudation of plasma and activation of bronchial eosinophils, respectively.
  
  
  RESULTS
  Bronchomotor responsiveness increased during the pollen season (median difference in the reduction of FEV1 9% (95% confidence interval (CI) -3 to 26)) but histamine induced exudation of plasma was not increased. Baseline sputum levels of alpha 2-macroglobulin and ECP did not increase. Histamine induced exudation of alpha 2-macroglobulin was associated with increased sputum levels of ECP exclusively during the pollen season (median difference 8.2 ng/ml (95% CI 0.4 to 562.0)).
  
  
  CONCLUSIONS
  Bronchial hyperresponsiveness in seasonal allergic rhinitis may not be associated with bronchovascular exudative hyperresponsiveness. Sputum levels of ECP were increased only during the season, and only after induced exudation (potentially moving ECP to the mucosal surface). It is suggested that the combined method of induced exudation and induced sputum may significantly improve the yield of some markers of inflammation in sputum samples.
authors.affiliation: Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital, Lund, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Greiff
authors.forename: M
authors.initials: M
authors.lastname: Andersson
authors.forename: C
authors.initials: C
authors.lastname: Svensson
authors.forename: M
authors.initials: M
authors.lastname: Linden
authors.forename: P
authors.initials: P
authors.lastname: Wollmer
authors.forename: C G
authors.initials: CG
authors.lastname: Persson
mesh_terms: D000328:Adult; D001249:Asthma / Q000276:immunology / Q000503:physiopathology; D001798:Blood Proteins / Q000378:metabolism; D016535:Bronchial Hyperreactivity / Q000276:immunology / Q000503:physiopathology; D047091:Eosinophil Granule Proteins; D004804:Eosinophils / Q000276:immunology* / Q000378:metabolism; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008213:Lymphocyte Activation; D008297:Male; D006255:Rhinitis, Allergic, Seasonal / Q000276:immunology* / Q000503:physiopathology; D012260:Ribonucleases; D013183:Sputum
chemical_list: D001798:Blood Proteins; D047091:Eosinophil Granule Proteins; D012260:Ribonucleases