Cough provocation with capsaicin is an objective way to test sensory hyperreactivity in patients with asthma-like symptoms.
BACKGROUND
A group of patients with asthma-like symptoms and sensitivity to chemical irritants, but without bronchial obstruction, has been found among subjects referred for suspected asthma. They have no well-defined diagnosis, and no objective diagnostic method has previously been available. These patients are more sensitive to inhaled capsaicin than are patients with asthma or healthy controls. The aim was to study cough and other capsaicin-induced symptoms and to test the effect of a drug (lidocaine) that inhibits nerve transmission in sensory nerves.


METHODS
Twelve patients were provoked with three different concentrations of inhaled capsaicin solutions in a randomized, double-blind order. They all had asthma-like symptoms and were sensitive to chemical irritants, but had no IgE-mediated allergy or demonstrable bronchial obstruction. Before the provocations, the patients inhaled lidocaine or placebo (saline), also in a double-blind, randomized order. The results were expressed as the number of coughs and scores of various symptoms.


RESULTS
The patients reacted in a dose-dependent way with cough, airway, and eye symptoms, which were significantly reduced after preinhalation of lidocaine.


CONCLUSIONS
A drug that inhibits transmission in sensory nerves successfully blocked the number of coughs and other symptoms provoked by inhalation of capsaicin. This indicates that the mechanisms underlying chemical sensitivity in these patients may originate in the sensory nervous system, and we call this condition "sensory hyperreactivity".
Millqvist
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Allergy Centre, Sahlgrenska University Hospital, Gothenburg, Sweden.
D000280:Administration, Inhalation; D000328:Adult; D000779:Anesthetics, Local / Q000494:pharmacology; D001249:Asthma / Q000175:diagnosis; D002211:Capsaicin; D003371:Cough / Q000139:chemically induced*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D018777:Multiple Chemical Sensitivity / Q000175:diagnosis*; D010919:Placebos
D000779:Anesthetics, Local; D010919:Placebos; D008012:Lidocaine; D002211:Capsaicin