title: Lower airway inflammation before and after house dust mite nasal challenge: an age and allergen exposure-related phenomenon.
abstract: BACKGROUND
  Upper and lower airways allergic disease is currently considered unitarily. Allergic inflammation in one site can extend to other sites of the respiratory tract.
  
  
  OBJECTIVE
  To evaluate bronchial inflammation before and after allergen-specific nasal challenge (ASNC) in rhinitic and asthmatic children, considering the different levels of allergen exposure, i.e. summer (low) and winter (high).
  
  
  METHODS
  Fourteen children with rhinitis and 15 with rhinitis and asthma, all monosensitized to mites and 10 healthy controls were studied. Nasal IgE were measured before ASNC in summer and in winter season. Nasal clinical score, eosinophil cationic protein (ECP), nasal tryptase, bronchial clinical score, FEV(1), PEF, sputum ECP, sputum tryptase and exhaled nitric oxide (eNO) were evaluated before and after ASNC in summer and winter season.
  
  
  RESULTS
  Nasal scores significantly increased after ASNC in rhinitic and asthmatic children in both seasons. Nasal IgE were significantly higher in summer compared to winter. Bronchial symptoms, FEV(1) and PEF showed no mean differences in rhinitic and asthmatic children after ASNC, with an increase of bronchial symptoms and a decrease of FEV(1) and PEF occurring in 3/15 asthmatic children. In both groups nasal tryptase and ECP after ASNC significantly increased in summer and winter, while sputum tryptase was undetectable before or after ASNC in both groups. Sputum ECP and eNO at baseline were significantly higher in patients than in controls (summer P=0.002, winter P=0.001). Sputum ECP significantly increased after ASNC in 3/15 asthmatics in summer and in 11/15 in winter, as well as in 3/14 rhinitics in summer and in 4/14 in winter. eNO significantly increased after ASNC in 3/15 asthmatics in summer and in 10/15 in winter, and in 1/14 rhinitics in summer and in 4/14 in winter. A significant median increase of sputum ECP (P=0.0007) and eNO (P=0.0012) after ASNC in asthmatic and of eNO (P=0.013) in rhinitic children was also found in winter.
  
  
  CONCLUSIONS
  Basal sputum ECP and eNO values, significantly higher before ASNC in rhinitic patients compared to control subjects, confirm the inflammatory link of upper and lower airways. The more frequent detection of inflammatory changes induced by ASNC in winter suggests that allergen exposure favours the transfer of nasal inflammation to lower airways.
authors.affiliation: Department of Obstetric, Gynaecologic, Pediatric Sciences, University of Perugia, Policlinico Monteluce, Via Brunamonti, 06122 Perugia, Italy. marcucci@unipg.it
authors.forename: F
authors.initials: F
authors.lastname: Marcucci
authors.forename: G
authors.initials: G
authors.lastname: Passalacqua
authors.forename: G W
authors.initials: GW
authors.lastname: Canonica
authors.forename: F
authors.initials: F
authors.lastname: Frati
authors.forename: S
authors.initials: S
authors.lastname: Salvatori
authors.forename: G
authors.initials: G
authors.lastname: Di cara
authors.forename: I
authors.initials: I
authors.lastname: Petrini
authors.forename: M
authors.initials: M
authors.lastname: Bernini
authors.forename: E
authors.initials: E
authors.lastname: Novembre
authors.forename: R
authors.initials: R
authors.lastname: Bernardini
authors.forename: C
authors.initials: C
authors.lastname: Incorvaia
authors.forename: L G
authors.initials: LG
authors.lastname: Sensi
mesh_terms: D000281:Administration, Intranasal; D000485:Allergens / Q000276:immunology*; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000276:immunology*; D001249:Asthma / Q000276:immunology* / Q000503:physiopathology; D002648:Child; D040002:Dermatophagoides pteronyssinus / Q000276:immunology*; D047150:Eosinophil Cationic Protein / Q000378:metabolism; D005541:Forced Expiratory Volume; D006801:Humans; D007073:Immunoglobulin E / Q000096:biosynthesis / Q000097:blood; D009299:Nasal Provocation Tests; D009569:Nitric Oxide / Q000378:metabolism; D010366:Peak Expiratory Flow Rate; D012220:Rhinitis / Q000276:immunology* / Q000503:physiopathology; D012621:Seasons; D012882:Skin Tests / Q000379:methods; D013183:Sputum / Q000276:immunology / Q000378:metabolism; D053802:Tryptases / Q000378:metabolism
chemical_list: D000485:Allergens; D039741:Antigens, Dermatophagoides; D009569:Nitric Oxide; D007073:Immunoglobulin E; D047150:Eosinophil Cationic Protein; D053802:Tryptases