Nasal challenge with allergen leads to maxillary sinus inflammation.
BACKGROUND
Allergic rhinitis and chronic rhinosinusitis are both characterized by chronic inflammation.


OBJECTIVE
We sought to investigate the effect of nasal allergen challenge on the maxillary sinus and study the effect of premedication with loratadine.


METHODS
We performed a double blind, crossover, randomized, placebo-controlled study in 20 allergic subjects out of season. After treatment with either placebo or loratadine (10 mg PO daily) for 1 week, a catheter was inserted into one maxillary sinus and used to lavage the cavity. The subjects then underwent nasal challenge with diluent for the allergen extract, followed by 3 concentrations of grass or ragweed. Nasal and ipsilateral sinus lavages were performed after each challenge and then hourly for 8 hours. Sneezes and symptoms were recorded, and the lavage specimens were evaluated for eosinophils and levels of eosinophil cationic protein, albumin, and histamine. Eleven of the subjects underwent a similar challenge with lactated Ringer's solution.


RESULTS
Compared with the lactated Ringer's solution challenge, allergen challenge resulted in significant increases in most early- and late-phase nasal parameters. Allergen challenge of the nose also led to a significant increase compared with control values in maxillary sinus eosinophils and the levels of albumin, eosinophil cationic protein, and histamine during the late response. Loratadine resulted in significant inhibition of the nasal early response compared with that seen with placebo (P < .05).


CONCLUSIONS
These findings suggest that a neural reflex or systemic allergic inflammation is responsible for the sinus inflammatory response and that this inflammatory response might play a role in the development of rhinosinusitis in allergic subjects.
Baroody
Fuad M
FM
Section of Otolaryngology-Head and Neck Surgery, the Pritzker School of Medicine, the University of Chicago, Chicago, IL 60637, USA. fbaroody@surgery.bsd.uchicago.edu
Mucha
Samantha M
SM
Detineo
Marcy
M
Naclerio
Robert M
RM
D000328:Adult; D000418:Albumins / Q000032:analysis; D031164:Ambrosia / Q000737:chemistry / Q000276:immunology*; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004804:Eosinophils; D005260:Female; D006632:Histamine / Q000032:analysis; D006801:Humans; D017336:Loratadine / Q000627:therapeutic use; D008297:Male; D015523:Maxillary Sinusitis / Q000209:etiology* / Q000276:immunology* / Q000517:prevention & control; D017817:Nasal Lavage Fluid / Q000737:chemistry / Q000276:immunology; D009297:Nasal Mucosa / Q000187:drug effects / Q000276:immunology; D009299:Nasal Provocation Tests; D010919:Placebos; D010936:Plant Extracts / Q000276:immunology; D006255:Rhinitis, Allergic, Seasonal / Q000150:complications*
D000418:Albumins; D018926:Anti-Allergic Agents; D010919:Placebos; D010936:Plant Extracts; D017336:Loratadine; D006632:Histamine