title: Effect of natural seasonal pollen exposure and repeated nasal allergen provocations on elevation of exhaled nitric oxide.
abstract: BACKGROUND
  Exhaled nitric oxide (FENO) is a marker for allergic airway inflammation. We wondered whether in patients with intermittent allergic rhinitis only (i) natural pollen exposure and (ii) artificial pollen exposure by repeated nasal allergen provocations may lead to an elevation of FENO.
  
  
  METHODS
  In two prospective studies, we compared the FENO of nonatopic controls with the FENO of nonasthmatic individuals with mild intermittent rhinitis to tree and/or grass pollen. Study I: 13 atopic individuals and seven controls had measurements of FENO, blood eosinophils and eosinophilic cationic protein (ECP) before, during and after pollen season. Study II: 16 atopic individuals and 12 controls had nasal allergen provocations on four following days out of pollen season, with daily measurements of FENO before, 2 and 6 h after provocation, and determination of blood eosinophils, ECP and FEV1 at baseline, on days 5 and 10-12.
  
  
  RESULTS
  Natural pollen exposure (study I) caused a significant elevation of FENO in allergic individuals. Nasal allergen provocations (study II) did not elicit a statistically significant rise neither of FENO nor of blood eosinophils between baseline and day 5. However, a subgroup of four individuals with a rise of blood eosinophils during nasal allergen provocations showed also a rise of FENO.
  
  
  CONCLUSIONS
  We suppose that in allergic rhinitis a concomitant reaction of the bronchial system is dependent on a strong local inflammation leading to a generalized immune stimulation.
authors.affiliation: Department of Rheumatology and Clinical Immunology/Allergology, Division of Allergology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Bergmann-Hug
authors.forename: R
authors.initials: R
authors.lastname: Wirth
authors.forename: M
authors.initials: M
authors.lastname: Henseler
authors.forename: A
authors.initials: A
authors.lastname: Helbling
authors.forename: W J
authors.initials: WJ
authors.lastname: Pichler
authors.forename: B
authors.initials: B
authors.lastname: Schnyder
mesh_terms: D000281:Administration, Intranasal; D000485:Allergens / Q000276:immunology*; D001249:Asthma / Q000276:immunology* / Q000378:metabolism; D029662:Betula / Q000009:adverse effects / Q000276:immunology; D004804:Eosinophils / Q000166:cytology / Q000276:immunology; D045853:Exhalation; D005541:Forced Expiratory Volume / Q000276:immunology; D006801:Humans; D009297:Nasal Mucosa / Q000276:immunology; D009299:Nasal Provocation Tests / Q000379:methods*; D009569:Nitric Oxide / Q000032:analysis* / Q000378:metabolism; D006109:Poaceae / Q000009:adverse effects / Q000276:immunology; D011058:Pollen / Q000009:adverse effects / Q000276:immunology*; D006255:Rhinitis, Allergic, Seasonal / Q000276:immunology* / Q000503:physiopathology
chemical_list: D000485:Allergens; D009569:Nitric Oxide