Nasal AMP and histamine challenge within and outside the pollen season in patients with seasonal allergic rhinitis

Sriram Vaidyanathan; Peter Williamson; Karine Clearie; Ashley Morrison; Brian Lipworth

doi:10.1016/j.jaci.2010.09.006

Nasal AMP and histamine challenge within and outside the pollen season in patients with seasonal allergic rhinitis

Sriram Vaidyanathan, Peter Williamson, Karine Clearie, Ashley Morrison, Brian Lipworth (Lead / Corresponding author)

Research output: Contribution to journal › Article › peer-review

9 Citations (Scopus)

Abstract

Background: Nasal hyperreactivity is a prominent feature of allergic rhinitis. Variation in nasal hyperreactivity with different challenge agents in and out of the pollen season has not been examined.

Objective: We sought to compare nasal hyperreactivity with different challenge agents before, during, and after the pollen season.

Methods: Grass pollen-monosensitized patients performed cumulative-dose challenges with nasal AMP (25-800 mg . mL(-1)) and histamine (0.25-8 mg . mL(-1)) before, during, and after the grass pollen season. Outcomes included the provocative concentration of agent causing a 30% decrease in the peak nasal inspiratory flow (PNIF) (PC30), recovery profile, and diary cards.

Results: Nineteen participants completed per protocol. AMP PC30 values for PNIF worsened by 1.33 (95% CI, 0.20-2.44; P = .02) doubling dilutions during the season but recovered after the season. The AMP recovery curve showed a 214.39% difference (95% CI, -21.11% to -7.66%; P < .001) during the season and remained abnormal after the season (-8.05% [95% CI, -14.78% to -1.33%; P <.05). Histamine PC30 values did not change during the season, but recovery was prolonged by 214.47% (95% CI, 222.19% to -6.76%, P < .001), returning to baseline values after the season. Nasal symptoms, domiciliary PNIF, and serum eosinophil-derived neurotoxin levels returned to baseline values after the season.

Conclusions: There is a reduction in AMP PC threshold but not histamine PC threshold during the pollen season, indicating that AMP is a more sensitive indicator of allergic inflammation. The residual hyperreactivity to nasal AMP, but not histamine, outside of the pollen season, seen as a persistently prolonged recovery curve, suggests the presence of primed airway mucosal mast cells, even in asymptomatic patients, and persistent activation of mediator pathways, such as cysteinyl leukotrienes. (J Allergy Clin Immunol 2011;127:173-8.)

Original language	English
Pages (from-to)	173-203.e3
Number of pages	9
Journal	Journal of Allergy and Clinical Immunology
Volume	127
Issue number	1
DOIs	https://doi.org/10.1016/j.jaci.2010.09.006
Publication status	Published - Jan 2011

Keywords

Nasal hyperreactivity
Nasal provocation
Adenosine monophosphate
Histamine
Peak nasal inspiratory flow rate
Nasal airway resistance
Adenosine monophosphate
Corticosteroid response
Acoustic rhinometry
Consensus report
Inflammation
Provocation
Rhinomanometry
Ceitirizine
Mediators
Release

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10.1016/j.jaci.2010.09.006

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@article{77b004c876354965acbcd81be50eb4df,

title = "Nasal AMP and histamine challenge within and outside the pollen season in patients with seasonal allergic rhinitis",

abstract = "Background: Nasal hyperreactivity is a prominent feature of allergic rhinitis. Variation in nasal hyperreactivity with different challenge agents in and out of the pollen season has not been examined.Objective: We sought to compare nasal hyperreactivity with different challenge agents before, during, and after the pollen season.Methods: Grass pollen-monosensitized patients performed cumulative-dose challenges with nasal AMP (25-800 mg . mL(-1)) and histamine (0.25-8 mg . mL(-1)) before, during, and after the grass pollen season. Outcomes included the provocative concentration of agent causing a 30% decrease in the peak nasal inspiratory flow (PNIF) (PC30), recovery profile, and diary cards.Results: Nineteen participants completed per protocol. AMP PC30 values for PNIF worsened by 1.33 (95% CI, 0.20-2.44; P = .02) doubling dilutions during the season but recovered after the season. The AMP recovery curve showed a 214.39% difference (95% CI, -21.11% to -7.66%; P < .001) during the season and remained abnormal after the season (-8.05% [95% CI, -14.78% to -1.33%; P <.05). Histamine PC30 values did not change during the season, but recovery was prolonged by 214.47% (95% CI, 222.19% to -6.76%, P < .001), returning to baseline values after the season. Nasal symptoms, domiciliary PNIF, and serum eosinophil-derived neurotoxin levels returned to baseline values after the season.Conclusions: There is a reduction in AMP PC threshold but not histamine PC threshold during the pollen season, indicating that AMP is a more sensitive indicator of allergic inflammation. The residual hyperreactivity to nasal AMP, but not histamine, outside of the pollen season, seen as a persistently prolonged recovery curve, suggests the presence of primed airway mucosal mast cells, even in asymptomatic patients, and persistent activation of mediator pathways, such as cysteinyl leukotrienes. (J Allergy Clin Immunol 2011;127:173-8.)",

keywords = "Nasal hyperreactivity, Nasal provocation, Adenosine monophosphate, Histamine, Peak nasal inspiratory flow rate, Nasal airway resistance, Adenosine monophosphate, Corticosteroid response, Acoustic rhinometry, Consensus report, Inflammation, Provocation, Rhinomanometry, Ceitirizine, Mediators, Release",

author = "Sriram Vaidyanathan and Peter Williamson and Karine Clearie and Ashley Morrison and Brian Lipworth",

year = "2011",

month = jan,

doi = "10.1016/j.jaci.2010.09.006",

language = "English",

volume = "127",

pages = "173--203.e3",

journal = "Journal of Allergy and Clinical Immunology",

issn = "0091-6749",

publisher = "Elsevier",

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TY - JOUR

T1 - Nasal AMP and histamine challenge within and outside the pollen season in patients with seasonal allergic rhinitis

AU - Vaidyanathan, Sriram

AU - Williamson, Peter

AU - Clearie, Karine

AU - Morrison, Ashley

AU - Lipworth, Brian

PY - 2011/1

Y1 - 2011/1

N2 - Background: Nasal hyperreactivity is a prominent feature of allergic rhinitis. Variation in nasal hyperreactivity with different challenge agents in and out of the pollen season has not been examined.Objective: We sought to compare nasal hyperreactivity with different challenge agents before, during, and after the pollen season.Methods: Grass pollen-monosensitized patients performed cumulative-dose challenges with nasal AMP (25-800 mg . mL(-1)) and histamine (0.25-8 mg . mL(-1)) before, during, and after the grass pollen season. Outcomes included the provocative concentration of agent causing a 30% decrease in the peak nasal inspiratory flow (PNIF) (PC30), recovery profile, and diary cards.Results: Nineteen participants completed per protocol. AMP PC30 values for PNIF worsened by 1.33 (95% CI, 0.20-2.44; P = .02) doubling dilutions during the season but recovered after the season. The AMP recovery curve showed a 214.39% difference (95% CI, -21.11% to -7.66%; P < .001) during the season and remained abnormal after the season (-8.05% [95% CI, -14.78% to -1.33%; P <.05). Histamine PC30 values did not change during the season, but recovery was prolonged by 214.47% (95% CI, 222.19% to -6.76%, P < .001), returning to baseline values after the season. Nasal symptoms, domiciliary PNIF, and serum eosinophil-derived neurotoxin levels returned to baseline values after the season.Conclusions: There is a reduction in AMP PC threshold but not histamine PC threshold during the pollen season, indicating that AMP is a more sensitive indicator of allergic inflammation. The residual hyperreactivity to nasal AMP, but not histamine, outside of the pollen season, seen as a persistently prolonged recovery curve, suggests the presence of primed airway mucosal mast cells, even in asymptomatic patients, and persistent activation of mediator pathways, such as cysteinyl leukotrienes. (J Allergy Clin Immunol 2011;127:173-8.)

AB - Background: Nasal hyperreactivity is a prominent feature of allergic rhinitis. Variation in nasal hyperreactivity with different challenge agents in and out of the pollen season has not been examined.Objective: We sought to compare nasal hyperreactivity with different challenge agents before, during, and after the pollen season.Methods: Grass pollen-monosensitized patients performed cumulative-dose challenges with nasal AMP (25-800 mg . mL(-1)) and histamine (0.25-8 mg . mL(-1)) before, during, and after the grass pollen season. Outcomes included the provocative concentration of agent causing a 30% decrease in the peak nasal inspiratory flow (PNIF) (PC30), recovery profile, and diary cards.Results: Nineteen participants completed per protocol. AMP PC30 values for PNIF worsened by 1.33 (95% CI, 0.20-2.44; P = .02) doubling dilutions during the season but recovered after the season. The AMP recovery curve showed a 214.39% difference (95% CI, -21.11% to -7.66%; P < .001) during the season and remained abnormal after the season (-8.05% [95% CI, -14.78% to -1.33%; P <.05). Histamine PC30 values did not change during the season, but recovery was prolonged by 214.47% (95% CI, 222.19% to -6.76%, P < .001), returning to baseline values after the season. Nasal symptoms, domiciliary PNIF, and serum eosinophil-derived neurotoxin levels returned to baseline values after the season.Conclusions: There is a reduction in AMP PC threshold but not histamine PC threshold during the pollen season, indicating that AMP is a more sensitive indicator of allergic inflammation. The residual hyperreactivity to nasal AMP, but not histamine, outside of the pollen season, seen as a persistently prolonged recovery curve, suggests the presence of primed airway mucosal mast cells, even in asymptomatic patients, and persistent activation of mediator pathways, such as cysteinyl leukotrienes. (J Allergy Clin Immunol 2011;127:173-8.)

KW - Nasal hyperreactivity

KW - Nasal provocation

KW - Adenosine monophosphate

KW - Histamine

KW - Peak nasal inspiratory flow rate

KW - Nasal airway resistance

KW - Adenosine monophosphate

KW - Corticosteroid response

KW - Acoustic rhinometry

KW - Consensus report

KW - Inflammation

KW - Provocation

KW - Rhinomanometry

KW - Ceitirizine

KW - Mediators

KW - Release

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U2 - 10.1016/j.jaci.2010.09.006

DO - 10.1016/j.jaci.2010.09.006

M3 - Article

C2 - 21211652

SN - 0091-6749

VL - 127

SP - 173-203.e3

JO - Journal of Allergy and Clinical Immunology

JF - Journal of Allergy and Clinical Immunology

IS - 1

ER -

Nasal AMP and histamine challenge within and outside the pollen season in patients with seasonal allergic rhinitis

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