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 journalArticle

    6 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 languageEnglish
    Pages (from-to)173-203.e3
    Number of pages9
    JournalJournal of Allergy and Clinical Immunology
    Volume127
    Issue number1
    DOIs
    Publication statusPublished - 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

    Cite this

    Vaidyanathan, Sriram ; Williamson, Peter ; Clearie, Karine ; Morrison, Ashley ; Lipworth, Brian. / Nasal AMP and histamine challenge within and outside the pollen season in patients with seasonal allergic rhinitis. In: Journal of Allergy and Clinical Immunology. 2011 ; Vol. 127, No. 1. pp. 173-203.e3.
    @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.)",
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    author = "Sriram Vaidyanathan and Peter Williamson and Karine Clearie and Ashley Morrison and Brian Lipworth",
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    Nasal AMP and histamine challenge within and outside the pollen season in patients with seasonal allergic rhinitis. / Vaidyanathan, Sriram; Williamson, Peter; Clearie, Karine; Morrison, Ashley; Lipworth, Brian (Lead / Corresponding author).

    In: Journal of Allergy and Clinical Immunology, Vol. 127, No. 1, 01.2011, p. 173-203.e3.

    Research output: Contribution to journalArticle

    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

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    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.)

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    KW - Corticosteroid response

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    KW - Consensus report

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    KW - Provocation

    KW - Rhinomanometry

    KW - Ceitirizine

    KW - Mediators

    KW - Release

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