Original article
Correlation between symptoms and the threshold for release of mediators in nasal secretions during nasal challenge with grass-pollen grains

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Abstract

Nasal challenges with pollen grains represent one of the techniques of provocation. However, the clinical criteria of positivity are not clearly established. Nasal challenges with increasing numbers of orchard-grass pollen grains were performed in 60 patients allergic to grass pollens and 20 normal subjects. Before any challenge, the nose was washed three times with saline and then lactose, and 50, 150, 450, 1350, and 4050 orchard-grass pollen grains were insufflated into the nostrils until a symptom score of 5 was reached. This score was mainly based on major symptoms of allergic rhinitis, for example, rhinorrhea, nasal obstruction, sneezes, and to a lesser extent, on minor symptoms, such as pruritus, conjunctivitis, and pharyngitis. Nasal secretions were obtained after each challenge by lavage. Histamine was titrated by a radioimmunoassay with a monoclonal antibody against acylated histamine. Prostaglandin D2 (PGD2) was assayed with an enzyme immunoassay with a polyclonal antibody against PGD2 methoxamine. None of the normal subjects had a symptom score >2; 5560 patients had a positive challenge. The release of PGD2 was significantly (p < 0.001, Kruskal-Wallis test) correlated with a symptom score of 5; 74.5% of patients had a significant release of PGD2 in nasal secretions. In contrast, although 58.2% of patients had a release of histamine in nasal secretions when the challenge was positive, the correlation with symptom scores was not significant. PGD2 in nasal secretions increased 3.7-fold after a positive nasal challenge. In a second experiment series, the number of grains required to elicit a positive challenge was tested in 40 patients who were challenged twice, and a significant (p < 0.001, Kruskal-Wallis test) correlation was observed between the number of pollen grains required in both tests. The correlation between the threshold release of PGD2 or histamine in nasal secretions was tested in 24 patients who were challenged twice, and there was a significant correlation between the numbers of pollen grains required in both tests. This study confirms the value of PGD2 as a marker of nasal allergy and demonstrates that symptom scores can be used to assess the positivity of nasal challenges with pollen grains.

References (37)

  • M Okuda

    Nasal provocation

  • L Tuft et al.

    Pollen tolerance nasal tests in hay fever: experimental and clinical observations

    J Allergy

    (1950)
  • RM Naclerio et al.

    Mediator release after nasal airway challenge with allergen

    Am Rev Respir Dis

    (1983)
  • Y Bataille et al.

    Characterization of grass-allergic patients by nasal challenge with pollen [Abstract]

    J Allergy Clin Immunol

    (1986)
  • PS Creticos et al.

    Peptide leukotriene release after antigen challenge in patients sensitive to ragweed

    N Engl J Med

    (1984)
  • RM Naclerio et al.

    Inflammatory mediators in the late antigen-induced rhinitis

    N Engl J Med

    (1985)
  • CR Baumgarten et al.

    Influx of kininogens into nasal secretions following antigen challenge of allergic individuals

    J Clin Invest

    (1985)
  • AG Togias et al.

    Nasal challenge with cold, dry air results in release of inflammatory mediators: possible mast cell involvment

    J Clin Invest

    (1985)
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    Supported by an INSERM Grant No. 86/247.

    From the INSERM U58, Montpellier, France.

    ∗∗

    From the Clinique des Maladies Respiratoires, Montpellier, France.

    ∗∗∗

    From the Immunotech, Marseille, France.

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