Odnos specifične i nespecifične nosne hiperreaktivnosti u bolesnika sa sezonskim alergijskim rinitisom [Relationship between specific and nonspecific nasal hyperreactivity in patients with seasonal allergic rhinitis]

Tomljenović, Dejan (2018) Odnos specifične i nespecifične nosne hiperreaktivnosti u bolesnika sa sezonskim alergijskim rinitisom [Relationship between specific and nonspecific nasal hyperreactivity in patients with seasonal allergic rhinitis]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

This study is based on the hypothesis that the intensity of non-specific nasal hyperreactivity correlates with the intensity of specific nasal hyperreactivity and the intensity of early and late phase allergic cellular reaction in patients with seasonal allergic rhinitis. It included 30 patients of both sexes, aged 18 to 65, with monoallergy to grass or ambrosia pollen. Ten patients with non-alergic rhinitis were included as a control group. An out-of-allergy-season, provocation test with a specific allergen was administered to the patients’ nasal mucosa, followed by histamine and hypertonic solutions with a 24 and 72 hour delay, respectively. The subjective intensity of nasal and ocular symptoms was recorded. Nasal patency was evaluated through acoustic rhinometry, and tryptase, eosinophillic cationic protein and substance P concentrati-ons were measured in nasal secretions and tears before and after provocation. A statistically significant correlation in immediate subjective response and tryptase le-vels after allergen and histamine provocation was noted. In addition, eosinophillic cationic protein levels correlated with subjective response 24 hours after allergen exposure. These correlations were not observed after hypertonic fluid provocation. The subjective response to allergen and histamine provocation showed a stronger correlation with mast cell degranulation than eosinophillic activation in patients with seasonal allergic rhinitis. Cellular inflammatory response seems to have a stronger correlation to subjective symptoms scores than neurogenic inflammation.

Abstract in Croatian

Ova studija temeljena je na hipotezi da je intenzitet nespecifične nosne hiperreaktiv-nosti u značajnoj korelaciji s intenzitetom specifične nosne hiperreaktivnosti i intenzi-tetom aktivacije upalnih stanica rane i kasne faze alergijske reakcije u ispitanika sa sezonskim alergijskim rinitisom. Studija obuhvaća 30 odraslih ispitanika sa in vivo i in vitro dokazanim sezonskim alergijskim rinitisom, te kao kontrolnu skupinu 10 bolesni-ka s nealergijskim rinitisom. U ispitanika su provedene provokacije alergenom izvan sezone, te 24 i 72 sata nakon provokacije alergenom nespecifične provokacije hista-minom i hipertoničnom otopinom. Mjeren je subjektivni intenzitet nosnih i očnih sim-ptoma, nosna prohodnost se evaluirala akustičkom rinometrijom, a koncentracije trip-taze, eozinofilno-kationskog proteina i tvari P određivane su u nosnom sekretu i su-zama bazalno i nakon provokacijskih testova. Dokazana je značajna korelacija sub-jektivnog odgovora na provokaciju alergenom i histaminom, s razinama triptaze ne-posredno nakon provokacije alergenom, te EKP 24 sata nakon provokacije alerge-nom. Te korelacije nisu dokazane s odgovorom na provokaciju hipertoničnom otopi-nom. Subjektivni odgovor na provokaciju alergenom i histaminom jače korelira s deg-ranulacijom mastocita, tj. intenzitetom rane faze alergijske reakcije, nego s aktivaci-jom eozinofila u bolesnika sa sezonskim alergijskim rinitisom. Neurogena upala izra-žena otpuštanjem neurokinina nakon provokacije manje je povezana sa subjektivnim simptomima nego aktivacija upalnih stanica.

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