Association Between Nasal And Lower Airwa Inflammation In Patients With Allergic Rhinitis

Background and ObjectiveIn the statement of "one airway, one disease" presented by Grossman in1997, the concept of "inflammatory diseases of upper and lower respiratory tract should be considered as an entirety" was accentuated. In2001, during the Allergic Rhinitis and its Impact on Asthma (ARIA) WHO workshop, the expert panel proposed that allergic rhinitis was one of the major reasons for allergic asthma. The essential viewpoint of "both allergic rhinitis and asthma are systemic inflammatory conditions and often co-exist in the same patients" was clearly confirmed in ARIA guidelines2008Update. Therefore, the inflammatory diseases of upper and lower respiratory tract should be studied as an entirety. Recently, the study focused on the consistency and relativity between the inflammatory diseases of upper and lower respiratory tract. Our investigation aimed at the discussion to the consistency between the allergic inflammations of upper and lower respiratory tract via comparison of the inflammatory indices in patients with allergic rhinitis and normal healthy adults.Methods All subjects enrolled in the study were categorized into two groups, allergic rhinitis group (53cases) and normal control group (50cases) according to the clinical symptoms and signs of allergic rhinitis and allergen skin prick test results. To all the cases, blood routine test, differential cytology tests of nasal lavage fluid and induced sputum, histamine nasal provocation test, and methacholine bronchial provocation test were performed.Results1. Comparison of the inflammatory indices of nasal and lower airway between patients with allergic rhinitis and normal healthy adults①Ratios of eosinophil in nasal lavage fluid(7.93±7.15)and induced sputum(3.49±4.25) of allergic rhinitis group were higher than those of the normal control group(0.72±0.71,1.33±1.08, respectively), and the differences were statistically significant (P<0.05, R<0.05).②The positive rates of histamine nasal provocation test (73.6%,39/53) and methacholine bronchial provocation test (24.5%,13/53) of allergic rhinitis group were much higher than those of the normal control group(40.0%,2.0%, respectively), and the differences were statistically significant (P<0.01, P<0.01).2. Comparison between the inflammatory indices of nasal and lower airway in patients with allergic rhinitis①Ratio of eosinophil in nasal lavage fluid (7.93±7.15) was positively correlated to that of induced sputum (3.49±4.25) in the allergic rhinitis group (r=0.385,P=0.04).②The positive rate of histamine nasal provocation test had no correlation with that of methacholine bronchial provocation test in the allergic rhinitis group (r=0.143, P=0.308).③In the allergic rhinitis group, the difference of ratio of eosinophil in induced sputum between subgroups with positive and negative methacholine bronchial provocation test was statistically significant(P<0.05),while the difference in nasal lavage fluid between the two subgroups was insignificant(P>0.05).④In the allergic rhinitis group, the difference of ratio of eosinophil in nasal lavage fluid between subgroups with positive and negative histamine nasal provocation test was statistically significant(P<0.05),while the difference in induced sputum between the two subgroups was insignificant(P>0.05).⑤In the allergic rhinitis group, the ratios of eosinophil in nasal lavage fluid, and induced sputum were closely correlated to that in peripheral blood(P<0.05).Conclusion1. Compared with normal healthy ones, obvious inflammation exits in the nasal and lower airway of patients with allergic rhinitis.2. In patients with allergic rhinitis, the consistency between nasal inflammation and lower airway inflammation can be observed.3. Allergic rhinitis is an allergic disease with co-existence of local and systemic inflammation.4. Eosinophil infiltration in the lower airway may be the reason of bronchial hyperresponsiveness.