Comparative influence of a single allergen exposure on the different components of airway response to methacholine.

Abstract

We compared the effects of an allergen challenge on airway responsiveness to methacholine, the slope of the dose-response curve (DRC) and post-methacholine fall in forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV1)/FVC, and determined whether any changes in these parameters were related to the presence and magnitude of the late asthmatic response (LAR) in mild stable asthma. Twenty-three allergic asthmatic subjects had an allergen challenge, preceded and followed 24 (n = 12) and/or 48 (n = 22) h later by a methacholine challenge. Sixteen subjects had a dual asthmatic response to the allergen. On the post-allergen methacholine challenge, as compared with the pre-allergen test, differences in mean fall in FVC or FEV1/FVC at 20% fall in FEV1 and the slope of the DRC did not achieve statistical significance, even in the group with LAR, which showed a significant increase in airway responsiveness at 24 h. There was, however, a correlation between allergen-induced changes in PC20 and (1) the change in post-methacholine FVC fall in the LAR group at 48 h, and (2) the change in the slope of the DRC in the early-asthmatic-response group at 24 h. In conclusion, allergen-challenge-induced changes in airway response to methacholine are heterogeneous among asthmatic subjects and although it may increase airway responsiveness (PC20), particularly in late responders, it minimally affects the other aspects of airway response to methacholine, suggesting that a more powerful or sustained allergic stimulus is required to modify the latter.