Late Nasal Response Research Articles

Effects of Oral Cromolyn on the Nasal Response due to Foods

Thirty-eight patients with a perennial allergic rhinitis, who developed a nasal response to ingestion challenge with certain foods, were randomly selected for protection tests with oral cromolyn sodium (Nalcrom). The food challenges were performed in combination with rhinomanometry. The patients were pretreated with cromolyn or placebo by double-blind crossover schedule, in a daily oral dose of 200 mg (four times), starting 3 days before and continuing up to 3 days after the food ingestion challenge. The 38 patients previously developed 25 immediate, 24 late, and 6 delayed nasal responses to food ingestion challenge. Cromolyn fully prevented 15, significantly decreased 9, and was ineffective in 1 case of immediate nasal response. Of the 24 cases of late response, cromolyn fully prevented 10, significantly decreased 12, and was ineffective in 2. Of the 6 cases of delayed response, 2 cases were decreased significantly by cromolyn, while the other 4 cases were not. The protection effects of oral cromolyn were highly significant for the immediate and late nasal responses and nonsignificant for delayed responses. It can be concluded that cromolyn in a daily oral dose of 200 mg four times prevented the immediate and late nasal responses to ingested food.

Cytologic changes in the nasal secretions during the late nasal response

One hundred sixty-four patients with allergic rhinitis (104 patients with positive late nasal responses (LNRs) and 60 patients with negative nasal responses to allergen challenge), correlating with history and skin tests, were randomly selected for this study. Nasal challenges were repeated and supplemented by cytologic examination of the nasal secretions (NSs). The cytologic examination of NS was also performed during 164 control challenges with phosphate-buffered saline. The positive LNR was accompanied by significant changes in the count of neutrophils in 84% of the cases (increase immediately before and decrease during appearance of LNR, with increase again during resolving of late nasal response), of eosinophils in 58% (increase immediately before and decrease during appearance of LNR), of epithelial cells in 73% (increase followed by decrease, running parallel with LNR), of goblet cells in 63% (increase followed by decrease), of basophils in 8%, and of lymphocytes in 6% (both of these cells demonstrated a slight increase during LNR) in the NS. No significant changes in the count of other types of cells in the NS during most of the LNR cases were recorded. Most cases of negative response were not accompanied by significant changes in the count of individual cell types. No significant changes in the count of any cell type in the NS were recorded in any patient during the phosphate-buffered saline-control challenges. The cytologic examination of NS, accompanying the nasal challenge with allergen, appears therefore to be a valuable supplementary diagnostic parameter for the LNR and a promising model for further immunologic and clinical studies of the LNR.

Late Phase Eustachian Tube and Nasal Allergic Responses Associated with Inflammatory Mediator Elaboration

Previous work in our laboratories has documented an IgE-mediated functional obstruction of the nose and eustachian tube (ET) immediately after nasal allergen challenge. The goals of this study were to monitor changes in nasal, ET, and bronchial physiology during the 12 hours following nasal allergen challenge and to correlate these changes with the elaboration of inflammatory mediators (IM). Subjects with ragweed allergic rhinitis were challenged intranasally with 2.5 mg of ragweed/nostril, and responses were assessed by posterior rhinomanometry for the nasal airway, sonotubometry for the eustachian tube, and spirometry for the bronchial airway. Blood was obtained simultaneously for quantitating the elaboration of three functionally and metabolically distinct IM. Late nasal responses (3–12 hours postchallenge) were observed in 7 of 10 subjects, with an average decrease of 67 ± 5% in nasal conductance at an average onset time of 6.6 ± 0.8 hours postchallenge. Dual late nasal responses were observed in five subjects. Late ET responses were observed in 10 ears (50%). Two sequential late ET responses were observed in three subjects. Late bronchial responses were detected in three subjects, one of whom did not have an early response. Plasma elevations of one or more IM were detected in all late nasal responders during the late phase response period. Late nasal and ET responses in association with an allergic nasopharyngeal inflammatory process could provide an important insight into the relationship between nasal allergy and middle ear disease.

462 Late phase eustachian tube (ET) and nasal allergic responses associated with inflammatory mediator (IM) elaboration

462 Late phase eustachian tube (ET) and nasal allergic responses associated with inflammatory mediator (IM) elaboration

A new disease: a nasal form of pigeon breeder's disease.

In 47 allergic rhinitis patients regularly exposed to pigeons, nasal provocation tests with pigeon dropping extracts, in combination with other parameters, were performed. Twenty-five of the 47 patients developed a late nasal response (LNR) to pigeon droppings (53%), six of them an isolated response and 19 a dual response (immediate + late). The precipitating antibodies to pigeon droppings were positive in 20 (80%) and to pigeon serum in nine LNR patients (36%). Late skin responses to pigeon droppings occurred in 15 (60%) and to pigeon serum in seven LNR patients (28%). In 13 patients (52%) general malaise, in seven (28%) increased blood eosinophilia, in nine (36%) increased body temperature and in 11 (44%) haemorrhages in the nasal mucosa were observed during the LNR. The results of this study provide evidence for the existence of a new disease, a nasal form of pigeon breeder's disease.

264 Late nasal response to pigeon dropping challenge — Possible nasal form of pigeon breeder's disease

264 Late nasal response to pigeon dropping challenge — Possible nasal form of pigeon breeder's disease