Effect of six-hour exposure to nitrogen dioxide on early-phase nasal response to allergen challenge in patients with a history of seasonal allergic rhinitis,☆☆,,★★

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Abstract

Background: Recent studies have suggested that exposure to air pollutants may enhance the airway responsiveness of susceptible individuals to inhaled allergen. Methods: To investigate the effect of exposure to nitrogen dioxide (NO2) on nasal airways resistance (NAR) and inflammatory mediators in nasal lavage fluid, eight subjects with a history of seasonal allergic rhinitis, who were tested out of season, were exposed in a randomized single-blind, crossover study to either air or 400 ppb NO2 for 6 hours. The changes in NAR and eosinophil cationic protein (ECP), mast cell tryptase (MCT), neutrophil myeloperoxidase (MPO), and interleukin-8 (IL-8) in nasal lavage fluid before and after exposure were evaluated. Another group of eight subjects with a history of seasonal allergic rhinitis were also randomized to exposure to air or 400 ppb NO2 for 6 hours and then challenged with allergen, before evaluation for changes in NAR and changes in ECP, MCT, MPO, and IL-8 in nasal lavage fluid. Results: Exposure to air or NO2 did not alter either NAR or the levels of ECP, MCT, MPO, or IL-8 in nasal lavage fluid. Allergen challenge after exposure to both air and NO2 significantly (p < 0.05) increased levels of MCT, but not MPO and IL-8, in the nasal lavage fluid. In addition, allergen challenge after exposure to NO2, but not air, significantly increased levels of only ECP in nasal lavage fluid (p < 0.05). Conclusions: These results suggest that acute exposure to NO2, at concentrations found at the curbside in heavy traffic during episodes of pollution, may “prime” eosinophils for subsequent activation by allergen in individuals with a history of seasonal allergic rhinitis. (J ALLERGY CLIN IMMUNOL 1995;96:669-76.)

Section snippets

Subjects

Because no data were available for comparison from similar studies, it was not possible to perform power statistics at the outset of this study, which was conducted in randomized, single-blind, and crossover manner outside the pollen season in the United Kingdom. Consequently, we performed our study in a total of 16 patients with a history of seasonal allergic rhinitis who were free of symptoms, on the basis of the study by Bascom et al.,11 which investigated the effect of 4-hour exposure to

RESULTS

No significant changes were found in NAR, during either inspiration or expiration after 6-hour exposure to air or 400 ppb NO2, in the subjects in group 1. Exposure for 6 hours to air or 400 ppb NO2 did not induce rhinorrhea nor did it significantly alter the mean number of sneezes in this group of volunteers (Table I). Analysis of ECP, MCT, MPO, and IL-8 levels in nasal lavage fluid demonstrated that these values were also not altered significantly after 6-hour exposure to air or 400 ppb NO2 (

DISCUSSION

Our studies have demonstrated that exposure of subjects with a history of seasonal allergic rhinitis who are free of symptoms to 400 ppb NO2 for 6 hours neither altered the nasal patency (NAR) nor increased nasal symptoms (sneezing) or the levels of inflammatory mediators (ECP, MPO, MCT, and IL-8) measured in nasal lavage fluid immediately after exposure. Although prior exposure to NO2 and air for 6 hours followed by allergen challenge led to a significant increase in the concentration of

Acknowledgements

We thank Ms. Janice Thomas, in the Department of Statistical Analysis, St. Bartholomew's Hospital, for assistance in statistical analysis.

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    From the Department of Respiratory Medicine and Allergy, St. Bartholomew’s Hospital, London.

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    Supported by the National Asthma Campaign (UK), Joint Research Board of St. Bartholomew’s Hospital and Glaxo Group Research Limited.

    Reprint requests: Robert J. Davies, MD, Department of Respiratory Medicine and Allergy, St. Bartholomew's Hospital, London EC1A 7BE, England UK.

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