Relationship between airways response to allergens and nonspecific bronchial

reactivity

Robert A. Nathan, M.D.,* Robert A. Kinsman, Ph.D., Sheldon L. Spector, M.D., ** and Douglas J. Horton, M.D. Denwr.

Wror7c~hitll

ir1l711/,11i011

pvjortt74

ot7

cl~ff,wtil

ttt7lig~~t7s.

i~/iit//c~ti,~~~

lo

183

t7rolil.s. ctt,li,cyt, wilh

lIoi,sP

ttrc

patients

of many

(4

ttitx\avs

( tttrllctr,qc.

Asthmatic

lo

(ttid

(I ptsili~x,

hail

louw

,/iv

ttii.rcd

b\i/ti

ctrcvtticul

0 po.vili\.c

and nonspecific

factors.

Increased

nonspecific

chial

reactivity

is so characteristic

tients

as to suggest

Reagin

substances is thought

some asthmatic patient thought

to play

patients.

by antigen

to be more

f/iv

grrtrrp

of

ttri.wt/

0 trc,,qc,ril~c

,,lot,c,

HU.S

A1.w).

(I higher

t7ol

t,,ssoc~i~,ld

pc’rc’cv,/t,,yc

u.ilI7

ti ICII\,

hY/tt

c~ilticv~

T/w ,c.wlls itt7ph chulletrgc~ to

thc,l

(11 Icw.sr

tiolitrc~ or

,I tt7i,l/70(

t, .spi7jic.

(I ttfotlcrirlc~ /ICV

trtiri~cti:

t7isl,itttit7(,

it,htrl~,liotr

lengcs tive

procedures by

skin

reactivity

is

tcrircd

testing

among

asthmatic

response

From the Department of Medicine. National Jewish Hospital and Revsarch Center. and the Departmenrs of Medicine and PsychiaIr). Umversil) of Colorado School of Medicine. Supponed in part by National Iwitutes of Health Grams HL-2206.5 and Al- 15392.

The

C. V. Mosby

study

I I2 fcmalc. 30.5

5

Co.

antigcnic

of rhr

bpring

from

inhalation skin

and chal-

~1

rcac-

All

of allergic

hkin

[esf\

birch.

\hcltharh

patient. Jewish

3h-year t’acrors

and

Hcrc

slm.

-~lr;l\sc~:

Jul!.

included

irrc-

Subjscrh

antipcw \shirc timorhv.

64, No. 6, Part

and

from

In asthma.

to I6 individual

Vol.

Ho\pilal

period

\ubjc~rh

American hickory:

7 I male

14 to 77 >r fnic’311 qc.

to National the

lL)77.

role

allergic and

and their

antigens,

rcactivitk,

IX3 Ltsthm~ltic in agr

during

to Dcccmber.

poplar.

inhalod

to the same

included

Center

ash.

who were charac-

antigen

ranging

107-l.

white

patients

was

airways

AND METHODS

\pcctivc received

nonspccitic

of positive

15. I yr) admirtcd

Rcscxch

reactivity

of this study

skin test reactions

airways

’ chal-

of the rela-

airways

of

to the same

and nonspecific

MATERIALS Subjects

Presented In part at the thirty-fifth annual meeting of the American .4cademj of Allergy. New Orlean\. [.a.. March, 1979. Received for publication Oct. 9. lY78. Accepted for puhlicarion May X. 1979. Reprinr requests 10: Rotxn A.Nathan. 2709 N. Tejon. Colorado Springs. CO 80907. *Senior Fellow m Allergy and Clinical Immunology. Deptiment of Medlciw. Narmnal Jewish Hospiral and Research Center. **l.adv Davis Fellou. 1077-197X. The

rrlativc

tions

level

antigenic

patients.”

assessment

The purpose

the

airways

inhalation

and nonspecific

(I)

by their

airways

in asthmatic

of bronchial

patients.”

also appears

of a positive

in the clinical

of reagin

to dctcrmine:

of its role in the

challenge

has aided

role

reactivity

antigens

standardization

in asthmatic

in only

airways

to the occurrence

to inhaled

Recent

of such

role

’ Nonspecific

response

and methacholine.’

:C; 1979

rrtitl

it7 gr011p.s

Icnges

09500.9010

10

grt,.s.ws.

1~f70 hd

(2) the incidence

0091-67491’79!120491+

uwc

letrs/

/risrc,ti,it,c~

of’it7tli~~itl1,trl.s

lhitt,

alone.‘.

bron-

in the definition

than

it,

al

itrlrtrl~tliot,

tt7i.d

ttep,li\x,~

to contribute

pa-

Assessment accurate

as

of asthmatic

an important

inhalation

/ml/i

irws.

itrdi~~iilcictls

or

itrl7ululiotr hv

lo

tt7cthc,~~/7olit,c~.

trgcv7l.c.

allergens

by the inhalation

as histamine

swti

0,s it7tlc.rctl

specific

chemical

or

lo

trtrliKc,tt

tt,i.retl ll7osc~

cttfrigf~t,

/es/s

lcsl.

bronchoconstriction

its inclusion

o~‘rc~.spot,sc

For

ICCI.S/ otw skit7

0 pmiliw

tt7c~rttc,c~ttolit7i~

hrottc~tiitrl

lilY/y. skit7

citrtl

(po.sili~~~

wow

IO /t7cw

including

and can be assessed

rcwc/i\?l~ /rt hi.sltrtt7it7c

stimuli,

asthma

~~YcY/.

trtrtl

hvpi~rrcwi

tt pt.\ili~~c

develop

rtrg

trl

rc~c~c4l~cd

.si~tiif,~l,tfl~/~tr

trisliitt7irrc~

rospot7.w

lost

tl7rc~.~l7old.5

lrs/

find

htrcl

skit7

.sltrli.slicull,v

ih,llcvr,qc~.s ho/t7

tl7c~llll,l~/7olitlc.

u,ho prc~~io,t.s!\

(!frcJspottse

ti.s.coc~it,lcd

tr~ttr.spwiftc

tlol

itthirl~itioti

lhrd7oltl

,/ti(ntrs

a result

hurl

if/’ rc~spotiw

t7iglr

)I’(,.)‘

lhrcshold

t,t7ligc~t7

ll;.\/l,rtl;llc~.

willi

c.hcrllatt,qc,..skit,

it7l7trltrliot7

llirdtolti

i,t7ligf~t7

pi,ltcrti ,lusl

11 thffiwt7r

o/ pthili\~i,

or

.si,ttti’ 777is

iitld

lo pcttic~t7t.s

It7cli~~ihctls

/kc

tt7c~ll7trc~l7olit7i~.

l~hl,lllvl~c3

c,.s/htt7t,/ic

CO/O

(trees;

oak.

u,hitc

orchxd.

1, pp. 491-499

492

J. ALLERGY

Nathan

TABLE I. Geometric mean histamine threshold antigen inhalation challenge (AIC) response

(mglml)

for the three groups

defined

CLIN. IMMUNOL. DECEMBER 1979

by their skin test (ST)

Antigens Mixed trees

Mixed grasses

Mixed ragweed

N Mean t SE

N

Mean k SE

N

51 0.87 _c 0”:;;

49 0.80 t 8:;;

44

0.75 f ;;f;

65

0.90 _t 0”:;;

65

Y 0.85 AI 00:;;

25 0.84 t ;:;;

I9

1.20 !I y;t

39

0.74 -+ 0”:;:”

17 0.63 -+ 0”:;;

N Mean

Group

ST--. AIC ST+. AICST+. AIC+

+ SE*

31 0.22 + 0”:;;

Housedust Mean 2 SE

3 0.05 5 y;

Comparisons

Mixed molds N

Mean ir SE

1.02 + Z’r;;

14 0.23 t b):;;

Puinc~isr c~ompurison p wturs

ST-.

AICvs. ST+. AIC-

NS

NS

NS

NS

NS

ST+. AICP NS

VS.

co.01

NS