Nasal and bronchial responses to flour-inhalation in subjects with occupationally induced allergy affecting the airway

Objectives: The aim of the study was to follow the similarities and differe nces, of cellular and mediator changes and mucosal/vascular permeability in the upper and lower airway after specific and nonspecific bronchial provoc ation. in bakers with diagnosed occupationally induced allergy affecting th e airway. In addition, the authors try to find whether there is a relations hip between cellular changes in nasal and bronchoalveolar lavage, and bronc hial hyperreactivity. Methods: The study participants were 10 bakers with o ccupational bronchial asthma and allergic rhinitis. All patients were sensi tized to investigated allergen-flour. Nasal- and bronchoalveolar lavage tec hniques were used to evaluate the changes of the cellular and mediator resp onse (tryptase, eosinophil cationic protein, ECP) and albumin level after s pecific (flour) and placebo provocation. In addition, bronchial hyperreacti vity for histamine, and forced expiratory volume in 1 s (FEVI) were measure d after the challenge. Results: There was a significant increase in the per centage of eosinophils, basophils and albumin in nasal and bronchoalveolar lavage of occupationally sensitized bakers. A statistically significant inc rease in the percentage of neutrophils in bronchoalveolar lavage was observ ed only 24 h after the allergen challenge. The level of tryptase in nasal l avage was significantly higher during the early allergic response. The leve ls of ECP in both nasal and bronchoalveolar lavage were significantly incre ased during the lateallergic response. There were also severe bronchial rea ctions and increase of bronchial hyperreactivity for histamine in occupatio nally sensitized bakers in the late phase of allergic reaction. Conclusion: Eosinophils and basophils proved to be the predominant cells in nasal and bronchoalveolar lavage of patients with occupationally induced bronchial as thma and rhinitis. The prolonged increase of albumin level seems also to be a good predictor of protracted nasal and bronchial inflammation. The resul ts obtained confirmed that tryptase and ECP are good markers for monitoring mast cell and eosinophil degranulation during the allergic reaction. Incre ase of airway responsiveness reflects an eosinophil and basophil contributi on to airway allergic response.