Sağlıklı ve rinit'li hastalarda metakolin provokasyonu ile nazal hiperreaktivitenin değerlendirilmesi

Bu çalışmada 97 hasta ve 20 sağlıklı kişide metakolinin nazal hiperreaktiviteye yol açabilme ve sağlıklı-hasta ayırımı yapma bilme yetisi araştırıldı. Provokasyon sonrası kontrol ve hasta grupları arasında NAR (nasal airway resistance) değerleri anlamlı farklılık göstermedi (p>0.05). Provokasyon sonu NAR değeri ve skor arasında korelasyon bulundu. Metakolin provokasyonu hiçbir grupta anlamlı pozitif provokasyon düzeyi oluşturmadı. Metakolin NAR değerlerinde sağladığı artışı sağlıklı kontrol grubunda da oluşturduğu için hasta-sağlıklı ayırımı yapabilme gücü yetersiz kaldı. Metakolin anlamlı nazal reaktivite atışma yol açamadı.

Evaluation of the nasal hyperresponsiveness with metacholine provocation at the healthy and patients with rhinitis

Background and Design.- In the present study, metacholine power is investigated for the trigger of nasal hyperreactivity and achievement of healthy-ill selection at the 97 diseased and 20 healthy person. After provocation, there was no significant difference in NAR (nasal airway resistance) measurements between control and patient groups (p>0.05). There was a correlation between NAR measurement and score at the end of the provocation. There was no significant positive provocation level in any groups with metacholine provocation. Achievement of healthy-ill selection of the metacholine is inadequate because of that the increment of the NAR measurements was also seen at the healthy control group. Metacholine could not trigger a significant nasal reactivity increment.

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1. Bienenstock J, Befus AD, Pearce F, et al. Mast cell heterogeneity: Derivation and function, with emphasis on the intestine. J Allergy Clin Immunol 1982; 70: 407-10.
2. Bisgaard H, Olsson P, Bende M. Leukotriene D4 increases nasal blood flow in humans. Prostaglandins 1984; 27: 599-604.
3. Borum P. Nasal methacoline challenge. J Allergy Clin Immunol 1979; 63: 253-7.
4. Dokic D, Jovanovic SA, et al. Diagnosis of nasal allergy to the house dust mite. Rhinology 1991; 29: 117-123.
5. Gerth Van Wijk R, Dieges PH. Comparison of nasal responsiveness to histamine, methacholine and phentolamine in allergic rhinitis patients and controls. Clin Allergy 1987; 17: 563-570.
6. Gerth Van Wijk R, Mulder PGH, Dieges PH. Nasal provocation with histamine in allergic rhinitis patients: Clinical significance and reproductbility. Clin Exp Allergy 1989; 19: 293-298.
7. Gerth Van Wijk R, Dieges PH. Nasal hyper-responsivenes to histamine, methacholine and phentolamine in patients with perrennial non-allergic rhinitis and in patients with infectios rhinitis. Clin Otolaryngol 1991; 16: 133-137.
8. Gerth Van Wijk R, Dieges PH. Nasal reactivity to histamine and methacholine: Two different forms of upper airway responsivennes. Rhinology 1994; 32: 119-122.
9. Wihl JA, Malm L. Rhinomanometry in routine allergen challenge Clin Otolaryngol 1985; 10: 185-189.
10. Bousquet J, Calvayrac P, Gunerin B, et al. Immunoterapy with a Standartized Dernatophagoides ptersnssinnus extact. 1. invivo and vitro parameters after a short course odf treatment. J Allergy Clin Immunol 1985; 76: 734-744.
11. Mygind N. Mediators of nasal allergy. J Allergy Clin Immunol 1982; 70: 149-159.
12. Klainer M, Orange RP, Austen KF. Immunological release of histamine and slow reacting subtance of anaphylaxis from human lung: IV. Enhancement by cholinergic and alpha adrenergic stimulation. J Exp Med 1972; 136: 556-567.
13. Britton MG, Empey DW, John GC, et al. Histamine challenge and an nasal rhinometry. Their use in the assessment of psueduephedrine-ephedrine and tripolidine as nasal decongastants in subject with hay fever. Br J Clin Pharmac 1987; 6: 51-58.
14. Clement P, Stop AP, Kaufman L. Histamine thershıid and nasal hyperreactivity in nonspecific allergic rhinopathy. Rhinology 1985; 23: 32-42.
15. Okuda M, Hipointen O, Sakaguchi K, et al. Nasal histamine sensitivity in allergic rhinitis. Ann Allergy 1983; 51: 51-55.
16. Gronborg H, Borum P, Mygind N. Histamine and methacholine do not increase nasal reactivity. Clin Allergy 1986; 16: 597-602.
17. Mygind N, Secher C, Kirkegaard J. Role of histamine and antihistamines in the nose. Eur J Respir Dis 1983; 64 (suppl 128): 16-20.
18. Baroody FM, Wagenmann M, Naclerio RM. Comparison of the secretory response of the nasal mucousa to methacholine and histamine. J Appl Physiol 1993; 74: 2661-2671.
19. Wihl JA, Mygind N. Studies on the allergen – challenged human nasal mucosa. Acta orolaryngol (stochk) 1977; 84: 281-6.
20. Wihl JA, Peterson BN, Peterson LN, et al. Effect of nonsedative H1- receptor antagonist in perennial allergic and non-allergic rhinitis. J Allergy Clin Immunol 1985; 75: 270-7.
21. Wihl JA. Methods of assessing nasal reactivity. Eur J Respir Dis 1984; 64 (supll 128): 175-9.
22. Corrado OJ, Gould CAL, Kassab JY, et al. Nazal respons of rhinitic and non-rhinitic subjects to histamine and methacoline: A comparative study. Thorax 1986; 41: 863-868.
23. Doyle WJ, Boehems, Skoner DP. Physiologic responses to intranasal dose-response challenge with histamine, methacholine, bradykinin ans prostaglandin in adult volunteers with and without nasal allergy. J Allergy Clin Immunol 1990; 86: 924-935.
24. Saengpanich S, Assanasen P, de Tineo M, et al. Effects of intranasal Azelastin on the response to nasal allergen challenge. Laryngoscope 2002; 112:47-52
25. Holopanene E, Tarkianen E, Malmberg H. Nasal challenge. Rhinology 1976; 14:181-188.
26. Alvarez-Puebla MJ, Garcia-Figueroa BE, Tabar-Purroy AI, et al. Discriminant analysis in allergic rhinitis and asthma:methacholine dose-response slope allows a good differentiation between mild asthma and rhinitis. Respir Med 2003; 97: 30-6.