Nasal blown secretion evaluation in specific occupational nasal challenges

  • Patrizia Pignatti
  • Gianni Pala
  • Marta Pisati
  • Luca Perfetti
  • Gabriella Banchieri
  • Gianna Moscato
Original Article

Abstract

Purpose

To investigate the usefulness of nasal blown secretion evaluation during specific nasal provocation test (sNPT) in diagnosing occupational rhinitis (OR).

Methods

To validate the method, nasal blown secretions from 103 healthy subjects and 30 allergic rhinitis patients were analyzed. Furthermore, we analyzed nasal blown secretions, collected before and after sNPT, of 29 subjects with work-related rhinitis symptoms (WRRS) who underwent the diagnostic pathway for OR. Rhinoscopy and nasal symptom score were used to define a positive sNPT.

Results

A total of 89.6% WRRS subjects provided suitable nasal secretions. Eosinophils significantly increased after positive sNPTs compared to negative ones (P = 0.006). Four percent and/or 1 × 104 eosinophils/ml was the cut-off for a significant post-sNPT eosinophil increase. A total of 4/13 (33%) WRRS subjects with negative sNPT, assessed by rhinoscopy and nasal symptom score, presented a significant post-sNPT nasal eosinophil increase, and were identified as possible OR.

Conclusion

Eosinophil evaluation in nasal blown secretions is an important tool in monitoring the response to occupational specific nasal challenges.

Keywords

Eosinophils Nasal provocation test Nasal blown secretions Occupational rhinitis Reference values 

Abbreviations

sNPT

Specific nasal provocation test/challenge

OR

Occupational rhinitis

WRRS

Work-related rhinitis symptoms

AR

Allergic rhinitis

SD

Standard deviation

DTT

Dithithreitol

HMW

High molecular weight

LMW

Low molecular weight

References

  1. Airaksinen LK, Tuomi TO, Tuppurainen MO et al (2008) Inhalation challenge test in the diagnosis of occupational rhinitis. Am J Rhinol 22:38–46CrossRefGoogle Scholar
  2. Blaski CA, Watt JL, Quinn TJ et al (1996) Nasal lavage cellularity, grain dust, and airflow obstruction. Chest 109:1086–1092CrossRefGoogle Scholar
  3. Bousquet J, Khaltaev N, Cruz AA et al (2008) Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 63(suppl 86):8–160CrossRefGoogle Scholar
  4. Castano R, Thériault G, Maghni K et al (2008) Reproducibility of nasal lavage in the context of the inhalation challenge investigation of occupational rhinitis. Am J Rhinol 22:271–275CrossRefGoogle Scholar
  5. Castano R, Gautrin D, Thériault G et al (2009) Occupational rhinitis in workers investigated for occupational asthma. Thorax 64:50–54CrossRefGoogle Scholar
  6. Efthimiadis A, Spanevello A, Hamid Q et al (2002) Methods of sputum processing for cell counts, immunocytochemistry and in situ hybridisation. Eur Respir J Suppl 37:19s–23sGoogle Scholar
  7. Górski P, Krakowiak A, Ruta U (2000) Nasal and bronchial responses to flour-inhalation in subjects with occupationally induced allergy affecting the airway. Int Arch Occup Environ Health 73:488–497CrossRefGoogle Scholar
  8. Górski P, Krakowiak A, Pazdrak K et al (1998) Nasal challenge test in the diagnosis of allergic respiratory diseases in subjects occupationally exposed to a high molecular allergen (flour). Occup Med 48:91–97CrossRefGoogle Scholar
  9. Gosepath J, Amedee RG, Mann WJ (2005) Nasal provocation testing as an international standard for evaluation of allergic and nonallergic rhinitis. Laryngoscope 115:512–516CrossRefGoogle Scholar
  10. Howarth PH, Persson CGA, Meltzer EO et al (2005) Objective monitoring of nasal airway inflammation in rhinitis. J Allergy Clin Immunol 115:S414–S441CrossRefGoogle Scholar
  11. Hytönen M, Sala E (1996) Nasal provocation test in the diagnostics of occupational allergic rhinitis. Rhinology 34:86–90Google Scholar
  12. Hytönen M, Leino T, Sala E et al (1997) Nasal provocation test in the diagnostics of hairdressers’ occupational rhinitis. Acta Otolaryngol Suppl 529:133–136CrossRefGoogle Scholar
  13. Ingels K, Durdurez JP, Cuvelier C et al (1997) Nasal biopsy is superior to nasal smear for finding eosinophils in nonallergic rhinitis. Allergy 52:338–341CrossRefGoogle Scholar
  14. Kinhult J, Egesten A, Benson M et al (2003) Increased expression of surface markers on neutrophils following migration into nasal lumen. Clin Exp Allergy 33:1141–1146CrossRefGoogle Scholar
  15. Krakowiak A, Walusiak J, Krawczyk P et al (2008) IL-18 levels in nasal lavage after inhalatory challenge test with flour in bakers diagnosed with occupational asthma. Int J Occup Med Environ Health 9:1–8Google Scholar
  16. Lee HS, Majima Y, Sakakura Y et al (1991) A technique for quantitative cytology of nasal secretions. Eur Arch Otorhinolaryngol 248:406–408CrossRefGoogle Scholar
  17. Lemière C, Ernst P, Olivenstein R et al (2006) Airway inflammation assessed by invasive and noninvasive means in severe asthma: eosinophilic and noneosinophilic phenotypes. J Allergy Clin Immunol 118:1033–1039CrossRefGoogle Scholar
  18. Miadonna A, Milazzo N, Gibelli S et al (1999) Nasal response to a single antigen challenge in patients with allergic rhinitic-inflammatory cell recruitment persists up to 48 h. Clin Exp Allergy 29:941–949CrossRefGoogle Scholar
  19. Moscato G, Pignatti P, Yacoub MR et al (2005) Occupational asthma and occupational rhinitis in hairdressers. Chest 128:3590–3598CrossRefGoogle Scholar
  20. Moscato G, Vandenplas O, Gerth Van Wijk R et al (2008) Occupational rhinitis. Allergy 63:969–980CrossRefGoogle Scholar
  21. Moscato G, Vandenplas O, Van Wijk R et al (2009) EAACI Position paper on occupational rhinitis. Respir Res 3:10–16Google Scholar
  22. Nikasinovic-Fournier L, Just J, Seta N et al (2002) Nasal lavage as a tool for the assessment of upper-airway inflammation in adults and children. J Lab Clin Med 139:173–180CrossRefGoogle Scholar
  23. Pałczyński C, Walusiak J, Ruta U et al (2001) Occupational asthma and rhinitis due to glutaraldehyde: changes in nasal lavage fluid after specific inhalatory challenge test. Allergy 56:1186–1191CrossRefGoogle Scholar
  24. Pignatti P, Delmastro M, Perfetti L et al (2002) Is dithiothreitol affecting cells and soluble mediators during sputum processing? A modified methodology to process sputum. J Allergy Clin Immunol 110:667–668CrossRefGoogle Scholar
  25. Prat J, Xaubet A, Mullol J et al (1993) Immunocytologic analysis of nasal cells obtained by nasal lavage: a comparative study with a standard method of cell identification. Allergy 48:587–591CrossRefGoogle Scholar
  26. Rajakulasingam K (2003) Nasal provocation testing. In: Adkinson NF Jr, Yunginger JW, Busse WW, Bochner BS, Holgate ST, Simons FER (eds) Middleton’s allergy principles and practice. Mosby, Philadelphia, pp 644–655Google Scholar
  27. Raulf-Heimsoth M, Wirtz C, Papenfuss F et al (2000) Nasal lavage mediator profile and cellular composition of nasal brushing material during latex challenge tests. Clin Exp Allergy 30:110–112CrossRefGoogle Scholar
  28. Roquet A, Ihre E, van-Hage Hamsten M et al (1996) Allergen-induced inflammation in the nose: a comparison of acute and repeated low-dose allergen exposure. Allergy 51:42–48Google Scholar
  29. Vandenplas O, Cartier A, Malo JL (2006) Occupational challenge test. In: Bernstein IL, Chan-Yeung M, Malo JL, Bernstein DI (eds) Asthma in the workplace. Taylor & Francis, New York, pp 227–252Google Scholar
  30. Walusiak J, Wiszniewska M, Krawczyk-Adamus P et al (2004) Occupational allergy to wheat flour. Nasal response to specific inhalative challenge in asthma and rhinitis versus isolated rhinitis: a comparative study. Int J Occup Med Environ Health 17:433–440Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Patrizia Pignatti
    • 1
  • Gianni Pala
    • 1
  • Marta Pisati
    • 1
  • Luca Perfetti
    • 1
  • Gabriella Banchieri
    • 1
  • Gianna Moscato
    • 1
  1. 1.Allergy and Immunology Unit and ISPESL Occupational Immunology and Allergy Laboratory, Fondazione ‘Salvatore Maugeri’Institute of Research and Care, Scientific Institute of PaviaPaviaItaly

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