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Clinical Investigations: ASTHMA |

Determinants of Allergen-Induced Late Bronchial Responses in Mild Asthmatics*

María J. Alvarez-Puebla, MD, PhD; Jose M. Olaguibel-Rivera, MD, PhD; Eduardo Urbiola-Marcilla, MD, PhD; Blanca E. Garcia, MD, PhD; Ana I. Tabar-Purroy, MD, PhD
Author and Funding Information

*From the Allergy Department (Dr. Alvarez-Puebla), Hospital de León, León, Spain; and the Allergy Department (Drs. Olaguibel-Rivera, Garcia, and Tabar-Purroy) and Pathology Department (Dr. Urbiola-Marcilla), Hospital Virgen del Camino, Pamplona, Spain.

Correspondence to: María J. Alvarez-Puebla, MD, PhD, Puebla C/Padre Arintero, n°11, 1°C, 24001 León, Spain; e-mail: mapuebla@terra.es



Chest. 2001;119(1):120-127. doi:10.1378/chest.119.1.120
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Study objective: To examine the baseline factors influencing the occurrence and magnitude of immediate- and late-phase responses in asthmatic patients after an allergen-induced bronchial provocation test (A-BPT).

Design: Cross-sectional analysis in a homogenous group of 31 mild, Dermatophagoides pteronyssinus-allergic patients with asthma.

Setting: Allergy Department, Hospital Virgen del Camino, Pamplona, Spain.

Interventions and measurements: Patients completed an asthma symptom questionnaire and underwent skin tests, sputum induction, and methacholine bronchial provocation test. The A-BPT was performed on a separate day. Sputum cell profile and eosinophil cationic protein (ECP), tryptase, albumin, and interleukin-5 levels were quantified in the entire sputum supernatant. Assays were done for eosinophils in blood, and/or ECP, and total and specific IgE levels in serum. Exposure to D pteronyssinus major allergens (Der p1 and Der 2) was measured by an assay based on monoclonal antibodies.

Results: A-BPT findings were positive in all patients, and late-phase responses were detected in 29%. Late responders were exposed to higher levels of Der p1 (p = 0.028), had greater levels of ECP (p = 0.007) and albumin (p = 0.019) in sputum, and showed a trend toward higher lymphocyte numbers (p = 0.053) in sputum than isolated early responders. The allergen-induced provocative dose that induced a fall in FEV1 values ≥ 20% from the postdiluent values correlated with bronchial hyperresponsiveness (r = 0.36). The late-phase response magnitude correlated with Der p1 exposure (r = 0.49) and showed a trend toward correlation with sputum ECP levels (r = 0.38).

Conclusion: Factors involved in the development of allergen-induced immediate- and late-phase responses are different. Allergen natural exposure might prime the infiltration of the airway by activated inflammatory cells enhancing the appearance and the severity of late-phase responses.

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allergens

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