Wpływ swoistej immunoterapii alergenowej na stężenie substancji P w popłuczynach nosowych chorych na alergiczny nieżyt nosa uczulonych na pyłek bylicy

Neural mechanisms are proved to play a role in the mechanism of allergic rhinitis symptoms. The purpose of our study was to examine the impact of specific allergen immunotherapy on concentration of substance P in nasal lavage fluid of patients with allergic rhinitis sensitive to mugwort.Method24 patients with seasonal allergic rhinitis, mean age 34.20 ± 8.1 years were included into trial. 15 sensitive to mugwort (skin prick test and serum antigen specific IgE (Pharmacia CAP system)) patients were desensitized with hypoallergic extract of mugwort (Allergovit, Allergopharma) for 3 years. The control group consisted of 9 polyallergic rhinitis patients whose symptoms were controlled only by pharmacotherapy. Nasal allergen provocation tests using mugwort extract followed by collection of lavage fluid were repeatedly done before the pollen season. All patients recorded clinical symptoms in the diary. The substance P (SP) nasal lavage fluid level was determined by EIA methods (Assay Designs Inc., USA) in all patients.ResultsThere were similar levels of SP in both groups at baseline prior to therapy (SIT group: 56.1 ± 15.5 vs. controls 54.3 ± 10.1 pg/ml). SP concentration in NLF after mugwort challenge in 1 year was lower in SIT group (48.1 ± 13.8 pg/ml versus 53.6 ± 6.8 pg/l; p < 0.05) with a further, but not statistically significant decrease in SP levels after 2 and 3 years of SIT (40.9 ± 17,6 pg/ml vs. 51.2 ± 9.2 pg/ml). Significant reduction of symptoms and medications use was observed in hyposensitized patients.ConclusionsSubstance P seems to play a role in the pathophysiology of nasal allergic responses to mugwort pollen in allergic rhinitis patients. Decreased level of SP as a result of SIT suggests that some of the symptomatic benefits of SIT may be related to the reduced release of substance P into nasal secretions.