Asthma, Rhinitis, Other Respiratory Diseases
Intranasal heparin reduces eosinophil recruitment after nasal allergen challenge in patients with allergic rhinitis

https://doi.org/10.1067/mai.2001.118785Get rights and content

Abstract

Background: Recently, several studies have shown that heparin possesses various anti-inflammatory and antiallergic properties. It has been proposed that heparin might play an important role in limiting the inflammatory events associated with asthma and allergic rhinitis by neutralizing inflammatory mediators, such as eosinophil cationic protein and major basic protein, and by limiting eosinophil recruitment. Objective: To test the hypothesis that heparin can limit the extent and magnitude of eosinophilic inflammation, we examined the effect of inhaled intranasal heparin on nasal response to allergen challenge in 10 patients with allergic rhinitis. Methods: The capacity of heparin to reduce nasal response was studied by evaluating symptom score, eosinophil cationic protein concentration, and eosinophil counts in nasal lavage fluids 10, 60, and 360 minutes after allergen challenge. Results: Pretreatment with intranasal heparin produced a significant reduction in symptom score 10 minutes after allergen challenge and reduced the eosinophil influx at each time point after antigen challenge, statistical significance being reached 60 and 360 minutes after allergen challenge. Similarly, the amount of eosinophil cationic protein in the nasal wash was reduced at each time point; this reached statistical significance 360 minutes after allergic challenge. Conclusion: Heparin was shown to provide protection with respect to nasal allergen challenge. The mechanism by which heparin produces its protective activity seems to be related to the neutralization of eosinophil cationic protein as well as to the reduction of eosinophil recruitment. (J Allergy Clin Immunol 2001;108:703-8.)

Section snippets

Subjects

We studied 10 subjects (3 male and 7 female) aged 18 to 40 years (mean age ± SD, 31.3 ± 10.2 years), each with an obvious history of allergic rhinitis. Allergic rhinitis was defined by a positive cutaneous prick test result and a positive RAST result of class 3 or 4. Patients with allergic rhinitis had seasonal symptoms; all patients were allergic to Parietaria judaica (10 patients). None had nasal polyposis, chronic nasal obstruction, or other serious illness.

No subject was admitted to the

Symptom scores

As expected, nasal challenge with increasing concentration of allergen resulted in immediate symptoms in all subjects. All patients completed the study, and no severe adverse reactions during the nasal lavage and challenge procedures were noted. Results, given as mean nasal symptom scores after allergen challenge following treatment with heparin or saline solution, are presented in Fig 1.

. Symptom scores 10, 60, and 360 minutes after allergen challenge following treatment with heparin (blue bars)

Discussion

In patients with allergic rhinitis, nasal antigen challenge has been successfully used to monitor allergic inflammatory responses during both the EPR and the LPR.22, 23 Mast cells are crucial for the development of EPR; in contrast, eosinophils are considered the most prominent effector cells in the LPR, and their role in the pathogenesis of allergic diseases is believed to be critical. Eosinophils are in fact able to produce a wide array of proinflammatory cytokines and have the capacity to

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    Reprint requests: Carlo Vancheri, MD, PhD, Institute of Respiratory Diseases, University of Catania, Via Passo Gravina, 187 95125-Catania, Italy.

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