Novel Perspectives in the Detection of Oral and Nasal Oxidative Stress and Inflammation in Pediatric United Airway Diseases

Abstract

United airway disease (UAD) concept proposed that asthma and rhinitis are both different clinical manifestation of a single inflammatory process. The aim of this study is to assess in upper and lower airways the level of inflammation and oxidative stress and to investigate the relationship between biomarkers in persistent allergic rhinitis (PER) and in concomitant asthma with PER. By a cross-sectional study we measured oral and nasal (FE_NO) and oral and nasal EBC 8-isoprostane, LTB₄ and PGE in children with PER (n=14) and with PER and concomitant intermittent asthma (IA; n=25), mild persistent asthma (mA; n=28), moderate persistent asthma (MA; n=13) and in Healthy Controls (HCs; n=13). Oral and nasal FE_NO concentrations were increased in children with PER, IA, mA and MA when compared with HCs. Nasal 8-isoprostane was higher in EBC of children with PER and asthma than in HCs. Oral and nasal LTB₄ were higher in EBC of children with PER and mA than in HCs. Oral and nasal PGE₂ concentrations were higher in EBC of children with PER than in HCs. Positive correlations between oral and nasal biomarkers were found in IA for LTB4 and PGE2, in mA for FE_NO, 8-isoprostane, LTB and PGE₂, and in MA for PGE₂. No correlations were observed in children with PER and HCs. Our results suggest that non-invasive markers of inflammation and oxidative stress might be useful to study the relationships between oral and nasal compartments in allergic children with PER and concomitant asthma with the aim of defining the UAD.

Keywords

allergy oxidative stress inflammation united airway disease

References

Profita

La Grutta

Carpagnano

. Noninvasive methods for the detection of upper and lower airway inflammation in atopic children. J Allergy Clin Immunol 2006; 118:1068–74.

Tanou

Koutsokera

Kiropoulos

. Inflammatory and oxidative stress biomarkers in allergic rhinitis: the effect of smoking. Clin Exp Allergy 2009; 39:345–53.

Braunstahl

. The unified immune system: respiratory tract-nasobronchial interaction mechanisms in allergic airway disease. J Allergy Clin Immunol 2005; 115:142–8.

Cibella

Cuttitta

La Grutta

Passalacqua

Viegi

. Factors that influence exhaled nitric oxide in Italian schoolchildren. Ann Allergy Asthma Immunol 2008; 101:407–12.

de Jongste

Carraro

Hop

Baraldi

. Daily telemonitoring of exhaled nitric oxide and symptoms in the treatment of childhood asthma. Am J Respir Crit Care Med 2009; 179:93–7.

Baraldi

Giordano

Pasquale

. 3-Nitrotyrosine, a marker of nitrosative stress, is increased in breath condensate of allergic asthmatic children. Allergy 2006; 61:90–6.

Zanconato

Carraro

Corradi

. Leukotrienes and 8-isoprostane in exhaled breath condensate of children with stable and unstable asthma. J Allergy Clin Immunol 2004; 113:257–63.

Montuschi

. Pharmacological treatment of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2006; 1:409–23.

Mondino

Ciabattoni

Koch

. Effects of inhaled corticosteroids on exhaled leukotrienes and prostanoids in asthmatic children. J Allergy Clin Immunol 2004; 114:761–7.

10.

Montuschi

Barnes

. Exhaled leukotrienes and prostaglandins in asthma. J Allergy Clin Immunol 2002; 109:615–20.

11.

Peters-Golden

MGM

Togias

. Cysteinyl leukotrienes: multi-functional mediators in allergic rhinitis. Clin Exp Allergy 2006; 36:689–703.

12.

Montuschi

Barnes

Roberts

2nd . Isoprostanes: markers and mediators of oxidative stress. Faseb J 2004; 18:1791–800.

13.

Profita

Sala

Bonanno

. Increased prostaglandin E2 concentrations and cyclooxygenase-2 expression in asthmatic subjects with sputum eosinophilia. J Allergy Clin Immunol 2003; 112:709–16.

14.

Beckman

Chen

Marshall

Freeman

. Apparent hydroxyl radical production by peroxynitrite: implications for endothelial injury from nitric oxide and superoxide. Proceedings Nat Acad Sciences 1990; 87:1620–4.

15.

Bousquet

Khaltaev

Cruz

. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 86:8–160.

16.

Miller

Hankinson

Brusasco

. Standardisation of spirometry. Eur Respir J 2005; 26:319–38.

17.

Dreborg

. Skin testing the safety of Skin tests and the information obtained from using different methods and concentration of allergen. Allergy 1993; 48:473–5.

18.

ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med 2005; 171:912–30.

19.

Barreto

Villa

Olita

Martella

Ciabattoni

Montuschi

. 8-Isoprostane in exhaled breath condensate and exercise-induced bronchoconstriction in asthmatic children and adolescents. Chest 2009; 135:66–73.

20.

Carraro

Corradi

Zanconato

Alinovi

Pasquale

Zacchello

Baraldi

. Exhaled breath condensate cysteinyl leukotrienes are increased in children with exercise-induced bronchoconstriction. J Allergy Clin Immunol 2005; 115:764–70.

21.

Montuschi

Varone

Valente

Spina

Mondino

Ciappi

Ciabattoni

. Methodological aspects of exhaled prostanoid measurements. Eur Respir J 2003; 22:54:18.

22.

Montuschi

Kharitonov

Ciabattoni

Barnes

. Exhaled leukotrienes and prostaglandins in COPD. Thorax 2003; 58:585–8.

23.

Rimmer

Ruhno

. Rhinitis and asthma: united airway disease. MJA 2006; 185:565–71.

24.

Crystal-Peters

Neslusan

Crown

Torres

. Treating allergic rhinitis in patients with comorbid asthma: the risk of asthma-related hospitalizations and emergency department visits. J Allergy Clin Immunol 2002; 109:57–62.

25.

Ciprandi

Tosca

Passalacqua

Canonica

. Long-term cetirizine treatment reduces allergic symptoms and drug prescriptions in children with mite allergy. Ann Allergy Asthma Immunol 2001; 87:222–6.