Late Phase Eustachian Tube and Nasal Allergic Responses Associated with Inflammatory Mediator Elaboration

Abstract

Previous work in our laboratories has documented an IgE-mediated functional obstruction of the nose and eustachian tube (ET) immediately after nasal allergen challenge. The goals of this study were to monitor changes in nasal, ET, and bronchial physiology during the 12 hours following nasal allergen challenge and to correlate these changes with the elaboration of inflammatory mediators (IM). Subjects with ragweed allergic rhinitis were challenged intranasally with 2.5 mg of ragweed/nostril, and responses were assessed by posterior rhinomanometry for the nasal airway, sonotubometry for the eustachian tube, and spirometry for the bronchial airway. Blood was obtained simultaneously for quantitating the elaboration of three functionally and metabolically distinct IM. Late nasal responses (3–12 hours postchallenge) were observed in 7 of 10 subjects, with an average decrease of 67 ± 5% in nasal conductance at an average onset time of 6.6 ± 0.8 hours postchallenge. Dual late nasal responses were observed in five subjects. Late ET responses were observed in 10 ears (50%). Two sequential late ET responses were observed in three subjects. Late bronchial responses were detected in three subjects, one of whom did not have an early response. Plasma elevations of one or more IM were detected in all late nasal responders during the late phase response period. Late nasal and ET responses in association with an allergic nasopharyngeal inflammatory process could provide an important insight into the relationship between nasal allergy and middle ear disease.