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Objective monitoring of nasal airway inflammation in rhinitis
Peter H. Howarth, BSc (Hons), DM, FRCP, Carl G.A. Persson, PhD, Eli O. Meltzer, MD, Mikila R. Jacobson, PhD, Stephen R. Durham, MD, Philip E. Silkoff, MBBS, MRCP, FCCP Journal of Allergy and Clinical Immunology Volume 115, Issue 3, Pages S414-S441 (March 2005) DOI: /j.jaci Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 1 Airway lumen: elimination of proteins (arrows) and cells.
Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 2 Changes in nasal lavage concentrations of histamine (lower panel) and tryptase (upper panel) in 15 subjects after intranasal allergen challenge. The shaded rectangles represent the mean values at each time point, with standard error bars superimposed. ∗P < .05 vs baseline prechallenge (Howarth, unpublished data, January 2005). Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 3 Measurements of histamine concentrations in nasal lavage fluid illustrating the effect of repeated nasal lavage (A) and the repeatability of the fifth lavage (B) when nasal lavage is undertaken in the same subjects 14 days apart (Howarth, unpublished data, January 2005). Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 4 Seasonal changes in nasal lavage ECP concentrations. Subjects were symptomatic in season and not receiving any regular maintenance therapy for their disease (Howarth, unpublished data, January 2005). Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 5 Nasal lavage EPX concentrations (ng/mL) in pollen-sensitive subjects, studied outside the pollen season when asymptomatic, illustrating the variability in individual response to intranasal pollen allergen challenge (Howarth, unpublished data, January 2005). Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 6 EG2+ cells/mm2 nasal submucosa from multiple sections taken from 5 subjects with seasonal allergic rhinitis. Each point represents the cell count from a single section. The red stars and bars represent the mean ± SD (Jacobson and Durham, unpublished data, January 2005). Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 7 Reliability of the subject means for EG2+ cells based on the number of nasal biopsies observed per subject when selected randomly from the complete set of biopsies (Jacobson and Durham, unpublished data, January 2005). Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 8 Tryptase+ mast cells in nasal cytospins (A) and nasal biopsies (B) from grass pollen–sensitive individuals preseason and during season showing the superficial accumulation of mast cells in natural disease and the inhibitory effect of 6 weeks of therapy with nasal fluticasone propionate. Reproduced with permission from Blackwell Publishing.155 Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 9 BMK13+ eosinophils in nasal cytospins (A) and nasal biopsies (B) from grass pollen–sensitive individuals preseason and during season showing the superficial accumulation of mast cells in natural disease and the inhibitory effect of 6 weeks of therapy with nasal fluticasone propionate. Reproduced with permission from Blackwell Publishing.155 Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 10 Nasal NO in allergic rhinitis (AR) compared with normal controls (NC) and the effect of nasal beclomethasone diproprionate (BDP) and nasal antihistamine (ANTI-H) on nasal FENO in AR. Adapted from Baraldi et al.182 Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 11 Conditioning of transnasal airflow with NO diffusing caused by a gradient between the nasal wall NO concentration (Cw) and lumen, with passage of NO from the paranasal sinuses. NO concentration rises progressively as gas traverses the nasal cavity. Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 12 Nasal NO concentration versus time during 2 separate determinations showing a rise to a steady nasal NO plateau (SP), which is highly reproducible. Ambient NO is recorded in the portion of the tracing between the measurements. Adapted from Kharitonov.185 Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 13 Flow dependence of nasal NO. Adapted from Am J Respir Crit Care Med.185 Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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Fig 14 One configuration of the apparatus required to measure nasal NO according to the method recommended by ATS.185 Journal of Allergy and Clinical Immunology , S414-S441DOI: ( /j.jaci ) Copyright © 2005 American Academy of Allergy, Asthma and Immunology Terms and Conditions
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