Delayed-type asthmatic response to bronchial challenge with allergen, I: clinical features.

BACKGROUND

Patients with allergic asthma being challenged with allergen may develop different types of asthmatic response, such as immediate asthmatic response (IAR), late asthmatic response (LAR), or dual late asthmatic response (DLAR), because of different immunologic mechanisms.

OBJECTIVES

To investigate the clinical features of delayed asthmatic response (DYAR), its reproducibility, and its association with other in vivo and in vitro diagnostic parameters and to contribute to the understanding of the possible mechanism(s) underlying this unusual clinical phenomenon.

METHODS

In 51 asthma patients developing 51 DYARs, the bronchial challenges with the same allergens were repeated and supplemented with additional diagnostic parameters. Control groups consisted of asthma patients developing IAR (n = 56), LAR (n = 43), and DLAR (n = 31) and healthy individuals (n = 48).

RESULTS

The DYAR began at 26 to 32 hours, reached a maximum at 32 to 48 hours, and resolved within 56 hours after the challenge. DYAR was statistically highly significant (P < .001) compared with phosphate-buffered saline controls.The differences between the initial and repeated DYAR were not significant (P = .14). The DYAR was associated with dyspnea, wheezing, tiredness, increased peripheral blood leukocyte count, lymphocytosis, neutrophilia but not eosinophilia, significant changes in the T(H)1/T(H)2 ratio in peripheral blood in favor of T(H)1 cells, and significant increase in the intracellular concentration of interferon gamma but not interleukin 4 or 5.

CONCLUSIONS

In addition to the previously established IAR, LAR, and DLAR, existence of another, the so-called DYAR to allergen challenge, has been demonstrated. In this type, the T(H)1 cells, together with neutrophils, may well play the predominant causal role.