Pub Date : 2011-03-02eCollection Date: 2011-01-01DOI: 10.5402/2011/792613
Gerdt C Riise, Kjell Torén, Anna-Carin Olin
Background. Measurement of fraction of exhaled nitric oxide (FENO) is a promising tool to increase validity in epidemiological studies of asthma. The association between airway inflammation and FENO has, however, only been examined in clinical settings and may be biased by selection of patients with asthma. Methods. In a population study with FENO registrations on 370 individuals, we identified nine subjects out of thirty subjects with high levels of FENO (>85th percentile, 30.3 ppb), irrespective of presence of respiratory symptoms, and 21 control subjects with FENO at median levels (11.1-16.4 ppb) willing to undergo bronchoscopy and bronchoalveolar lavage (BAL), all nonsmokers. FENO was measured in accordance with ATS criteria, and the examination also included spirometry, methacholine challenge test, and sampling of exhaled breath condensate (EBC). Results. Subjects with high FENO levels had significantly higher median the percentage of eosinophils in BAL than controls (2.1 versus 0.6, P < .006), and there was a significant association between FENO and the percentage of eosinophils in BAL (ρ=0.6, P < .002) and ECP in BAL (ρ=0.65, P < .05) examining the whole group, but no association with gender, FEV1, or degree of metacholine sensitivity or any of the biomarkers in EBC. All subjects with high FENO had respiratory symptoms, but only three had diagnosed asthma. There were a significant association between hydrogen peroxide in EBC and the percentage of neutrophils in bronchial wash. Conclusion. High FENO levels signal asthmatic or allergic respiratory disease in a population-based study. FENO levels are associated with degree of eosinophil airway inflammation as measured by the percentage of eosinophils and ECP in BAL.
背景。呼气一氧化氮(FENO)分数的测量是一个有前途的工具，以提高有效性的哮喘流行病学研究。然而，气道炎症与FENO之间的关联仅在临床环境中进行了研究，并且可能因选择哮喘患者而存在偏差。方法。在一项对370人进行FENO登记的人群研究中，我们从30名FENO水平高(>85百分位数，30.3 ppb)的受试者中确定了9名受试者，无论是否存在呼吸道症状，以及21名FENO水平中位数(11.1-16.4 ppb)的对照受试者，他们都愿意接受支气管镜检查和支气管肺泡灌洗(BAL)，均为非吸烟者。按照ATS标准测定FENO，检查包括肺活量测定、甲胆碱激发试验、呼气冷凝水(EBC)取样。结果。FENO水平高的受试者BAL中嗜酸性粒细胞百分比的中位数显著高于对照组(2.1比0.6,P < 0.006)，并且在检查整个组时，FENO与BAL中嗜酸性粒细胞百分比(ρ=0.6, P < 0.002)和BAL中ECP (ρ=0.65, P < 0.05)之间存在显著关联，但与性别、FEV1、乙酰胆碱敏感性程度或EBC中的任何生物标志物无关。所有FENO高的受试者都有呼吸道症状，但只有3人被诊断为哮喘。EBC中的过氧化氢与支气管洗涤液中中性粒细胞的百分比有显著的关联。结论。在一项基于人群的研究中，高FENO水平是哮喘或过敏性呼吸道疾病的信号。通过BAL中嗜酸性粒细胞和ECP的百分比测量，FENO水平与嗜酸性粒细胞气道炎症程度相关。
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Pub Date : 2011-02-22Print Date: 2011-01-01DOI: 10.5402/2011/353045
Lukas Kofler, Hanno Ulmer, Heinz Kofler
Background. Histamine intolerance results from an imbalance between histamine intake and degradation. In healthy persons, dietary histamine can be sufficiently metabolized by amine oxidases, whereas persons with low amine oxidase activity are at risk of histamine toxicity. Diamine oxidase (DAO) is the key enzyme in degradation. Histamine elicits a wide range of effects. Histamine intolerance displays symptoms, such as rhinitis, headache, gastrointestinal symptoms, palpitations, urticaria and pruritus. Objective. Diagnosis of histamine intolerance until now is based on case history; neither a validated questionnaire nor a routine test is available. It was the aim of this trial to evaluate the usefullness of a prick-test for the diagnosis of histamine intolerance. Methods. Prick-testing with 1% histamine solution and wheal size-measurement to assess the relation between the wheal in prick-test, read after 20 to 50 minutes, as sign of slowed histamine degradation as well as history and symptoms of histamine intolerance. Results. Besides a pretest with 17 patients with HIT we investigated 156 persons (81 with HIT, 75 controls): 64 out of 81 with histamine intolerance(HIT), but only 14 out of 75 persons from the control-group presented with a histamine wheal ≥3 mm after 50 minutes (P < .0001). Conclusion and Clinical Relevance. Histamine-50 skin-prickt-test offers a simple tool with relevance.
背景。组胺不耐受是由组胺摄入和降解之间的不平衡引起的。在健康人群中，饮食中的组胺可以被胺氧化酶充分代谢，而胺氧化酶活性低的人则有组胺中毒的风险。二胺氧化酶(DAO)是生物降解的关键酶。组胺具有广泛的作用。组胺不耐受表现出鼻炎、头痛、胃肠道症状、心悸、荨麻疹和瘙痒等症状。目标。到目前为止，组胺不耐受的诊断是基于病史;既没有有效的问卷调查，也没有常规测试。本试验的目的是评价针刺试验对组胺不耐症诊断的有效性。方法。用1%组胺溶液进行刺痛试验，并测量车轮尺寸，以评估刺痛试验中车轮的关系，在20至50分钟后读取，作为组胺降解减缓的迹象，以及组胺不耐受的历史和症状。结果。除了对17例HIT患者进行预试验外，我们调查了156人(HIT患者81人，对照组75人):81人中有64人患有组胺不耐受(HIT)，但对照组75人中只有14人在50分钟后出现组胺轮≥3 mm (P < 0.0001)。结论及临床意义。组胺-50皮肤针刺试验提供了一个简单的相关工具。
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