Euromedica 2010 I Ignatova S Smirnova allergic rhinosinusopathy. some pecularities of pathogenesis"

I. Ignatova S. Smirnova	ALLERGIC RHINOSINUSOPATHY. SOME PECULARITIES OF PATHOGENESIS
	State Institution Research Institute of medical problems of the North, Siberian Department of Russian Academy of Medical Science, Krasnoyarsk, Russia

The urgency of the topic under discussion is explained by high morbidity of allergic rhinosinusopathy connected with its weighting and course modification.Considering extreme climatic conditions this problem is highly important for people of Eastern Syberia.

Allergic rhinosinusopathy is one of the most common displays of allergic clinical implications. Since 40% of Earth population suffer from allergic diseases, the share of AR is 25%. Thus more than half of allergic diseases has respiratory displays in the form of allergic rhinosinusopathy. (See Figure 1).

Earth Population Incidence Rate of Allergy

Allergic rhinosinusopathy is a disease or syndrome which is evident as paroxysmal rhinorrhea, sneezing, nose irritation and respiratory difficulty. These symptoms are based on the change of hyperreactivity and nose mucitis as a result of damaging action of allergic mediators, which elution is mediated by immunal and/or non-immunal mechanisms.

The Research Aim:

To allocate clinicopathogenetical variants of allergic rhinosinusopathy on the ground of research of its prevalence and pathogenesis patterns. To develop differential methods of its diagnostics and therapy.

To fulfil the desired goal the following tasks are defined:

To study the concentration pattern of IL-2, IL-4, IL-6 and IFN-γ in blood serum and nasal swabs depending on AR clinicopathogenic form.
To specify the pattern of population and subpopulation structure of blood lymphocytes and their intrinsic cellular metabolism depending on AR clinicopathogenic form.
To study characteristics of microbal spectre of nasal mucuous coat on AR clinicopathogenic form.

The Scope of Carried out Research:

Materials and means of the rasearch	Number of people
Total examined, of them
The study of population and subpopulation structure of blood serum lymphocytes by immunoﬂuorescence procedure with the help of homogeneous antibodies	121
Identification of local and systemic profile of some cytokines in blood serum and nasal swabs by the method of solid-phase enzyme immunoassay	73

AR PATIENTS SURVEY METHODS Otolaryngological Allergological Immunological Microbiological

population and subpopulation structure lymphocytes by immunoﬂuorescence procedure with the help of homogeneous antibodies
cytokines – solid-phase enzyme immunoassay Statistical Various clinical displays of allergic process are the result of damaging action of allergic mediators, which elution is mediated by immunal and/or non-immunal ways and which depend upon:
The way of admission of allergen and/or non-immunological activator to the body;
The “shock” organ of immune complex fixation or non-immunological cell activation – organistic localisation of allergic (pseudo allergic) reaction.
The type of immunopathologic base of allergic reaction startup. AR Classification based on pathogenesis

Pathogenetic forms

Clinicopathogenetic variants of AR

I. Original allergic

rhinosinusopathy

I.1 – Mediated by immune mechanisms

I.1.1 – atopic (reagin-dependent)

I.1.2 – non-atopic (not reagin-dependent)

I.2 - Mediated by combined (immune and non-immune) mechanisms

I.2.1 – in the presence of atopic mechanisms (reagin dependent)

I.2.2 - in the presence of non-atopic mechanisms (not reagin-dependent)

II. pseudoallergic

rhinosinusopathy

II.1 – Pseudoatopic (atopic analog) in connection with:

II.1.1 – introduction of monoamines mechanism

II.1.2 – abnormality of arachidonic acid metabolism

II.1.3 – abnormality of digestive apparatus functions

II.2 - Pseudoallergic (non-atopic analog) in connection with:

II.2.1 – abnormality of complement activation

II.2.2 – abnormality of digestive apparatus functions

To confirm pathogenetic differences of AR basic forms and specify new differential diagnostic criteria we carried ot the following clinical laboratory researches: identification of local and systematic cytokines profile; population and subpopulation structure of blood lymphocytes.

Local and System production of cytokines has its own features depending on clinical pathogenical variants of AR:

with atopy there is predominance of cytokine production Th2-lymphocytes (IIL-4, IL-6)
with pseudo atopy there is predominance of cytokine production Th1-lymphocytes (IIL-2, IFN-γ)

The results of the research confirmed that AR of atopic genesis is possible in the lack of suppressor inﬂuence of T-lymphocytes upon B- lymphocytes, which leads to hyperproduction of IgE

The discovered antipode changes of populational and subpopulational structure of blood lymphocytes depending on pathogenetical form of AR confirm its different setters. Differential diagnostical patterns of original AR and pseudo AR are based on:

Otolaryngologic and allergologic anamnesis
Data of clinical examinations
Figures, showing immunologic and allergologic reactivity condition
Functional condition of digestive apparatus (gastrointestinal tract, hepatobiliary system)

Differential diagnostical patterns of original AR and pseudo AR obtained during the research:

The discovered antipode changes of immunological reactivity (structure of CD-cells) depending on pathogenetical form of AR confirm their different evolution mechanisms.
Cytokine profile has its own features depending on clinical pathogenetical variant of AR. Thus, in the presence of original AR of atopic genesis the increased content of IL-4, IL-6 in blood serum and nasal swabs is discovered, which indicates the prevalence of Th-2 immune response. Cytokine concentration in blood serum and nasal swabs with pseudo AR is characterised by the prevalence of Th-1 immune response (increase in IL-2, IFN-γ).
The differences in the microﬂora were found: in the case of pseudo AR there were S.delphini, S.arlettae, S.chromogenes, S.lugdunensis and in the case of original AR there were a species of Micrococcus, yeast-like fungi, S.schleiferi. The discovered characteristics in the components of nasal mucuous coat microﬂora are probably associated to various etiological factors and pathogenetic mechanisms.