HYPERREACTIVITY

Experimental methods for determining the potential of materials to produce hypersensitivity reactions by inhalation use procedures to detect hyperreactivity of the airways as demonstrated by marked changes in resistance to air flow, and the detection of antibodies in blood semm (93). 

Vagal effects, salivation/A blood pressure, dry mouth/4- ocular accommodation Vagal effects, salivation adrenergic/A blood pressure/facilitates D1 stim Hyperreactivity/facilitates a-activation... 

Inhaled steroids (commonly used are beclomethasone, budesonide, triamcinolone, fluticasone, flunisolide) appear to attenuate the inflammatory response, to reduce bronchial hyperreactivity, to decrease exacerbations and to improve health status they may also reduce the risk of myocar dial infar ction, but they do not modify the longterm decline in lung function. Whether- steroids affect mortality remains unclear. Many patients appear to be resistant to steroids and large, long-term trials have shown only limited effectiveness of inhaled corticosteroid ther apy. Certainly, the benefit from steroids is smaller in COPD than in asthma. Topical side-effects of inhaled steroids are oropharyngeal candidiasis and hoarse voice. At the normal doses systemic side-effects of inhaled steroids have not been firmly established. The current recommendation is that the addition of inhaled gluco-coiticosteroids to bronchodilator treatment is appropriate for patients with severe to veiy sever e COPD. 

Fig. 19.3. Subjective skin hyperreactivity after salicylic acid peel...

Daffonchio, L., Payne, A.N., Lees. I.W. and Whittle, B.J.R. (1989). Airway hyperreactivity follows anaphylactic microshock in anaesthetised guinea-pigs. Eur. J. Pharmacol., 161, 135-142. 

Empey, D.W., Laitinen, L.A., Jacobs. L., Gold, W.M. and Nadel, J.A. (1976). Mechanisms of bronchial hyperreactivity in normal subjects after upper respiratory tract infection. Am. Rev. Resp. Dis. 113, 131 - 139. 

Yeadon, M. and Payne, A.N. (1989). Ozone-induced bronchial hyperreactivity to histamine and ovalbumin in sensitised guinea-p differences between intravenous and aerosol challenge. Eur. Resp. J. 2, 2995. 

Yeadon, M., Wilkinson, D., Darley-Usmar, V., O Leary, V.J. and Payne, A.N. (1992). Mechanisms contributing to ozone-induced bronchial hyperreactivity in guinea-pigs. Pulmon. Pharmacol. 5, 39-50. 

Yeadon, M., Eve, D. and Payne, A.N. (1993b). Ozone exposure in guinea-pigs induces bronchial hyperreactivity to histamine and salbutamol, but not to leukotriene D4. Br. J. Pharmacol. 108, 220P. 

Intranasal anticholinergic agents (e.g., ipratropium) reduce the severity and duration of rhinorrhea but have no effect on other nasal symptoms.11,12,21 Ipratropium reduces cholinergic hyperreactivity and cholinergically mediated histamine- and antigen-induced secretion. Intranasal ipratropium acts locally, with only minimal systemic absorption. Clinical trials demonstrated that ipratropium bromide 0.3% reduced rhinorrhea in adults and children with PAR.11,12 Intranasal ipratropium is an option for patients in whom rhinorrhea is refractory to topical intranasal corticosteroids and/or antihistamines.8,12 Intranasal ipratropium is available only by prescription, and the dose is two sprays nasally two to three times daily.15 Adverse effects are minimal, but dry nasal membranes have been reported.11,12... 

Allergic rhinitis A highly prevalent, allergen-induced, upper airway inflammatory disease characterized by chronic hyperreactive airway mucosa with periods of acute exacerbations. 

Gonzalo JA, Pan Y, Lloyd CM, et al. Mouse monocyte-derived chemokine is involved in airway hyperreactivity and lung inflammation. J Immunol 1999 163(1) 403 111. 

Thomas MS, Kunkel SL, Lukacs NW. Regulation of cockroach antigen-induced allergic airway hyperreactivity by the CXCR3 ligand CXCL9. J Immunol 2004 173(l) 615-623. 

Schaller MA, Lundy SK, Huffnagle GB, Lukacs NW. CD8+ T cell contributions to allergen induced pulmonary inflammation and airway hyperreactivity. Eur J Immunol 2005 35(7) 2061-2070. 

Koth LL, Rodriguez MW, Bernstein XL, et al. Aspergillus antigen induces robust Th2 cytokine production, inflammation, airway hyperreactivity and fibrosis in the absence of MCP-1 or CCR2. Respir Res 2004 5(1) 12. 

Campbell EM, Charo IF, Kunkel SL, et al. Monocyte chemoattractant protein-1 mediates cockroach allergen-induced bronchial hyperreactivity in normal but not CCR2 / mice the role of mast cells. J Immunol 1999 163(4) 2160-2167. 

Lukacs NW, Berlin A, Schols D, Skerlj RT, Bridger GJ. AMD3100, a CxCR4 antagonist, attenuates allergic lung inflammation and airway hyperreactivity. Am J Pathol 2002 160(4) 1353-1360. 

Miller AL, Stricter RM, Gruber AD, Ho SB, Lukacs NW. CXCR2 regulates respiratory syncytial virus-induced airway hyperreactivity and mucus overproduction. J Immunol 2003 170(6) 3348-3356. 

Fig. 19.3. Subjective skin hyperreactivity after salicylic Fig. 19.4. Subjective skin hyperreactivity after salicylic acid peel acid peel...

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