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Allergic rhinitis: Pathophysiology

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The inflammatory response in the nasal mucosa in subjects with allergic rhinitis challenged intranasally with an allergen includes an immediate IgE-mediated mast cell response as well as a late-phase response characterized by recruitment of eosinophils, basophils, and T cells expressing Th2 cytokines including IL-4, a switch factor for IgE synthesis, and IL-5, an eosinophil growth factor. Recent advances have suggested that additional pathways may contribute to the pathophysiology of allergic rhinitis including local synthesis of IgE in the nasal mucosa, the epithelial expression of cytokines that regulate Th2 cytokine responses (i.e., thymic stromal lymphopoietin, IL-25, and IL-33), and the activation of histamine receptors other than H1 and H2 such as H4-histamine receptors. This review focuses on briefly reviewing well-established pathways in the pathophysiology of allergic rhinitis and then updating knowledge on recent advances in the pathophysiology of allergic rhinitis. The review references information obtained from original articles published and available online on PubMed. In vitro and in vivo studies indicate that B cells in nasal mucosa can be induced to express IgE. Preclinical studies show an important role for epithelial-derived cytokines (thymic stromal lymphopoietin, IL-25, and IL-33) in regulating Th2 responses at mucosal surfaces, and for H4-histamine receptors in mediating itching. In addition, regulatory T cells may play an important role in mediating active tolerance to allergens. An improved understanding of the pathophysiology of allergic rhinitis may provide important insight into novel therapeutic targets.
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Keywords: Eosinophil; H4-receptor; IL-25; IL-33; IgE; T cell; TSLP; histamine; mast cell

Document Type: Research Article

Affiliations: Department of Medicine, University of California San Diego, San Diego, California, USA

Publication date: 01 September 2010

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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