ABSTRACT
I. Introduction 83
II. Do ECP Blood Serum Levels Correlate with Disease Activity and
Mucosal Hyperreactivity? 84
A. In Adult Patients with Allergic and Nonallergic Asthma
and COPD 84
Introduction 84
Patients with Allergic Asthma 84
Patients with Both Allergic and Nonallergic Asthma 85
Patients with COPD 86
B. In Children with Allergic and Nonallergic Asthma 87
Introduction 87
Investigations Showing No Correlations 87
Investigations Suggesting Correlations 88
Investigations Showing Statistically Significant Correlations 88
Explanations for a Lack of Correlation 89
C. In Adult Patients with Allergic Rhinitis 91
Introduction 91
Investigations Showing No Correlations 91
Investigations Showing Statistically Significant Correlations 92
D. In Children with Allergic Rhinitis 93
Introduction 93
Investigations Showing No Correlations 94
Investigations Showing Statistically Significant Correlations 94
III. Do ECP Levels in Local Body Fluids (Sputum,
Nasal Secretion) Correlate with Disease Activity
and Mucosal Hyperreactivity? 95
A. In Children and Adult Patients with Allergic and
Nonallergic Asthma and COPD 95
Introduction 95
Patients with Both Allergic and Nonallergic Asthma 95
Patients with COPD 97
Bronchoalveolar Challenge Tests 97
B. In Adult Patients with Allergic Rhinitis 97
Introduction 97
ECP Levels in Nasal Secretions After Allergen Challenge 98
ECP Levels in Nasal Secretions Under Natural Allergen
Exposure Within the Season 99
ECP Levels in Nasal Secretions in Different Forms of Rhinitis 100
ECP Levels in Nasal Secretions Under Therapy 100
C. In Children with Allergic Rhinitis 101
Introduction 101
ECP Levels in Nasal Secretions Under Natural Allergen
Exposure Within the Season 101
ECP Levels in Nasal Secretions Under Therapy 102
IV. Do ECP Blood Serum Levels Correlate with ECP Levels in Local
Body Fluids (Sputum, Nasal Secretion)? 102
A. Introduction 102
B. Correlation Between ECP Blood Serum Levels and ECP
Levels in Sputum or Bronchoalveolar Lavage Fluid 103
Introduction 103
Clinical Studies 103
Therapy Studies 103
Direct Control of the Correlation 104
C. Correlation Between ECP Blood Serum Levels and ECP
Levels in Nasal Secretions 104
Introduction 104
Investigations Showing No Correlation 104
Investigations Suggesting Correlations 105
V. Variation of ECP Levels 106
A. Variation of ECP Blood Serum Levels 106
Introduction 106
In Vivo 106
In Vitro 107
B. Variation of ECP Levels in Sputum and Bronchoalveolar
Lavage Fluid 108
In Vivo 108
In Vitro 108
C. Variation of ECP Levels in Nasal Secretion and Nasal
Lavage Fluid 108
In Vivo and In Vitro 108
Influence of Sampling Methods 109
VI. Summary 109
Acknowledgments 111
References 111
I. Introduction
Allergic rhinitis is a type I allergic reaction causing an inflammation of the nasal
mucosa. In type I allergies an immediate phase and a late phase of the allergic
reaction may occur. The immediate phase is caused by a mast cell degranulation
with the release of histamine and other mediators, whereas the late phase
is caused by an immigration of inflammatory cells into the mucosa. A cell type
with major importance among these inflammatory cells is the eosinophil cell
(1-4). During the late phase of the allergic reaction the eosinophil cells are
not only attracted but also activated, leading to a release of granular proteins,
which cause the mucosal inflammation. These granular proteins are major
basic protein, eosinophil peroxidase, eosinophil-derived neurotoxin, and eosino-
phil cationic protein (ECP) (5). Since the content of ECP in cells other than
eosinophil cells is negligible and since it is only released by activated eosinophil
cells (6), ECP is a good and specific indicator of eosinophil cell activity and turn-
over, and possibly of mucosal inflammation (7).
