The Expression And Significance Of Immunoglobulin Free Light Chain In Allergic Rhinitis And Non-allergic Rhinitis

Background:The high prevalence of the rhinitis and it impact on qualityof life is still challenge for physician in management as complication ofpathogenesis of the rhinitis. Rhinitis is generally categorized as allergic ornonallergic. The IgE-mediated allergic rhinitis is the most common clinicalform. Considerable cases of nonallergic rhinitis in clinical, however,manifestate nasal hypersensitivity. The symptoms of the hypersensitive rhinitisare very similar to allergic rhinitis but the causes appear to be entirely different.According to EAACI (2001) and WAO (2004), the pathogenic mechanism ofhypersensitivity may be immunologic or non-immunologic and the hypers-ensitive rhinitis induced by immunologic mechanism is classified IgE-mediatedand non-IgE-mediated. The non-IgE-mediated hypersensitive rhinitis (NIHR)induced by immunomechanism as clinical entity, Redegeld et al. demonstratedfirstly that the specific immunoglobulins free light chain (FLC) may induce theimmediate hypersensitive response depending upon the mast cells. After this,Redegeld and his research group proved sequentially that the FLC may elicitallergic asthma and proposal that FLC may be a novel target in the therapy ofchronic inflammatory diseases. According above, Powe et al.(2010) studiedpatients with nasal hypersensitivity and found that significantly increasedFLC-expressing cells in the mucosa of patients with persistent allergic andNon-allergic rhinitis with eosinophilia syndrome (NARES), localized in mastcells and plasma cells, and increased FLC serum levels in subjects withNARES. FLC may provide an additional non-IgE immune pathway to augmentor replace IgE-mediated hypersensitivity in chronic mucosal inflammatorydisease. The pathogenesis of non-allergic rhinitis with nasal hypersensitivity is notclear so far resulting in confusion and weak on the basis of treatment. Thepresent study aim to proving hypothesis that The FLC may play important rolein nonallergic rhinitis (NAR) with nasal hyperreactivity but NARES throughobserving the expression level of FLC, tryptase (biomarker of mast cells), ECP(biomarker of eosinophils) in nasal mucosa, nasal secretion and serum frompatients without positive results of allergen skin test and serum level of allergenspecific IgE.Method:On the first part,398consecutive patients were recruited in2009.Questionnaire survey based on ARIA2008was conducted to both groups of ARand NAR. Multiple aspects were analyzed to find the difference. On the secondpart, Selected60consecutive patients from Sep to Dec in2009involved30allergic rhinitis patients,30non-allergic rhinitis patients who were diagnosedby Symptom, Sign, SPT and sIgE, and10volunteers and20patients withdeviation of nasal septum who were choosen to be control. ELISA was used todetect the total IgE, eosinophil cationic protein(ECP), mast cell tryptase,κFLC,λFLC of nasal secretions and serum. Histopathological observations andimmunohistochemical staining for κFLC, λFLC, ECP and MCT wereperformed on30specimens (10AR,10NAR and10specimen's inferiorturbinate of deviation of nasal septum). The serum and nasal secretionsexpression levels of totel IgE, ECP, MCT, κFLC,λFLC were determined byELISA (30AR,30NAR,10normal human and20specimens inferior turbinateof deviation of nasal septum). Whilst the mRNA expression of κFLC,λFLCAND MCT was determined by real-time quantitative PCR were performed on30specimens (10AR,10NAR and10specimens inferior turbinate of deviationof nasal septum).Result: In AR, male was more than female, whereas in NAR (P﹤0.01).The highest morbidity age in AR was teenagers (P﹤0.01), while in NAR was middle-aged (P﹤.01). The main onset season in AR was autumn, while noseasonal diversity in NAR. The main classification of AR was moderate-severepersisten(tP﹤.01), while in NAR was moderate-severe intermitten(tP﹤0.01).The frequency of clinical symptoms was different except sneezing and gasping.(P﹤0.05).The severity of clinical symptoms was different exceptrhinocnesmus(P﹤0.05). There was consistency about induced factors in ARand NAR(P＞0.05). The second parts shown that FLC main expressed on mastcell, ELISA examine shown that κFLC,λFLC,ECP&Tryptase were increase inAR and NAR compared to HC (P<0.01); There are significantly differencesbetween AR and NAR of ECP form nasal secretions (P<0.05), The total IgEfrom serum were increased in AR compared to NAR and HC (P<0.05), andthere are differences of the total IgE form nasal secretions among three groups(p<0.05).Conclusion: There were significant differences between AR and NAR insex, age, classification and seasons. The frequency of clinical symptoms weresignificantly different between AR and NAR except sneezing andgasping.Comparised the clinical symptoms of nose and eye, The severity ofclinical symptoms in AR was higher than that in NAR except rhinocnesmus.There was consistency about induced factors in AR and NAR. This study hassome clinical significance in correct recognition and diagnosis of AR and NAR.Immunoglobulin free light chain took part in the pathophysiological process ofallergic rhinitis and non-allergic rhinitis with the immunological mechanism.