The cellular basis for allergic rhinitis

In both seasonal and perennial rhinitis there is epithelial mast cell accumulation and tissue infiltration by eosinophils. Activation of these cells can be observed by electron microscopy and by elevated levels of tryptase and eosinophil cationic protein in nasal lavage fluid. Furthermore, seasonal increases in the antigen presenting cell (Langerhans’cell) are also evident. Investigations into the mechanisms involved in cell accumulation and activation reveals upregulation of leucocyte endothelial adhesion molecules and an increase in interleukin‐4 (IL‐4) in naturally occurring rhinitis, while mRNA for IL‐4, IL‐5 and granulocyte macrophage colony stimulating factor activity and lavage tumour necrosis factor‐alpha (TNFα) levels are increased following local allergen challenge. These cytokines may be derived from a variety of sources, including mast cells, eosinophils and T‐lymphocytes, and contribute to the underlying inflammatory process in rhinitis.