Nasal mucosal hyperpermeability to macromolecules in atopic rhinitis and extrinsic asthma.

This study was designed to test the hypothesis that patients with atopic rhinitis and extrinsic asthma have a nasal mucous membrane defect that allows inhaled macromolecules access to immunocompetent cells. Three groups were studied: normal subjects, patients with extrinsic asthma, and patients with atopic rhinitis. Albumin 125I(20 muc) was applied to the nasal mucosa and venous blood samples were drawn at set intervals up to 4 hours. Thirty-two minutes after administration, a significantly greater percentage of the dose was found in the plasma of patients with atopic rhinitis than in that of normal subjects (p smaller than 0.001). Transport of intact albumin across the nasal mucosa was demonstrated by dialysis, gel filtration, and immunopercipitation experiments in 3/9 normal subjects, 1/9 patients with asthma, and 9/10 patients with rhinitis (p smaller than 0.02). These studies suggest that large, potentially antigenic molecules pass more readily across the nasal mucous membrane of patients with allergic rhinitis than that of normal subjects. No increase in nasal transport was seen in patients with extrinsic asthma. It has not been determined whether this defect is a cause or an effect of atopic rhinitis.