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Eva Millqvist,¹ Ewa Ternesten-Hasséus,¹ Arne Ståhl,¹ and Mats Bende²

¹Asthma and Allergy Research Group, Department of Respiratory Medicine and Allergy, Sahlgrenska University Hospital, Göteborg, Sweden; ²Allergy Centre, Central Hospital, Skövde, Sweden

Abstract
Patients complaining of upper and lower airway symptoms caused by scents and chemicals have previously been shown to have increased cough sensitivity to inhaled capsaicin, but the precise mechanisms behind this reaction are unknown. Hypothesizing that a neurochemical alteration related to sensory hyperreactivity (SHR) of the airway mucosa occurs, we measured levels of nerve growth factor (NGF) in nasal lavage fluid (NAL) before and after capsaicin inhalation provocations and related the capsaicin cough sensitivity to the NGF levels. Thirteen patients with SHR and 14 control subjects were provoked with capsaicin inhalation at three different doses. We measured NGF in NAL before and after provocation and recorded cough and capsaicin-induced symptoms. All subjects demonstrated a dose-dependent cough response to capsaicin inhalation, with a more pronounced effect in patients than in controls. Basal levels of NGF were significantly lower in the patient group than in the control subjects (p < 0.01) . After capsaicin provocation, the patients showed a significant increase in NGF (p < 0.01) , which was related to capsaicin cough sensitivity. The findings demonstrate that, in patients with airway symptoms induced by scents and chemicals, SHR is real and measurable, demonstrating a pathophysiology in the airways of these patients compared to healthy subjects. Key words: airway symptoms, chemical intolerance, multiple chemical sensitivity, nasal lavage fluid, nerve growth factor, sensory hyperreactivity. Environ Health Perspect 113: 849-852 (2005) . doi:10.1289/ehp.7657 available via http://dx.doi.org/ [Online 17 March 2005]

Address correspondence to E. Millqvist, Asthma and Allergy Research Group, Department of Respiratory Medicine and Allergy, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden. Telephone: 46-31-3423635. Fax: 46-31-417824. E-mail: eva.millqvist@medfak.gu.se

We thank S. Rak for valuable discussions and E. Carlsson for skillful laboratory assistance.

This study was supported by grants from the Vårdal Foundation, the Regional Health Care Authority of West Sweden, and the Swedish Heart and Lung Foundation.

The authors declare they have no competing financial interests.

Received 13 October 2004 ; accepted 17 March 2005.