Otolaryngology– Head and Neck Surgery 145(3) 396–400 © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2011 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599811410531 http://otojournal.org No sponsorships or competing interests have been disclosed for this article. Abstract Objective. The purpose of this study was to understand and assess the inflammatory response within the upper and lower airways in patients suffering from both asthma and allergic rhinitis. Study Design. Cross-sectional study. Setting. A laboratory-based study of patients with allergic rhi- nitis and asthma. Subjects and Methods. Glycol methacrylate resin–embedded specimens from 10 patients with allergic rhinitis and asthma taken from the nose and bronchi were assessed by immu- nohistochemistry. Monoclonal antibodies directed against specific cell markers for mast cells (AA1), eosinophils (EG2), neutrophils (NOE), and lymphocytes (CD3 + , CD4 + , CD8 + ) were studied. Cells were counted blind (as cells/mm 2 ) in the submucosal matrix. Mann-Whitney U test was used for analyses. P values of .05 or lower were considered statistically significant. Results. There was a significant increase in CD4 + (P = .05) and CD8 + cell counts (P = .001) in the lower airway compared to the upper airway. There were no differences between the 2 groups in the number of neutrophils, mast cells, eosinophils, and the CD3 + cell counts. Conclusion. The upper and lower airways have parallel inflam- mation with possible bidirectional extension of inflammation in patients suffering from asthma and allergic rhinitis. There is increased lymphocytic infiltration in the lower airway, sug- gesting a possible preponderance for development and main- tenance of allergic disease in the lower airway. Keywords allergic rhinitis, asthma, mast cells, eosinophils, neutrophils, lymphocytes, nasal mucosa, bronchial mucosa Received September 14, 2009; revised April 6, 2011; accepted April 25, 2011. A llergic rhinitis is an inflammatory disease of global prevalence with a parallel increase in the prevalence of asthma. Most patients with asthma also have a his- tory or evidence of rhinitis, and up to 30% of patients with persistent rhinitis have or develop asthma. Individuals with preexisting allergic rhinitis (AR) have an increased risk for the development of asthma, 1 particularly in the presence of risk factors such as family history of asthma and atopy. 2 Asymptomatic bronchial hyperresponsiveness (BHR) is generally caused by airway inflammation, a feature of asthma, and is also frequently present in allergic rhinitis. 3 The inflam- matory responses in the nasal mucosa and in the bronchial mucosa have not been fully elucidated in patients with clinical symptoms of allergic rhinitis and asthma. Very few studies have investigated upper and lower airways simultaneously in atopic patients. Chanez et al 4 compared nasal and bronchial inflammation in asthmatic patients with perennial rhinitis and found more eosinophilia and structural changes in the bronchial mucosa than in the nasal mucosa. Two other studies compared upper and lower airway inflammatory cell infiltration in asthma and allergic rhinitis but in individual groups of patients with asthma, rhinitis, and healthy controls. 5,6 We studied the inflam- matory cell infiltration in the upper and lower airways of patients with the clinical symptoms of allergic rhinitis and asthma simultaneously to assess any difference or preponder- ance of inflammation in the 2 airways. Materials and Methods Subjects Ten subjects with perennial allergic rhinitis and mild to moderate asthma on short-acting β 2 -agonists on demand volunteered to 410531OTO XX X 10.1177/0194599811410531Bhim rao et alOtolaryngology–Head and Neck Surgery © The Author(s) 2010 Reprints and permission: sagepub.com/journalsPermissions.nav 1 Division of Airway, Inflammation and Repair, School of Medicine, University of Southampton, Southampton, UK This article was presented at the 2009 AAO-HNSF Annual Meeting & OTO EXPO; October 4-7, 2009; San Diego, California. Corresponding Author: Sanjiv K. Bhimrao, DM, FRCS, Department of Otolaryngology, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0QQ, UK Email: skambekar@gmail.com Airway Inflammation in Atopic Patients: A Comparison of the Upper and Lower Airways Sanjiv K. Bhimrao, DM, FRCS 1 , Susan J. Wilson, PhD 1 , and Peter H. Howarth, DM, FRCP 1 Original Research—Allergy