Upper respiratory tract environmental tobacco smoke sensitivity

Some patients report rhinitis symptoms after exposure to environmental tobacco smoke (ETS), but objective assessments of this response have been lacking. Furthermore, the mechanism of this response is unknown. We assessed the frequency of ETS-related symptoms by administering a questionnaire to 77 healthy nonsmoking young adults who were participating in an unrelated study. Of the subjects 34% (26 of 77) reported one or more rhinitis symptoms (congestion, rhinorrhea, or sneezing) following ETS exposure. We then exposed 10 historically ETS-sensitive (ETS-S) and 11 historically ETS-nonsensitive (ETS-NS) subjects to 15 min of clean air followed by 15 min of sidestream tobacco smoke (CO concentration of 45 parts per million). At selected time points during these procedures we recorded symptoms, posterior nasal resistance, and spirometry and performed nasal lavages. ETS-S but not ETS-NS subjects reported significant (p < 0.01) increases in nasal congestion, headache, chest discomfort or tightness, and cough following exposure to sidestream tobacco smoke. Rhinorrhea symptoms were greater and more prolonged in ETS-S subjects compared to ETS-NS subjects. Significant (p < 0.01) increases in perception of odor and in eye, nose, and throat irritation occurred in both study groups, but ETS-S subjects reported significantly more nose and throat irritation. No significant changes in posterior nasal resistance occurred in the ETS-NS group but a significant increase occurred in the ETS-S subjects, with the resistance rising from 3.8 ± 0.5 cm H₂O/L/s (mean ± SE) preexposure to a peak of 8.0 ± 2.7 cm H₂O/L/s 20 min after completion of the smoke exposure (p < 0.001). Pulmonary function changes were of a small magnitude (<7%) in both groups. No significant increases occurred in the levels of histamine, albumin, kinin, or TAME-esterase activity in nasal lavage fluids. These data provide objective evidence of an increased responsiveness to ETS in historically sensitive subjects but suggest that an allergic, IgE-mediated mechanism is unlikely since no histamine was detected despite the symptomatic and physiologic response.