Clinical application of capsaicin cough challenge test / 中国基层医药

The capsaicin cough provocation test is the most commonly used test to objectively evaluate cough sensitivity.The mechanism is simple and the test can be accepted by a lot of patients, which could evaluate the degree of cough, guide medicine, promote new drug development, seek for the cause.This article mainly reviews the clinical application of capsaicin cough test to assess degree of cough and guide treatment.

Clinical application of capsaicin cough challenge test / 中国基层医药

The capsaicin cough provocation test is the most commonly used test to objectively evaluate cough sensitivity.The mechanism is simple and the test can be accepted by a lot of patients,which could evaluate the degree of cough,guide medicine,promote new drug development,seek for the cause.This article mainly reviews the clinical application of capsaicin cough test to assess degree of cough and guide treatment.

Paradoxical Response to Cold Dry Air Provocation according to the Season in Allergic Rhinitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We investigated the seasonal variation of nonspecific hyperreactivity by performing the cold dry air (CDA) provocation test in both summer and winter in patients with rhinitis. SUBJECTS AND METHOD: We performed the CDA provocation test in 57 patients with allergic rhinitis (AR) or non-allergic rhinitis (NAR). Depending on the season and the type of rhinitis, we divided patients into four groups (Summer AR group, n=17; Winter AR group, n=15; Summer NAR group, n=18 and Winter NAR group, n=7) and compared the changes in nasal symptoms, total nasal volume (TNV), and minimal cross-sectional area (MCA) measured by acoustic rhinometry after CDA provocation in each group. RESULTS: When the CDA provocation was performed for AR patients in summer, nasal symptoms improved slightly, which was significantly different from those shown in winter (Summer AR vs. Winter AR, p=0.012). In addition, there was a significant difference in symptom change between AR and NAR patients in the summer (Summer AR vs. Summer NAR, p=0.033). There was no significant difference in TNV or MCA changes after CDA provocation depending on the type of rhinitis and season (p>0.05). CONCLUSION: When performing CDA provocation in AR patients in summer, the examiner should pay attention to the possible paradoxical response.

Cold Dry Air Provocation and Immunoglobulin E in Nasal Fluid for Diagnosing Nonspecific Hyper-Reactivity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to evaluate the usefulness of cold dry air (CDA) provocation test in patients with non-allergic or allergic rhinitis. SUBJECTS AND METHOD: Twenty-one patients (13 males and 8 females, mean age 36.9±17.6 years) with symptoms of rhinitis were enrolled. We classified patients into groups A (control group, n=9) and B (allergic group, n=12) according to their skin prick test results. Before and after CDA provocation (0℃, relative humidity<10%, total 400 liters during 6 minutes), we evaluated changes in nasal symptoms. We collected serum, and nasal fluid before and after CDA provocation using the filter paper method. We measured serum and nasal fluid IgE levels, compared them between the groups, and evaluated the correlation between serum and nasal fluid IgE. RESULTS: After the CDA provocation, group B had more aggravation of symptoms than group A, with a statistical significance (for nasal obstruction, group A: 3.0±2.4, group B: 5.8±3.4, p=0.049; for itching, group A: 1.0±1.6, group B: 3.8±3.4, p=0.045). The level of serum total IgE was significantly higher in group B (group A: 152.7±67.3 ng/mL, group B: 612.1±291.4 ng/mL, p=0.001). The titer of nasal fluid IgE was higher in group B, before and after the CDA challenge (before CDA, group A: 91.7±52.6 ng/mL, group B: 810.0±1042.3 ng/mL, p=0.029, after CDA, group A: 55.8±43.8 ng/mL, group B: 354.9±236.7 ng/mL, p=0.003). There was a significant correlation between the serum IgE and nasal fluid IgE levels after the CDA provocation test (R2=0.749, p<0.001). CONCLUSION: The CDA provocation test and measurement of nasal fluid IgE level could be useful for the evaluation of nonspecific hyper-reactivity.

Usefulness of Allerkin House Dust Mite Extract for Nasal Provocation Testing

OBJECTIVES: We evaluated the clinical usefulness of Allerkin (Lofarma) for nasal provocation testing (NPT) in patients with rhinitis symptoms, by examining changes in nasal symptoms and acoustic parameters after exposure to house dust mite (HDM) extract. METHODS: Twenty patients (16 males and 4 females, mean age: 29.6±14.6 years) were enrolled. We performed skin prick test (SPT) before and 15 and 30 minutes after intranasal challenge with Allerkin HDM extract, and we evaluated symptom changes (nasal obstruction, rhinorrhea, sneezing, and itching) using a visual analogue scale. We also evaluated changes in acoustic parameters such as total nasal volume (TNV) and minimal cross-sectional area (MCA) before and after challenge. RESULTS: Group A (the nonallergic group, n=8) showed negative results for all tested aeroallergens in SPT and nonprovocative results ( 29% decrease in TNV/MCA from the baseline value). Patients in group C showed significant aggravation of nasal obstruction compared to those in group A (P < 0.05). Thirty minutes after HDM challenge, patients in groups B and C showed significantly greater decreases in MCA compared to those in group A (P < 0.01). CONCLUSION: Allerkin HDM extract can be a useful provocative agent in NPT for diagnosing allergic rhinitis and local allergic rhinitis.

Evidences for Local Allergic Rhinitis

Local allergic rhinitis is defined as a localized allergic reaction of the nasal mucosa in the absence of systemic atopy. Its main pathophysiological mechanism can be summarized as: 1) increased specific immunoglobulin E in the nasal fluid, and 2) Th2 allergic mechanism localized in the nasal mucosa. In patients whose result of a skin prick test is totally negative for all antigens, practitioners could diagnose local allergic rhinitis using a nasal provocation test. Oral antihistamines and intranasal steroids can be an effective treatment. Subcutaneous immunotherapy can also be helpful. Further study is essential to further elucidate the detailed pathophysiologic mechanism and set up global standard diagnostic criteria.

Instrumentos objetivos tradicionais de avaliação respiratória em respiradores orais / Traditional instruments objectives of respiratory evaluation in mouth breathers

A obstrução nasal é uma das principais anormalidades que afetam a permeabilidade nasal (PN) e em consequência está associada à respiração oral. Considerando a importância das complicações respiratórias e sua relação com o mecanismo de obstrução nasal, ressalta-se a necessidade e importância desse tipo de avaliação na população pediátrica e adulta. Objetivo: apresentar uma atualização da literatura quanto aos instrumentos objetivos para avaliação da permeabilidade das vias aéreas superiores e sua aplicabilidade na avaliação respiratória de indivíduos RO. Síntese dos dados: a revisão bibliográfica foi realizada utilizando as palavras-chaves: mouth breathing, nasal obstruction, nasal patency evaluation e instrumentos objetivos tradicionais da permeabilidade das vias aéreas: rhinomanometry, sniff nasal inspiratory pressure nasal peak flow, acoustic rhinometry, rhinomanometry e nasal spirometry. Uma síntese dos trabalhos foi organizada apresentando os instrumentos objetivos mais tradicionais encontrados na literatura. Com base nos estudos selecionados, discutiu-se sobre a indicação destes recursos na avaliação da permeabilidade de vias aéreas superiores. Conclusões: a avaliação respiratória objetiva de RO pode ser realizada por diferentes instrumentos tradicionais, utilizados tanto na avaliação, diagnóstico e identificação de efeitos de intervenções de RO.

The Current Knowledge of Allergen Nasal Provocation Test

Nasal provocation test (NPT) is a procedure used to evaluate the hyper-responsiveness of nasal mucosa after exposure to a provocative allergen. We aimed to identify the clinical indication and contra-indication for the use of NPT, and to introduce the actual NPT laboratory protocol in our clinical practice. We also provide clinical information which could be useful in conducting NPT. Finally, we discuss the current limitations of NPT and present a plan to overcome these difficulties.

Comparison of Collecting Methods of Nasal Fluids Using Albumin after Nasal Provocation in Allergic Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although different methods of collecting nasal fluid exist and can influence the result of the study, there have not been any studies made yet to compare the different methods. The authors aimed to evaluate the usefulness of these methods by comparing the albumin concentration of nasal fluid after nasal provocation in patients with allergic rhinitis. SUBJECTS AND METHOD: In 22 patients with allergic rhinitis, we measured the change of nasal obstruction and rhinorrhea after nasal provocation using Visual Analogue Scale (VAS). In Group A (n=10), the nasal lavage and direct suction method were used and in Group B (n=12), nasal lavage and filter paper method were used. Nasal fluids were obtained before, 20 min after and 8 hours after provocation. The concentration of albumin was calculated using rate nephelometry. RESULTS: Patients' nasal symptoms were aggravated in early allergic reaction but subsided in late reaction. There was meaningful increase of albumin concentration with the use of direct suction and filter paper methods. In contrast, there was no significant increase of concentration with the use of lavage method. CONCLUSION: The filter paper method is superior in the quantitative analysis of mediators in nasal fluid after nasal provocation in allergic patients. The lavage method, however, is considered inappropriate because of its dilution effect.

Função pulmonar e sintomas extra-nasais observados durante testes de provocação nasal com histamina em crianças e adolescentes / Lung function and non nasal symptoms observed during histamine nasal provocation tests in children and adolescents

Objetivo: Descrever o comportamento dos valores de função pulmonar e os sintomas extra-nasais induzidos pelo teste de provocação nasal (TPN) com histamina em crianças e adolescentescom rinite alérgica (RA) e em controles não alérgicos. Métodos: Vinte crianças e adolescentes com RA persistente (11 asmáticos) e 20 controles foram submetidos a TPN com histamina. Os pacientes com RA foram tratados com corticosteróide tópico nasal e re-provocados. Sintomas extra-nasaisforma registrados durante os TPN e função pulmonar (VEF1) foi mensurada antes e ao final da provocação. Resultados: Valores aceitáveis e reprodutíveis de função pulmonar foram obtidos em 32 dos TPN do grupo com rinite alérgica e em 15 de controles. Não houve diferença nos valores de VEF1 antes e após os TPN. Redução igual ou superior a 7% do valor basal de VEF1 foi encontrada em 7 pacientes com RA, todos asmáticos, e em um controle. Os pacientes asmáticos apresentaram variação VEF1 significantemente maior que os não asmáticos (diminuição de 4,2% versus 1,6%). Tosse foi observada em 12 TPN, sendo 11 em pacientes com RA (9 em asmáticos). Sintomas oculares foram observados em 18 TPN, 14 de pacientes com RA (10 antes do tratamento e 4 depois). Sintomas faríngeos foram desencadeados em 11 TPN, sendo 8 em pacientes com RA. Nenhuma reação grave foi observada. Conclusões: TPN com histamina são seguros, sem nenhuma reação adversa grave observada em 60 testes realizados. Queda dos valores de função pulmonar e sintomas respiratórios baixos podem ocorrer, particularmente em pacientes com asma concomitante. A indução de sintomas faríngeos e oculares em pacientes com RA é comum nesses testes e raramentese observa sintomas em outros órgãos.

Objective: To describe lung function and non nasal symptomsin histamine nasal provocation tests (NPT) in children and adolescents with allergic rhinitis (AR) and controls. Methods: Twenty children and adolescents with persistent AR (11 with asthma) and 20 controls were submitted to histamineNPT. Patients with AR were treated with topical nasal steroids and re-tested. Non nasal symptoms were recorded during NPT and lung function (FEV1) was measured before and after the provocation. Results: Acceptable and reproducible values of lung function were obtained in 32 NPT from the AR group and in 15 from the control group. No difference in pre and post NPT FEV1 was observed. Reduction of 7% or more from basal FEV1 was noted in 7 patients with AR, all asthmatics, and in one control. Asthmatic patients showed significantly higher FEV1 variation than non asthmatics (4.2% reduction versus 1.6%). Cough was observedin 12 NPT, 11 from AR patients (9 from asthmatics). Ocular symptoms were induced in 18 NPT, 14 from AR patients(10 before treatment and 4 after). Pharyngeal symptoms were observed in 11 NPT, 8 from AR patients. No severe adverse reaction was observed. Conclusions: Histamine NPT are safe without any severe adverse reaction observed in 60 provocations. Reduction of lung function values and lower respiratory symptoms can occur, particularly in patients with concomitant asthma. Pharyngeal and ocular symptoms are frequently induced in AR patients during NPT, but symptoms in other organs are rare.