Value of allergen nasal provocation test in assessment of the efficacy of house dust mites specific immunotherapy / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the value of nasal provocation test（NPT） in evaluating the efficacy of allergen immunotherapy（AIT） in patients with dust mite induced allergic rhinitis（AR）. Methods:A total of 83 patients with dust mite induced AR with/without asthma were included. Symptom score（SS）, daily medication score（DMS）, combined symptom and medication score（CSMS）, rhinoconjunctivitis quality of life questionnaire（RQLQ）, NPT and skin prick test（SPT） were assessed before and after 1 year AIT. Results:There were statistical differences in SS（P<0.000 1）, DMS（P<0.000 1）, CSMS（P<0.000 1）, and RQLQ（P<0.000 1） after 1 year of AIT compared with pre-treatment. The effective rate of CSMS was 73.49%, and the effective rate of NPT was 42.17%. CSMS was consistent with NPT in efficacy assessment（Kappa=0.437, P<0.001）; while in 54 patients with pre-treatment NPT concentrations other than the original concentration, CMSM and NPT showed better consistence（Kappa=0.895, P<0.001）. Among the 48 patients with ineffective NPT assessment in the first year, 25 patients completed the second-year follow-up, and 12 patients（48.00%） showed effective in NPT. However, 10 out of 12 patients（83.33%） with NPT concentration other than original solution pre-treatment showed effective NPT at the second year. Conclusion:NPT can be used as one of the indicators for efficacy evaluation for dust mite induced AR patients, especially for patients with positive NPT induced at lower concentrations before treatment.

Research progress and clinical application of allergen nasal provocation test / 临床耳鼻咽喉头颈外科杂志

The allergen nasal provocation testing（NPT）, in which allergens are applied directly to the nasal mucosa under standard and controlled conditions to provoke the main symptoms of allergic rhinitis（AR）, reproduces the response of the upper respiratory tract to natural exposure to allergens under controlled conditions and is the only test currently available to confirm nasal reactivity to allergens. It is invaluable in studying the mechanisms of AR and in assessing the response to novel anti-allergic treatments. The test may play an increasingly important role in clinical practice, especially in the identification of local AR, the diagnosis of occupational AR, the clarification of the composition of allergens, the assessment of the efficacy of AR treatment and the selection of candidates undergoing allergen immunotherapy. This article reviewed the application of NPT in the diagnosis of allergic and non-allergic rhinitis, and also introduces the indications, contraindications, advantages and limitations of NPT in evaluating nasal response.

Efficacy of Nasal Cellulose Powder in the Symptomatic Treatment of Allergic Rhinitis: A Randomized, Double-Blind, Placebo-Controlled Trial

PURPOSE: Nasal Cellulose Powder (NCP), which can prevent from binding an allergen to nasal mucosa, may reduce allergic rhinitis (AR) symptoms in dust mite-sensitized children. This study was conducted to assess the efficacy of NCP in improving clinical symptoms of a nasal airflow limitation and the response of nasal inflammatory cells. METHODS: Children with dust mite-sensitized AR aged 6–18 years were recruited. After a 4-week run-in period, NCP or a placebo was administered, 1 puff per nostril 3 times daily for 4 weeks. The nasal provocation test (NPT) with Dermatophagoides pteronyssinus (Der p) was performed before and after treatment. The daily symptom scores (DSS), daily medication scores (DMS), the peak nasal inspiratory flows (PNIF), nasal airway resistance (NAR), as well as the maximum tolerated dose of NPT and eosinophil counts in nasal scraping, were evaluated. RESULTS: Sixty children (30 NCP and 30 placebos) were enrolled. Before treatment, there were no significant differences in age, dust mite control measures, DSS, DMS, PNIF, NAR, the maximum tolerated dose of NPT, or nasal eosinophil scores between children receiving NCP and placebos. After treatment, there were no significant differences between the NCP and placebo groups in the median (range) of the outcomes—DSS: 2.06 (0.18–3.77) vs. 1.79 (0.08–7.79), P=0.756; DMS: 1.60 (0–5.13) vs. 0.56 (0–4.84), P=0.239; PNIF (L/min): 110 (60–160) vs. 100 (50–180), P=0.870; NAR (Pa/cm³/s): 0.40 (0.20–0.97) vs. 0.39 (0.24–1.32), P=0.690; the maximum tolerated dose of NPT and the nasal eosinophil scores: 1 (0–4) vs. 1 (0–4), P=0.861. CONCLUSIONS: NCP treatment may not be more effective than placebo treatment in dust mite-sensitized AR children.

Prevalence and Clinical Characteristics of Local Allergic Rhinitis to House Dust Mites

Local allergic rhinitis (LAR) is a localized nasal allergic response in the absence of systemic atopy. The aim of this study was to evaluate the prevalence and clinical characteristics of LAR in Korean rhinitis patients compared to allergic rhinitis (AR) and non-allergic rhinitis (NAR). A total of 304 rhinitis patients were enrolled from November 2014 to March 2016. A skin prick test, serum total and specific immunoglobulin E, and a nasal provocation test (NPT) with house dust mite (HDM) were performed on all patients. Subjects also documented changes in rhinitis symptoms before and after NPT. Seventy-four patients with nasal hyper-reactivity and 80 patients with subclinical allergy were excluded. AR was diagnosed in 69 (46.0%) patients, NAR in 75 (50.0%) patients, and LAR to HDM in 6 (4.0%) patients. The average medication score and disease duration of each group were 14.5 points and 77.6 months in AR, 12.1 point and 51.1 months in NAR, and 17.7 point and 106.0 months in LAR, respectively. There were no significant differences in the baseline nasal symptom score of the three groups. However, after NPT with HDM, the score of rhinitis, itching, and obstructive were 4.83±1.47 vs. 1.95±2.53, 3.00±2.10 vs. 1.45±2.06, and 5.50±1.38 vs. 2.57±2.84 in LAR and NAR, respectively (p<0.05). LAR patients had longer duration of disease and tended to be older and have higher medication score than other rhinitis patients.

Usefulness of House Dust Mite Nasal Provocation Test in Asthma

PURPOSE: We previously reported that the skin prick test was sensitive and the serum specific immunoglobulin E test was specific for predicting positive airway responses to house dust mites (HDMs) in patients with asthma. Because the nose and bronchus are one airway, the nasal provocation test would be more specific for predicting the bronchial responses to HDM than the skin test. METHODS: The allergy skin prick test and nasal and bronchial provocation tests using HDM (Dermatophagoides farinae) were performed in 41 young men (age, 19–28 years) who wanted military certification for asthma. The nasal responses to HDM was scored according to the severity of rhinorrhea, sneezing, and nose itching. RESULTS: The prevalence of a positive skin prick test to HDM did not significantly differ between patients with (n=24) and without (n=17) an early airway reaction (EAR; 79.2% vs 70.6%, P=0.534). However, the prevalence of a positive nasal test was significantly higher in the airway responders than in the others (37.5% vs 0%, P=0.005). The concordance of a positive response to the nasal test (κ=0.332, P=0.004) but not to the skin prick test (κ=0.091, P=0.529) was significant with an EAR. The diagnostic sensitivity of the nasal test (37.5%) was lower than that of the skin prick test (79.2%), but the specificity was higher (100% vs 29.4%). CONCLUSIONS: The skin prick test is more sensitive, whereas the nasal test is more specific and accurate, for predicting an EAR to HDM in patients with asthma.

A Case of Occupational Rhinitis Induced by Maize Pollen Exposure in a Farmer: Detection of IgE-Binding Components

Corn is a major staple food, along with rice and wheat, in many parts of the world. There are several reports of hypersensitivity to maize pollen. However, cases of occupational allergic rhinitis induced by inhalation of maize pollen are very rare. We herein report the case of a 67-year-old male with occupational rhinitis caused by occupational exposure to maize pollen in a cornfield. He showed positive responses to maize pollen, as well as grass pollens, in skin prick tests. A high level of serum immunoglobulin E (IgE) specific to maize pollen extracts was detected by an enzyme-linked immunosorbent assay (ELISA). Laboratory tests showed a high serum level of total IgE (724 kU/L) and a high level of IgE specific to maize pollen (8.32 kU/L) using the Immuno-CAP system. Occupational rhinitis was confirmed by a nasal provocation test with maize pollen extracts. IgE ELISA inhibition tests showed antibody cross-reactivity between maize pollen and grass pollen extracts. IgE immunoblotting using maize pollen extracts demonstrated a 27 kDa IgE-binding component. These findings suggest that maize pollen can induce IgE-mediated occupational rhinitis in exposed workers.

Nasal provocation test: how to maximize its clinical use.

In order to diagnose allergic rhinitis (AR), skin prick tests and serum specific IgE level are the most common used methods. But there are some conditions which the results of both methods do not correlate with the clinical presentation of AR. Nasal provocation test is the method of detecting local IgE at the shock organ. There are some variations of NPT in terms of dosage, allergen administration, evaluation and scoring system. This article summarized the usefulness of NPT, its indication and contraindication, dosage and instillation techniques for allergens and evaluation of outcome in the hope that if we can standardize the procedure and make it easier to perform, NPT will be applied more in clinical practice. In addition normal values among Asian ethnics are presented for appropriate interpretation of the test

Rinometria acústica e testes de provocação nasal / Acoustic rhinometry and nasal provocation tests

A rinometria acústica é uma técnica que possibilita a avaliação da geometria nasal pela emissão e captação ondas sonoras na entrada da cavidade nasal, com a mensuração de seu volume em diferentes pontos. A rinometria acústica não depende da cooperação do paciente e consiste em método confiável e reprodutível para a análise do volume nasal de crianças e de adultos.Os testes de provocação nasal (TPN) são bioensaios que tentam reproduzir ou simular diferentes agravos sofridos pela mucosa nasal, em condições padronizadas e reprodutíveis. Os TPN consistem, basicamente, na instilação de concentrações crescentes de agentes capazes de induzir resposta local com o desencadeamento de sintomas (espirros, coriza e prurido) e alterações no fluxo aéreo nasal. TPN são considerados como importante ferramenta para estudo da fisiopatologia de rinopatias crônicas, como a rinite alérgica. Além disso, os TPN também podem ser empregados no seguimento temporal da gravidade da doença e na avaliação de resposta a diversos tratamentos e intervenções. Medidas objetivas devem ser empregadas no seu monitoramento e a rinometria acústica, por suas características, representa uma promissora opção.

The Effect of Allergen Provocation on the Nasal Cycle / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal airflow is asymmetrical and is subjected to spontaneous reciprocal changes which are referred to as the nasal cycle. Limited information is available about how they are affected by allergens. The purpose of this study was to evaluate effects of allergen provocation on the nasal cycle. SUBJECTS AND METHOD: This study was performed in 11 patients with allergic rhinitis and 6 healthy controls. Acoustic rhinometry was used to test subjects before and after the allergen provocation. The subjects underwent acoustic rhinometry in 15 minutes interval for evaluation of nasal cycle and 3 minutes interval for immediate response. RESULTS: With the allergic subjects, 10 of the 11 subjects (90.9%) showed nasal cycle and they still had nasal cycle after the allergen provocation. In the study on the changes of the immediate responses, recovery time was on the average of 33.0 minutes and reduction rate of non-patent side was higher than that of patient side. And the period of nasal cycle was on the average of 173 minutes before the allergen provocation and the average 159 minutes after the allergen provocation; there were no statistical differences. The amplitude of each nasal cycle increased after allergen provocation and the difference had statistical meaning. CONCLUSION: Overall duration and reciprocity of nasal cycle were not changed after the allergen provocation and the amplitude of nasal cycle was increased significantly after the allergen provocation.

Correlation between MAST, the skin prick test, and the nasal provocation test in patients with allergic rhinitis / 천식및알레르기

OBJECTIVE: Allergic rhinitis is one of the most common diseases in the field of otorhinolaryngology. Correct diagnosis for allergic rhinitis is important for its optimal management. Many studies have been reported for the diagnosis with allergens. This study was performed to identify the relationship between MAST, the skin test, and the nasal provocation test. We attempted to find an appropriate diagnostic method for finding causative allergens. METHOD: We reviewed the medical records of patients with allergic rhinitis symptoms and physical findings from August 2001 through July 2002 at Inha University Hospital. We selected 197 patients who were examined with MAST, the skin prick test, and the nasal provocation test. The relationship between these tests was determined with SPSS (Ver10.0). RESULTS: There was a significant correlation between MAST and the skin prick test(P<.05). There were also significant correlations between MAST and the nasal provocation test, and between the skin prick test and the nasal provocation test(P<.05). CONCLUSION: MAST might be a useful diagnostic method for finding causative allergens, especially in children and patients with skin hypersensitivity and other skin disorders.

Result of Allergic Skin Test, MAST and Nasal Provocation Test in Children with Atopic Dermatitis / 대한이비인후과학회지

BACKGROUND & OBJECTIVES: Allergic diseases are considered to be systemic diseases. Atopic diseases are the first manifestation among allergic diseases, with the suggested relation to allergic rhinitis and asthma, as reported in several studies. The objective of this study was to evaluate the responses to allergic tests in children who have atopic dermatitis or have allergic rhinitis and atopic dermatitis. Materials & Methods : Eighty subjects without atopic dermatitis (control group) and 80 patients with atopic dermatitis (atopy group) were subjected to study from Nov. 1997 to Nov. 1999. The atopic group included pediatric patients who were diagnosed as having atopic dermatitis, but excluded patients who received medical treatment of steroid or antihistamine before the test for 1 month. In all the control and atopic groups, the nasal cavity volume was first estimated by acoustic rhinometry, followed by the allergic skin test (AST) and MAST. A nasal provocation test was taken with a positive allergen for patients who showed positive response to AST and MAST; for patients who showed negative response to AST and MAST, the test was taken with the House dust mites. RESULTS: In the atopic dermatitis group, the rate of positive responses to AST and MAST were 65% and 72.5%, respectively; in the control group, the rates were 25% and 35%, respectively. The most common positive allergen was the House dust mite in AST and MAST. In the nasal provocation test, the more positive rate was observed in the atopic group. CONCLUSION: The atopic group showed more positive response than the control group to AST, MAST and the nasal provocation test. Also, the nasal mucosa of 37.5% of the atopic dermatitis patients were sensitized to a certain allergen.

Correlation between Clinical History, Skin Test, RAST and Nasal Provocation Test in Patients with Perennial Allergic Rhinitis

BACKGROUND AND OBJECTIVES: Correct diagnosis for allergic rhinitis is important for optimal management. A thorough history should be taken, followed by general and endoscopic examinations and confirmatory investigations. The role of diagnostic tests in the evaluation of patients with allergic rhinitis continues to evolve. This clinical study was performed to identify the relationship between clinical history and diagnostic tests. MATERIALS AND METHODS: Questionnaire surveys for clinical history, skin test, RAST, and nasal provocation test (acoustic rhinometry and symptom score) to the house dust mites (Dermatophagoides pteronyssinus) were performed in 100 patients from July, 1996 to August, 1998 at Inha University Hospital. The relationship between clinical history (change of syagoides pteronyssinus antigen (Allergopharma, Reinbeck, USA) was sprayed and 15 with PC-SAS. (ver 6.120) RESULTS: There was no correlation between clinical history and the diagnostic tests. However there was a correlation between the results of either skin or RAST testing and those of nasal provocation test. CONCLUSIONS: More careful and complete history taking is needed for diagnosis of allergic rhinitis. The combined use of RAST, skin testing and nasal provocation test yields more information.