[Vasomotor skin tests in non-eosinophilic and eosinophilic long-term (perennial) nonallergic rhinitis]. / Vazomotorni kozni testovi u neeosinofilnom i eozinofilnom dugotrajnom ("perenijalnom") nealergijskom rinitisu.

INTRODUCTION: It has generally been assumed that "perennial" non-allergic rhinitis is a heterogeneous syndrome consisting of at least two groups: non-eosinopilic and eosinophilic. Opposite to non-eosinophilic group, eosinophilic group is characterized by nasal secretion eosinophilia, frequent evolution to nasal polyposis or complete ASA triad (nasal polyposis, intrinsic asthma and intolerance of non-steroidal anti-inflammatory drugs) and by a good response to treatment with anti-histamines and corticosteroids. These characteristics obviously separate eosinophilic from non-eosinophilic rhinitis and point out the importance of nasal secretion eosinophilia for the evolution and therapy of rhinitis. However, the distinction between eosinophilic and non-eosinophilic rhinitis can only be made by nasal cytology. Skin tests with vasomotor agents were carried out to characterize vasomotor skin reactivity in "perennial" non-allergic rhinitis and determine whether the patients with non-eosinophilic rhinitis differ from patients with eosinophilic rhinitis. METHODS: On the basis of the examination of nasal smears of eosinophils, 74 patients with "perennial" non-allergic rhinitis were divided into non-eosinophilic (n = 63) and eosinophilic group (n = 11). Nasal eosinophilic was considered significant when 20% and more of the cells in nasal smear were eosinophils. Skin reactivity to intracutaneous test with different concentrations of papaverine, metacholine, histamine and compound 48/48 was measured, as well as specific skin reactivity to control saline solution. Pathological skin reactivity to vasomotor agents was defined as hyporeactivity to papaverine (5 mg/mL), when wheal-and-flare skin reaction diameter was less than 15 mm; hyper-reactivity to metacholine (0.02, 0.2 and 2.0 mg/mL), when two of three wheal-and-flare skin reaction diameters were greater than 15, 25 and 31 mm, respectively; hyper-reactivity to histamine (0.01, 0.1, 1.0 and 10.0 micrograms/mL), when three of four wheal-and-flare skin reaction diameters were greater than 7, 13, 25 and 40 mm, respectively; and hyper-reactivity to compound 48/80 (0.01, 0.1, 1.0 and 10.0 micrograms/mL, when three of four wheal-and-flare skin reaction diameters were greater than 9, 16, 26 and 38 mm, respectively. RESULTS: Seventy four patients with "perennial" non-allergic rhinitis were included in the study. There were 51 females, age range from 18 to 57 yrs. (mean 37 yrs.) and 23 males, age range from 18 to 73 yrs. (mean 44 yrs.). The difference between the number of females and males was significant (p = 1.1 x 10(-3)), while no significant difference regarding the age between females and males was found (p = 0.122). Significant percentage of eosinophils was found in 15% of "perennial" non-allergic rhinitis patients, and they were classified into eosinophilic group (n = 11). In this group, the percentage of eosinophils varied from 20% to 80%, mean 35%. In non-eosinophilic group (n = 63), it ranged from 0% to 10%, mean 1%. No significant difference concerning sex and age between the two groups of the rhinitis patients was observed (Table 1). There was no significant intergroup difference for pathological skin reactivity to papaverine, metacholine, histamine, compound 48/80 and saline (Table 2). Total pathological skin reactivity to vasomotor agents, single and in combination, was found in 78% of non-eosinophilic and in 91% of eosiniophilic rhinitis patients (Table 3). In both, non-eosinophilic and eosinophilic groups, frequencies of total pathological skin reactivity to vasomotor agents was significantly greater than frequencies of total normal skin reactivity (p = 1.1 x 10(-5) and p = 0.007 respectively). However, the difference of total pathological skin reactivity to vasomotor agents between the two groups was not significant (p = 0.552). (ABSTRACT TRUNCATED)

[Intradermal tests using vasomotor agents in allergic rhinitis]. / Intradermisni testovi vazomotornim agensima u alergijskom rinitisu.

INTRODUCTION: Allergic rhinitis is characterised by nasal hyperactivity to specific and non-specific agents. For research purposes, non-specific nasal hyperactivity can be estimated by histamine and metacholine nasal challenge tests. At present, nasal challenge tests are not used for routine diagnosis of rhinitis. Wayoff and colleagues proposed the examination of the skin reactivity to papaverine, acetylcholine, histamine and compound 48/80 in rhinitis patients. Our previous study of skin reactivity to vasomotor agents, using modified skin tests of Wayoff and colleagues showed their clinical validation and usefulness for subclassification of patients with non-allergic rhinitis. To the present, there are only a few studies of skin reactivity to vasomotor agents in patients with allergic rhinitis. The aim of this study was to examine the skin reactivity to vasomotor agents of allergic rhinitis patients and determine whether the patients with allergic rhinitis differ from healthy subjects. METHODS: A prospective, controlled, in vivo study was carried out in 86 subjects: 44 patients with allergic rhinitis and 42 healthy subjects. Skin reactivity was examined by intradermal tests with different concentrations of papaverine, metacholine, histamine and compound 48/48. The non-specific skin reactivity to saline was also measured. Skin reactivity to intradermal test with different concentrations of papaverine, metacholine, histamine and compound 48/48 was measured, as well as specific skin reactivity to control saline solution. Pathological skin reactivity to vasomotor agents was defined as follows: hyporeactivity to papaverine (5 mg/mL), when wheal-and-flare skin reaction diameter was less than 15 mm; hyper-reactivity to metacholine (0.02, 0.2 and 2.0 mg/mL), when two of three wheal-and-flare skin reaction diameters were greater than 15, 25 and 31 mm, respectively; hyper-reactivity to histamine (0.01, 0.1, 1.0 and 10.0 mg/mL), when three of four wheal-and-flare skin reaction diameters were greater than 7, 13, 25 and 40 mm, respectively; and hyper-reactivity to compound 48/80 (0.01, 0.1, 1.0 and 10.0 mg/mL), when three of four wheal-and-flare skin reaction diameters were greater than 9, 16, 26 and 38 mm, respectively. RESULTS: The study included 86 subjects: 44 patients with allergic rhinitis and 42 healthy subjects. The control group of healthy subjects consisted of 22 females, aged from 18 to 35 yrs (mean 28 yrs), and 20 males, aged from 18 to 40 yrs (mean 28 yrs). The difference between the number [p(= 0.758) > 0.05] and age [p(= 0.990) > 0.05] of females and males was not significant. In the allergic rhinitis patients group, there were 23 females, aged from 18 to 54 yrs (mean 33 yrs) and 21 males, aged from 18 to 50 yrs (mean 36 yrs). The difference between the number [p(= 0.763) > 0.05] and age [p(= 0.558) > 0.05] of females and males was not significant. Frequencies of pathological skin reactivity to single vasomotor agents and saline in the control group of healthy subjects and in the allergic rhinitis patients group are shown in Table 1. In the control group, frequencies of normal skin reactivity to papaverine [p(= 1.8 x 10(-7)) < 0.01], metacholine [p(= 4.3 x 10(-6)) < 0.01], histamine [p(= 4.3 x 10(-6)) < 0.01], compound 48/80 [p(= 1.8 x 10(-7) < 0.01] and saline [p(= 6.9 x 10(-4)) < 0.01] were significantly greater than frequencies of pathological skin reactivity. In the patients group, frequencies of normal skin reactivity to papaverine [p(= 6.0 x 10(-8)) < 0.01] and saline [p(= 2.6 x 10(-3) < 0.01] were significantly greater, and to metacholine [p(= 0.016) < 0.05] were significantly greater than frequencies of pathological skin reactivity. In this group, the difference between frequencies of pathological skin reactivity to histamine [p(= 0.366) > 0.05] and compound 48/80 [p(= 0.070) > 0.05] were not significant. There was no significant intergroup difference for pathological skin reactivity to papaverine, metacholine and saline (Table 1). In the patients group frequencies of pathological skin reactivity to histamine and compound 48/80 were significantly higher than in the control group of healthy subjects. Frequencies of pathological skin reactivity to single vasomotor agents and in combinations in the control group of healthy subjects and in the allergic rhinitis patients group are shown in Table 2. The difference of pathological skin reactivity to single vasomotor agents and in combinations between the control group (14/42) and the allergic rhinitis patients group (27/44) was significant [p(= 0.017) < 0.05]. CONCLUSION: In routine evaluation of the rhinitis patients, skin tests with vasomotor agents have some advantages: these tests do not require special equipment, they are not time-consuming, they are easy to perform and simple for the interpretation of results. (ABSTRACT TRUNCATED)

Intradermal tests with vasomotor agents in perennial non-allergic rhinitis.

Nasal reactivity in non-allergic rhinitis patients is well known, but the skin reactivity of these patients is less examined. The aim of this prospective study was to examine the skin reactivity to four vasomotor agents in healthy subjects and perennial non-allergic rhinitis patients and to determine whether rhinitis patients differ from healthy subjects or not. Seventy four perennial non-allergic rhinitis patients and fourty two healthy subjects were undergone to intradermal testing with papaverine (5 mg/ml), metacholine (0.02, 0.2 and 2.0 mg/ml), histamine (0.01, 0.1 and 10.0 micrograms/ml) and compound 48/80 (0.01, 0.1, 1.0 and 10.0 micrograms/ml). It was found that the frequency of pathological skin reactivity to papaverine in perennial non-allergic rhinitis patients (34%) was significantly greater (p = 0.007) then in healthy subjects (9.5%). There was no significant difference for metacholine, histamine, compound 48/80 and saline between these two groups. The frequency of the total pathological skin reactivity to vasomotor agents, singly and in combinations, in perennial non-allergic rhinitis patients (80%) was significantly greater (p = 1.8.10(-6)) then in healthy subjects (33%). These findings suggest that the pathological skin reactivity to vasomotor agents is a feature of perennial non-allergic rhinitis patients as well as healthy subjects and indicate that a difference in the skin reactivity between these groups is noticed.