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PubMedDate not supplied

Specific and non-specific nasal provocation tests in children with perennial allergic rhinitis.

BACKGROUND: nasal provocation tests (NPT) have been extensively used in clinical practice to evaluate chronic rhinopathies, mainly allergic rhinitis (AR). METHODS: we submitted 10 perennial AR children (aged from six to 15 years) to histamine (H), Dermatophagoides pteronyssinus (Dp) and Blomia tropicalis (Bt) NPT. All children were sensitized (positive skin prick test, mean wheal > 3 mm) to both mites. Dp and Bt specific NPT were realized in two occasions, apart one week, always preceeded 24 hours by H challenge. Increased concentrations were applied to the nasal mucosa during each NPT: H (0,03 to 16 mg/ml), Dp (1/100,000 to 1 /2.5) and Bt (1/125,000 to 1/10). NPT were evaluated by clinical and rhinomanometric parameters (total score, TS), and by lung function tests. NPT was considered positive, when total nasal resistance (TNR) doubled in relation to basal value. RESULTS: H NPT was positive twice in 8/10 patients. Concordance between H concentration that induces a positive NPT measured by TNR or TS was observed. Regarding to specific NPT, 90 % of patients were positive to Dp and 60 % to Bt. There was no concordance between the allergen concentration that induces a positive SPT and a positive NPT, considering the different concentrations. There were no modification in lung function tests during both specific and non-specific provocation tests. CONCLUSIONS: NPT with H is an objective and reproducible method which allow evaluate nasal reactivity. Specific NPT have restricted indications, mainly when there where doubts about AR's etiology.

Adolescent↗
PubMed2003

[Nasal provocation tests with house dust mite in patients with perennial rhinitis].

UNLABELLED: The aim of this study was to evaluate a response of the upper airways mucosae to allergens house dust mite: Dermatophagoides farinae and Dermatophagoides pteronyssinus. Compared were results of nasal challenge with results of skin prick tests. 87 patients with perennial rhinitis allergic to Dermatophagoides farinae and/or Dermatophagoides pteronyssinus were included. There were 58 men, 29 women, age 18-54 years, mean age 26 years. Nasal provocation tests were performed first with solvent, and next if flow rate did not change more than 20%, with Dermatophagoides farinae and Dermatophagoides pteronyssinus extracts. The nasal response was evaluated with active anterior rhinomanometry. Nasal flow was measured at 15, 30 and 45 minutes after allergen challenge. There were 99% positive skin prick tests Dermatophagoides farinae and 94% positive skin prick tests Dermatopagoides pteronyssinus. Nasal provocation tests with Dermatophagoides farinae extract were positive in 63% patients and Dermatophagoides pteronyssinus extract--in 62% patients. Majority of nasal challenges were positive at 15th minute. There is association between skin prick tests Dermatophagoides farinae and Dermatophagoide pteronyssinus 4+ and positive nasal provocation tests with the same allergen (p < 0.05). We have found correlation between skin tests Dermatophagoides farinae and Dermatophagoides pteronyssinus (correlation index = 0.58) and no correlation between nasal provocation Dermatophgoides farinae and Dermatophagoides pteronyssinus extracts. CONCLUSION: Nasal provocation tests are more specific than skin prick tests in patients with perennial rhinitis.

Adult↗
PubMed2001

Nasal provocation testing: a review.

OBJECTIVE: This review focuses on the uses of nasal provocation testing (NPT) for scientific investigations of the mechanisms of allergic and nonallergic rhinitis. It also describes the use of NPT as a diagnostic tool in clinical practice. The indications, contraindications, advantages, and limitations of different techniques for evaluation of nasal responses are reviewed. The paper familiarizes investigators with particulars of different nasal delivery systems, provocation agents, nasal patency measurements, secretion collection, and nasal lavage techniques. DATA SOURCES: Relevant publications obtained from a literature review. STUDY SELECTION: Relevant publications on the topics of NPT, allergic, and nonallergic rhinitis were critically evaluated. RESULTS AND CONCLUSIONS: To date, NPT has been used primarily as a research tool for the investigation of allergic and nonallergic rhinitis with a wide variety of techniques depending on the specific scientific purposes. NPT will continue to provide useful information about the pathogenesis of airway diseases. Standardized nasal provocation testing has the potential to become a more frequently used clinical test in the diagnosis of allergic and occupational rhinitis and for determination of the appropriate and focused therapy.

Administration, Intranasal↗
PubMedDate not supplied

Nasal provocation tests in the diagnosis of urticaria induced by acetylsalicylic acid.

Nasal provocation tests with lysine acetylsalicylic acid (ASA) have been used in the diagnosis of ASA-induced asthma and rhinitis. To establish its possible role in identifying aspirin sensitivity manifested by urticaria or angioedema, 18 patients suffering from chronic or acute recurring urticaria/angioedema (10 ASA-sensitive and 8 ASA-nonsensitive) were submitted to nasal provocation tests with freshly prepared solutions of lysine ASA. Clinical response and variation of nasal expiratory peak-flow were evaluated, classified according to previously defined scores, and compared. The results showed a significant difference between ASA-sensitive and ASA-nonsensitive patients, suggesting that this test can be an important diagnostic tool for ASA-induced urticaria/angioedema.

Adolescent↗
PubMed1989

Ferns and their allergenic importance: skin and nasal provocation tests to fern spore extract in allergic and non-allergic patients.

In our recent survey, fern spores were found to be the third most common airborne air spora in the Bangkok atmosphere; therefore, the significance of fern spores as a causative allergen was assessed in patients with allergic rhinitis. By using the extract from the spores of Acrostichum aureum Linn, which is a widespread fern, an intracutaneous test was done in 226 allergic rhinitis patients and 61.5% of these patients reacted positively. Nasal provocation test by using the same kind of fern spore extract was also performed in 24 allergic rhinitis patients and the positive reaction occurred in 70.8%. When skin tests and nasal provocation tests were performed in a group of 20 nonallergic ENT patients, only 20% gave weakly positive skin test reactions and 15% gave mild reactions to the nasal provocation test. The authors concluded that fern spores are potentially allergenic and allergists should be aware that ferns could be an important aeroallergen.

Humans↗
PubMedDate not supplied

The effectiveness of nasal provocation tests for the diagnosis of atopic bronchial asthma.

Because of a certain degree of risk involved in bronchial challenge tests an attempt has been made to evaluate the efficacy of nasal provocation tests for the diagnosis of sensitivity to inhalant allergens in patients with bronchial asthma. The present study involved thirty patients with asthma and thirty healthy controls. Three criteria were employed to assess nasal sensitivity to an allergen. These were clinical observations, thermographic recording of the temperature of the nose, and blockage index assessment. It was observed that positive nasal reactions were seen mostly in patients who had a history of sensitivity to the tested allergen and in the group with high levels of the allergen-specific IgE. Allergic rhinitis, which some patients had in addition to asthma, did not seem to affect the results of the nasal provocation tests. The nasal challenge test is thought to be a valuable method for the diagnosis of sensitivity to inhalant allergens in patients with atopic bronchial asthma. In our opinion recording of nasal temperature by means of thermography during nasal challenge is useful for evaluating the results of the test.

Adult↗
PubMed1997

Physiological fluctuations in nasal resistance may interfere with nasal monitoring in the nasal provocation test.

The physiological fluctuations in nasal flow and resistance in allergic subjects were studied by monitoring 12 subjects with perennial occupational allergic rhinitis with active anterior rhinomanometry (AAR) for 3 h at 15 min intervals. The subjects were then challenged bilaterally with the diluent solution for allergen extracts and the effect was monitored with AAR. In AAR. cellular rubber nose adapters were used. Many physiological fluctuations in nasal patency were observed. Reference intervals were calculated for the changes in flow and resistance at the gradient pressure of 150 pa. For example, a 100% increase in unilateral resistance was found to be significant at the risk level of 5-10% for the observation time of 30-60 min. The corresponding increase for bilateral resistance was close to 70%. Challenge with diluent solution had a negliglible effect on the resistance fluctuation, the reference intervals being close to those for baseline monitoring. In conclusion, rapid changes in nasal flow and resistance in allergic subjects were common, and caution is necessary when interpreting these changes as a positive nasal reaction in the nasal provocation test. In addition, the use of other objective parameters, such as the amount of nasal secretion is recommended.

Adult↗
PubMedDate not supplied

Evaluation of the nasal provocation test for its necessity in the diagnosis of nasal allergy to house dust mite.

The aim of this study was to evaluate rhinomanometric responses to nasal allergen provocation in children with allergic rhinitis sensitized to house dust mite. We studied 51 children, aged 6-16 years (mean: 11.5 +/- 2.6 years), with clinical symptoms of perennial allergic rhinitis without asthma and 20 non-atopic healthy controls in the same age range (mean: 11.8 +/- 3.8 years). All of the patients had positive skin prick test (SPT) results and serum specific IgE above 0.70 kU/l to Dermatophagoides pteronyssinus (Dp). Nasal provocation testing (NPT) was performed with increasing concentrations of Dp extracts and the nasal response was evaluated by active anterior rhinomanometry. A 100% increase of resistance in one or both nasal cavities was considered positive. There was a statistically significant difference of baseline nasal resistance (total, right and left sides) between the control and the patient groups (p < 0.001). A positive response to house dust mite allergens was recorded in 47/51 (92.2%) patients by rhinomanometry. The NPT presented no significant correlation with age, weight, height, SPT diameter, serum total and specific IgE levels to Dp and baseline nasal airway resistance values. This study suggests that a nasal provocation test with allergen is unnecessary in children with positive skin prick test and serum IgE specific to house dust mite. The rhinomanometric response to the allergen provocation does not correlate with the diameter of the skin prick test and the level of serum specific IgE.

Adolescent↗
PubMed1992

The nasal provocation test in the diagnosis of allergic rhinitis. Behaviour and dynamics of nasal flow during the test.

We analyzed the value of the (n) coefficient of nasal flow in the formula of nasal resistances in order to: (1) calculate nasal flow during the course of the nasal provocation test, and (2) try to find out whether nasal flow maintains the same characteristics during the test. Our results show that values vary between 1.6589 and 1.8801, with a weighted mean of 1.7645--suggesting that the flow is of a mixed character--without significant differences during the course of the test. At the same time we carried out an analysis of the dynamics of nasal flow during nasal provocation.

Adolescent↗
PubMed1981

Behaviour on the nasal provocation test in patients affected by conjunctivitis and/or asthma of allergic origin.

In the Allergo-Immunological Centre of Rome University we selected 120 patients of both sexes, ranging from 5-65 years of age, affected by asthma and/or conjunctivitis without past or present history of nasal impairment (itching, sneezing, hydrorrhea). As a result of the allergometric tests carried out, the authors divided the samples into three groups: 1) positive reaction to Dermatophagoides Pteronissimus (66.6%); 2) positive reaction to the Graminacee (28.3%); 3) positive reaction to Parietaria officinalis (5.1%). After having undergone the rhinoreomanometric test of nasal provocation, 50% of the patients revealed a positive reaction to the specific allergen, more specifically at 50 PNU/ml 40% of the case were positive, and at 100 PNU/ml 50% were positive. These results are discussed in the light of modern biological knowledge on the mastocytes in normal subjects and in those suffering from allergy.

Adolescent↗
PubMed2000

[The study of the nasal airway reactivity in specific nasal provocation test].

OBJECTIVE: To explore efficient evaluation method for specific nasal provocation test(SNPT) and to observe the pathogenic process and patho-physiological changes of allergic rhinitis. METHOD: 30 patients with perennial allergic rhinitis(patients group) and 14 normal adults(controls group) were challenged unilaterally with the Coca's solution and/or the solution for allergen extracts. The nasal resistance variations in all subjects were monitored with active anterior rhinomanometry and the nasal symptoms were observed. RESULT: The symptoms of nasal stiffness, sneezing and rhinorrhea appeared in most patients between 0.5 and 3 minutes after provocation. The ratio of continual sneezes above 5 in patients group(83.3%) was significantly higher than in controls group (21.4%) (P < 0.01). The increased ratio of total nasal resistance and unilaterally-challenged nasal resistance were significantly higher in patients group than in controls group (P < 0.05) and no difference between coca's solution in patients group and controls group. CONCLUSION: Positive SNPT was indicated if obvious nasal symptoms appeared and the unilaterally-challenged nasal resistance increased 100% as well as the total nasal resistance increased 40% after SNPT.

Adolescent↗
PubMed1987

Nasal allergen sensitivity and mucosal IgE antibodies.

Skin tests, nasal provocation tests, nasal smear tests, and serum-radioallergosorbent tests were performed on 17 patients with perennial allergic rhinitis, who had suffered nasal congestion without receiving any antiallergic treatment. After the above tests, tissue-radioallergosorbent tests (t-RAST) were conducted to determine IgE antibody levels in inferior turbinate mucosal samples taken peroperatively. The results obtained in this study suggest that the allergen sensitivity of the nasal mucosa correlates to some extent with the mucosal IgE antibody level, and that the t-RAST can provide us with objective data about nasal allergen sensitivity.

Humans↗
PubMed1997

In vivo diagnostic procedures: skin testing, nasal provocation, and bronchial provocation.

In vivo challenge procedures can be very useful in the analysis of allergic symptoms. Skin testing has a high degree of sensitivity and specificity for determining antigens that cause allergic disease. However, positive skin tests do not necessarily indicate that a specific allergen causes symptoms specific for a certain organ. Nasal and whole lung provocation testing can help define relevant allergens that cause rhinitis or asthma symptoms. These tests are safe when performed properly under close medical supervision and have predictive values that make them useful diagnostic tools.

Allergens↗
PubMed2004

[Optical Rhinometry. Continuous, direct measurement of swelling of the nasal mucosa with allergen provocation. Real-time monitoring of the nasal provocation test using optical rhinometry].

BACKGROUND: Various methods exist for measuring swelling of the nasal mucosa. This is necessary in order to make the nasal provocation test objective. With the new method of optical rhinometry, it is possible to measure swelling of the mucosa directly from outside of the nose in real-time. The measurement is carried out with monochromatic near-infrared light of different wavelengths, the intensity change of which are recorded and displayed during the swelling. MATERIALS AND METHODS: With the help of a specially developed prototype of an optical rhinometer, we carried out measurements on 15 subjects having positive nasal provocation tests with histamine and allergens, negative provocation tests with allergens in non-allergics, negative provocation tests with control solution, and decongestion with xylometazoline. RESULTS: We found significant differences between positive and negative provocation tests ( P<0.01). Decongestion was different from all other groups ( P<0.01). Nasal congestion subjectively reported by the subject always correlated with the optical rhinometry findings. CONCLUSION: The objective assessment of nasal swelling using optical rhinometry seems reliable. The course of the endonasal swelling can thereby be monitored in real-time. The measurement is largely independent of the cooperation of the patient. The swelling is measured directly and not indirectly via air flow resistance.

Diagnosis, Computer-Assisted↗
PubMed1991

Effects of terfenadine and pseudoephedrine, alone and in combination in a nasal provocation test and in perennial rhinitis.

The effects of terfenadine and pseudoephedrine, alone and in combination, have been assessed in a nasal provocation test and in perennial rhinitis. In a double-blind, placebo-controlled cross-over nasal provocation test, twelve men allergic to grass pollen were treated with two daily doses of placebo, terfenadine 60 mg, pseudoephedrine 120 mg, or the combination of the two, for 2 days preceding each test. The allergic reaction threshold, based on rhinorrhoea, sneezing and nasal inspiratory peak flow rate, was raised significantly both by terfenadine and pseudoephedrine, and their effects appeared additive (repeated measures analysis of variance). In a double-blind, randomized clinical study of perennial rhinitis two parallel groups, the efficacy and tolerability of terfenadine and terfenadine-pseudoephedrine were compared in 50 patients. Symptoms and signs in both groups were improved after 14 days of treatment. Differences between groups showed a trend in favour of terfenadine-pseudoephedrine, for swelling of the nasal mucosa (rhinoscopy) they were statistically significant. Both medications were well tolerated overall, although adverse events and reactions were more frequent in the terfenadine-pseudoephedrine group. In conclusion, terfenadine-pseudoephedrine and its constituents taken alone were effective. The combination performed better, but adverse events were somewhat more frequent with the combination than with terfenadine alone.

Adult↗
PubMed2005

Specific nasal provocation tests in patients hypersensitive to mould allergens.

BACKGROUND: In the case of allergies to outdoor mould spores and plant pollen allergens, which are often concomitant, doubts may arise as to the role of mould allergens in inducing specific clinical manifestations. Establishing their significance is crucial for qualifying the patient for specific immunotherapy. This information also helps to reduce the percentage of therapeutic failures. MATERIAL/METHODS: The study population comprised 31 patients with seasonal allergic rhinitis who were allergic to both plant pollen allergens and mould spores. In each patient we performed a skin prick test, sIgE level determination, and a specific nasal provocation test using mould allergens, according to standard allergological diagnostic procedure, and the results were objectified using acoustic rhinometry. RESULTS: Positive NPT results were obtained in 22 patients. The positive results were more frequent in persons allergic to Cladosporium herbarum (92.3%) than in those allergic to Alternaria alternata (55.5%); these differences were statistically significant (p = 0.039). No differences were found between the two subgroups in terms of the sIgE levels (p = 0.13). In the study group as a whole, a high correlation between the results of acoustic rhinometry and the intensity of clinical manifestations was observed after administration of the NPT (correlation coefficient of 0.9). The correlation between the sIgE levels and the results of the skin prick tests and the NPT was much lower (0.48 and 0.66, respectively). CONCLUSIONS: The specific nasal provocation test is a safe and easy diagnostic modality, and acoustic rhinometry provides a good method of measuring it.

Adult↗