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PubMed2005

A study of the effectiveness of chemosurgery with trichloroacetic acid for Japanese cedar pollenosis in terms of the chemical mediator levels in the nasal discharge and results of nasal provocation testing.

OBJECTIVE: The purpose of the present study was to investigate the effectiveness of chemosurgery with 80w/v% trichloroacetic acid (TCA) for the treatment of Japanese cedar pollenosis. The effectiveness of this treatment was evaluated in terms of the levels in the nasal washings of the chemical mediators histamine and eosinophil cationic protein, and the reactivity in the nasal provocation test. METHODS: Patients of cedar pollenosis were divided into two groups, the TCA-treated group (n=90) and the group that was not treated with TCA (nonTCA-treated group) (n=79), according to whether or not they received TCA treatment. In both the groups, the levels of the two aforementioned mediators in the nasal washings were measured during the pollen dispersal season. In addition, allergen provocation tests were performed using the disk method in volunteers from both the groups during the non-pollen dispersal season. The results of the above two determinations were compared statistically between the two groups. RESULTS: The results revealed significantly lower levels of the two mediators in the TCA-treated group than in the nonTCA-treated group (p<0.01). There was also a greater tendency for the subjects in the TCA-treated group as compared to those in the nonTCA-treated group to show negative reactivity in the allergen provocation test (p<0.01). CONCLUSION: Regional suppression of the allergic reaction to Japanese cedar pollen appears to occur as a result of chemosurgery with TCA performed as a day surgery.

Adult↗
PubMed1996

Nasal provocation test in the diagnostics of occupational allergic rhinitis.

The diagnosis of occupational rhinitis (OR) must be better confirmed than in allergic rhinitis of other aetiology. A provocation test is required to confirm the causality between the disease and the work exposure. The purpose of this study has been to examine the feasibility of active anterior rhinomanometry and visual analogue scale in the diagnostics of OR, and to compare the results of these measurements to a nasal status change score. The study subjects have been 50 consecutive patients suspected of having OR. Altogether 148 bilateral nasal provocation tests (NPTs), 55 placebo- and 93 allergen-NPTs, have been done. Based on the change in the nasal status and change in the nasal airway resistance (NAR), there are 42 positive NPTs. Although overlapping between placebo and allergen provocations exists, an increase of > 50% in NAR is recommended to regard the result as positive in NPT. The evaluation of the nasal reaction in the NPT is mainly based on anterior rhinoscopy and the change in the status score, but OR diagnostics should also include some physiological measurement.

Adult↗
PubMedDate not supplied

Rhinitis and asthma: nasal provocation test in the diagnosis of asthma.

Our purpose was to determine if the study of rhinitis is useful in the diagnosis of asthma. We formulated the hypothesis that the inflammation of the upper airway reflects the inflammation of the lower airway. It was found that there are allergens that produce rhinitis more frequently than asthma, and vice versa. This can be explained by size. This explanation, however, is questionable as the allergic proteins are extracted from the carrying agent, and through the lymphatic route or the blood, reach the entire human organism. It was also found that with bronchoalveolar lavage in allergic asthma it is possible to obtain the same results for eosinophils as with a nasal wash or using Citospyn. However, the results in the late phase are questionable. In the immediate phase and in the late phase, eosinophil cationic protein (ECP) was detected in the blood (in asthma) and in nasal washes (in rhinitis). In the immediate response tryptase was detected from the mast cells. The role of leukotrienes in asthma and rhinitis is well established in the early and late response. The use of leukotriene inhibitors guarantee their importance in the airway. Platelet-activating factor (PAF) has been demonstrated to increase vascular permeability and the use of antagonists were the best nasal feature. The inhalation of histamine caused bronchospasm, while instillation of histamine in the nasal passages increased resistance. With this information it seems that our hypothesis has been confirmed. Rhinitis and BHR together are equivalent to asthma, although the PFER decreases during the course of nasal provocation test (NPT) in nonasthmatic patients. In pure rhinitis patients, however, we find decreases in PFER due to effort. All this suggests that the study of nasal inflammation is still unclear with regard to bronchial inflammation.

Asthma↗
PubMed1991

[Nasal provocation test with histamine: rhinomanometry study of normal subjects].

Nasal reactivity to histamine was evaluated in 40 normal subjects. The application of a chloride histamine solution (1 mg) registered in 90% of the subjects the appearance of sneezing with the number of sneezes ranging between one and fourteen (5.7 +/- 3.76) and an average increase in the total resistence in the inspiration phase of 93.1% (+/- 63.2) and in the expiration phase of 98.1% (+/- 60.5) with a range between 37.7% and 24.1%. The authors conclude that sneezing and above all nasal congestion evaluated rhinomanometrically represent two important parameters in the evaluation of nasal reaction; an increase greater than or equal to 200% of the total nasal resistance can surely be considered an index of nasal hyperreactivity.

Adolescent↗
PubMed1987

The diagnosis of perennial rhinitis due to house dust mite (Dermatophagoides pteronyssinus) demonstrated by nasal provocation tests.

The paper describes a simple clinical method of performing allergic nasal challenges. It was found to give no complications in over 1,000 challenges with D. pteronyssinus solution. It requires no special apparatus. Reasons for not measuring nasal airways resistance are given. In 1,167 challenges, positive nasal challenges agreed with positive skin prick tests 943 times (81%). Twenty-five positive nasal tests had negative skin tests (2%). One hundred and ninety-nine negative nasal tests had positive skin tests (17%). In 60 patients who had positive RAST (Fadel-Nalebuff modification), 14 (23%) nasal challenges were negative. Five positive nasal challenges had negative RASTS (8%). This is the largest series of mite nasal challenges correlated to skin and RAST tests that has been published.

Airway Resistance↗
PubMed1999

Evaluation of acoustic rhinometry in a nasal provocation test with allergen.

BACKGROUND: The objective was to validate acoustic rhinometry (AR) in a nasal challenge with allergen. METHODS: Nasal response to allergen provocation was based on clinical and symptom scores, cross-sectional changes of the nasal mucosa as measured by AR with the Rhinoklack system, and peak nasal inspiratory flow (PNIF), in atopic and nonatopic volunteers. RESULTS: After allergen challenge, mean variation in minimal cross-sectional area (deltaMCA), as measured by AR, or in peak nasal inspiratory flow (deltaPNIF) in nonatopic volunteers, was -0.4+/-14.3% and 5.2+/-15.7%, respectively, compared to baseline. This allowed the determination of a reaction threshold of -29% for deltaMCA and of -26% for deltaPNIF. All but one of the 30 atopic patients reached the AR reaction threshold, whereas all patients reached the PNIF reaction threshold. AR and PNIF closely correlated with clinical and symptom scores for nasal congestion, since there was no significant difference at reaction threshold between both methods. CONCLUSIONS: In an allergen provocation test, AR appears to be as specific and sensitive as peak nasal inspiratory flow, with the advantage of being independent of the patient's active cooperation. Discrepancies between both methods emphasize the role of nasal cavity anatomy in measuring nasal congestion by AR.

Acoustics↗
PubMed2000

Nasal provocation test in the diagnosis of natural rubber latex allergy.

BACKGROUND: Natural rubber latex (NRL) allergy in workers using rubber gloves has been an occupational health problem for the last 10 years. In the case of the occupational agents, clinical history may be far from conclusive; hence, appropriate provocation should be carried out. The objective was to evaluate the usefulness of the nasal challenge test in the diagnosis of allergic rhinitis in subjects occupationally exposed to NRL. METHODS: A single-blind, placebo-controlled study was conducted in 16 nurses with respiratory symptoms (bronchial asthma and/or rhinitis) related to NRL exposure as well as positive skin prick test (SPT) response to NRL. The controls were nine nurses with asthma and/or perennial rhinitis unrelated to NRL exposure; six atopic patients not occupationally exposed to NRL, with asthma and/or perennial rhinitis; and six healthy subjects. All the controls had negative results of SPT with NRL. Patients with a history of anaphylaxis or positive results of RAST to NRL were not considered in the study. The "nasal pool" technique was used to evaluate the cellular response and changes in protein level and ECP concentration in nasal washings after topical provocation with allergen or placebo. RESULTS: A significant increase was noted in eosinophil and basophil number, albumin/total protein ratio, and ECP level only in NRL SPT-positive patients subjected to nasal challenge with NRL. Neither bronchial nor systemic reactions were found after the nasal provocation with NRL. CONCLUSIONS: The nasal challenge test appears to be useful for diagnosing occupational rhinitis in NRL-sensitized patients.

Adult↗
PubMed1999

Non-specific nasal provocation test with histamine. Analysis of the dose-response curve.

Non-Specific Nasal Hyper-reactivity (NSNH) is described as a clinical condition characterized by the presence of rhinitic symptoms that are a consequence of non-specific stimulations. Because of its effects on vascular, epithelial, and glandular receptors, NSNP Test (NSNPT) with histamine allows the study of NSNH. The aims of this study are 1. to analyze the behavior of NSNH both in non-allergic chronic vasomotory patients and in healthy control subjects 2. to correlate total nasal resistance(TNR) to each dosage of histamine to derive the dose/response curves and 3. to study these curves to analyze and possibly define different stages according to the intensities of response of NSNH. We have studied 26 subjects affected by non-allergic vasomotor rhinitis and 10 healthy control subjects. We sprayed a NSNPT with histamine-phosphate (0.2-0.3-0.4-0.5-0.6-0.8 mg) in different sessions to avoid accumulation phenomena. Five minutes before and five minutes after each challenge, TNR was determined by active anterior rhinomanometry. TNR was correlated to the doses of histamine by an empirical equation. The most important results of this study are as follows: a) the variation of TNR follows a model of exponential curve, b) it is possible to classify NSNH, as a function of the regression b coefficient belonging to the empirical equation used, in reactivity classes, c) from one reactivity class to another, post-stimulation TNRs double; 0.5 mg of histamine of the NSNPT is the optimal dose, d) there is an overlap between the responses of some normal subjects and rhinopathic patients that will be the subject of a further study. Finally, our data suggest that, in a future perspective, it is possible to use the NSNPT with histamine for diagnostic, prognostic and therapeutic control purposes.

Adult↗
PubMedDate not supplied

[Evaluation of eosinophils in nasal mucus from patients with perennial allergic rhinitis during nasal provocation tests].

The purpose of this study was the evaluation of the behaviour of the eosinophils in the nasal mucous of patients with perennial allergic rhinitis in the moment of making a nasal initiation test 30 subjects were studied to which a nasal initiation test was applied with a 1:100 dilution of aqueous extracts, the samples were taken with a inferior nostril swab in basal form, in 30 minutes. Two and eight hours after the antigenic dare, the samples were tinged with the Wright technic, and the quantity of eosinophils and polymorphonuclear cells were determined. There were not adverse reaction during the procedure. The results showed eosinophils of 4.9% basal form, 13% at the 30 minutes, 19% at two hours and 28%, eight hours after the antigenic initiation, the percentage of polymorphonuclear cells was of 40.6%, 34.2%, 34.8% and 31.7% respectively. The obtained results are in accordance to the expectations in the different phases of the allergic response in rhinitis. We suggest for a correct evaluation of this nasal cytology test in patients with allergic rhinitis, the allergic response phase where the patient is, should be known.

Adolescent↗
PubMedDate not supplied

Non-specific rhinoreactivity: non-specific nasal provocation tests with methacholine and cold water solution.

The Department of Allergo-Immunology of the II ENT Division of Rome University has studied the behaviour, relative to non-specific nasal provocation with methacholine and with cold water solution, in normal subjects, in subjects with seasonal allergic rhinitis in and out of crisis, and in subjects with perennial rhinitis of allergic and non-allergic origin. All subjects underwent an ENT visit, rhinoreomanometry (RRM), mucociliary Clearance (MCT) and quantitative evaluation of nasal secretion, both before and after the single non-specific provocations. We saw that even though provocation with methacholine didn't cause a significant reduction of nasal conductance, it was the cause of noticeable modifications of the amount of nasal secretion, according to the groups taken into consideration. Furthermore, provocation with the cold water solution, which didn't provoke noticeable changes in the mucociliary clearance and in the quantity of nasal secretion, did, however cause noticeable modification of the nasal conductance in all groups examined.

Adolescent↗