Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis

Rondón, Carmen; Campo, Paloma; Herrera, Ricardo Jorge Hernández; Blanca‐López, Natalia; Melendez, Lidia; Cantó, Gabriela; Torres, Marı́a José; Blanca, Miguel

doi:10.1016/j.jaci.2011.06.012

Cited by 101 publications

(110 citation statements)

References 16 publications

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“…Finally, the reactions observed in patients with seasonal allergic rhinitis outside the pollen season [19] or in patients with occupational rhinitis [18] cannot be extrapolated to those observed in patients with perennial or persistent rhinitis. Our data corroborate the results of most adult studies [11,13,[21][22][23][24] and confirm that AR is a practical and sensitive technique for monitoring NPT in children. To our knowledge, ours is one of the first studies to describe AR during NPT in children.…”

Section: Resultssupporting

confidence: 90%

Acoustic Rhinometry in Nasal Provocation Tests in Children and Adolescents

Gf¹,

Ai²,

Matsumoto³

et al. 2016

J Investig Allergol Clin Immunol

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Objectives: To standardize acoustic rhinometry (AR) in nasal provocation tests (NPTs) with histamine in children and adolescents. Patients and Methods: We performed a cross-sectional validation to compare AR with anterior active rhinomanometry (AAR) during histamine NPT in 20 children and adolescents with persistent allergic rhinitis and 20 controls. Changes in total nasal resistance (AAR) were compared with changes in nasal volume in the first 5 cm (V5 ; P=.04) at baseline. The mean histamine concentration necessary to increase total nasal resistance by at least 100% was significantly lower in the rhinitis group than in the control group (0.72 mg/mL vs 2.4 mg/mL; P<.001). At the end of the NPT a mean increase of 126% in total nasal resistance and a mean decrease of 24.3% in V5 were observed in the rhinitis group. When compared with the AAR criteria, the highest sensitivity and specificity values were observed for a cutoff represented by a 19%-21% drop in V5. Conclusions: We found AR to be a feasible and sensitive tool for monitoring nasal response in children and adolescents undergoing histamine NPT. The best AR cutoff for ending the NPT was a 19%-21% drop in V5. Key words: Rhinitis. Nasal provocation tests. Histamine. Acoustic rhinometry. Rhinomanometry. Nasal cavity. Airway resistance. ResumenObjetivos: Estandarizar la rinometría acústica (RA) como medida de la respuesta a la prueba de provocación nasal con histamina (PPN) en niños y adolescentes. Pacientes y métodos: Se realizó un estudio de validación transversal comparando la RA frente a la rinomanometría anterior (RAA) activa en la evaluación de la respuesta frente a la PPN con histamina, realizado en 20 niños o adolescentes, diagnosticados de rinitis alérgica persistente y 20 controles sanos. Las variables estudiadas fueron los cambios en la resistencia nasal total, medida mediante RAA y los cambios en el volumen nasal de los primeros 5 cm (V5) evaluados mediante RA. Resultados: En relación con los sujetos control, los pacientes con rinitis alérgica presentaban niveles basales de resistencia nasal total significativamente más elevados (medias respectivas 0,34 Pa/cm 3 /s versus 0,21 Pa/cm 3 /s; p= 0,01) y valores de V5 significativamente inferiores (medias respectivas 8,20 cm 3 versus 9,24 cm 3 ; p= 0,04). La concentración media de histamina necesaria para incrementar el 100% la resistencia total nasal fue significativamente más baja en los pacientes con rinitis que en los controles (medias respectivas 0,72 mg/ml versus 2,4 mg/ml; p< 0,001). Al final de la PPN el incremento medio de la resistencia nasal total fue del 126%, en los sujetos con rinitis alérgica. En ese momento también se observó en este grupo un decremento medio del V5 del 24,3%. Utilizando como patrón oro de respuesta positiva un incremento en la resistencia nasal total del 100% mediante RAA, los puntos de corte con mayor sensibilidad y especificidad para el descenso de V5 se encontraban en un descenso de entre el 19 y 21%. Conclusiones: Nuestros resultados demuestran que la RA es ...

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Section: Resultssupporting

confidence: 90%

Acoustic Rhinometry in Nasal Provocation Tests in Children and Adolescents

Gf¹,

Ai²,

Matsumoto³

et al. 2016

J Investig Allergol Clin Immunol

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“…At the first visit, we confirmed that the subjects fulfilled the washout criteria for medications such as intranasal corticosteroids or antihistamines: (i) mono-or nonsensitized to house dust mites, (ii) no systemic corticosteroid for 1 month, (iii) no antihistamine or antileukotriene for 1 week, (iv) no intranasal steroid for 2 weeks [16] , and (v) no systemic or nasal vasoconstrictors for 1 week [10] . If the subject was on any medication, we recommended stopping for a certain period, i.e., until the second visit.…”

Section: Methodssupporting

confidence: 53%

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

Lee

et al. 2017

Int Arch Allergy Immunol

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Objective: The prevalence of local allergic rhinitis (LAR) in nonatopic children remains unknown. This study aimed to determine the prevalence, clinical characteristics, and severity of LAR in children in comparison to classical allergic rhinitis (AR) and nonallergic rhinitis (NAR). Study Design: A total of 145 children (aged 1-18 years) were enrolled and classified into 3 groups (AR, NAR, and LAR) based on a skin prick test (SPT) and a nasal provocation test (NPT) with house dust mite, i.e., Dermatophagoides pteronyssinus. NPT positivity was defined as a symptom score ≥2 standard deviations (SDs) above the healthy control score. Results: Eighty-one children had AR (55.9%), and 64 (44.1%) had symptoms of rhinitis with negative SPT; 59 NAR (40.7%) and 5 LAR (3.4%) children were identified. The κ score for agreement between the SPT and the NPT results was 0.778 (95% CI 0.726-0.830, p < 0.001). A significant correlation was observed between wheal diameter and maximum nasal symptom score provoked by D.pteronyssinus (rho = 0.589, p < 0.001). Nasal severity according to the ARIA guideline did not show any differences in the 3 groups (p = 0.693). The AR group was older than the LAR and NAR groups (AR > LAR > NAR, p = 0.003). Conclusions: Despite the evidence to support the existence of LAR in pediatric populations, we found that its prevalence was relatively low, possibly due to the high rate of agreement between SPT and NPT. Further investigations are needed to identify immunological as well as clinical implications of LAR.

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“…The course of nasal symptoms, regardless of severity, in this type of allergy can mimic chronic non-AR; therefore, in a significant group of patients, the true diagnosis of LAR was significantly delayed. This problem has also been reported by other authors [13,14]. In accord with other studies, NPT with a suspected allergen helped resolve the proper mechanism of chronic rhinitis in some study patients [15,16].…”

Section: Discussionsupporting

confidence: 87%

Local Allergic Rhinitis in Adult Patients with Chronic Nasal Symptoms

Krajewska-Wojtys¹,

Jarząb²,

Zawadzińska³

et al. 2017

Int Arch Allergy Immunol

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Background: Local allergic rhinitis (LAR) remains an underdiagnosed condition characterized by the local production of IgE antibodies during the natural exposure to aeroallergens. The prevalence of LAR in adult patients with a previous diagnosis of non-AR was assessed. Material and Methods: Eighty-four patients with perennial nasal allergy symptoms but a negative skin prick test and specific IgE antibodies against common inhalant allergens were included in the study. Nasal provocation tests were performed with the inhalant allergens Dermatophagoides pteronyssinus, Alternaria, and cat allergen, followed by the detection of nasal-specific IgE antibodies in the lavage during the challenge. Results: LAR was confirmed in 21 (25%) study patients. In the remaining 63 (75%) patients, non-AR was diagnosed. In addition, LAR was found following exposure to D. pteronyssinus in 19 (22.6%) patients, Alternaria in 3 (3.6%) patients, and the cat allergen in 1 (1.2%) patient. In 2 patients, concomitant allergies to D. pteronyssinus and Alternaria were observed. Conclusion: LAR can be a form of chronic perennial rhinitis that has previously been considered to be non-AR.

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Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis

Cited by 101 publications

References 16 publications

Acoustic Rhinometry in Nasal Provocation Tests in Children and Adolescents

Acoustic Rhinometry in Nasal Provocation Tests in Children and Adolescents

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

Local Allergic Rhinitis in Adult Patients with Chronic Nasal Symptoms

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