Objectification of the nasal patency assessment techniques used in nasal allergen provocation testing

Abstract

Topical allergen application in nasal provocation testing (NPT) is associated with remarkably rapid changes in nasal patency. Thus, selecting the techniques of assessing the extent of nasal obstruction (as one of the responses to topical allergen application) is an important component of NPT. The study attempted to systematize and evaluate the techniques selected for assessing nasal patency during NPT based on a review of relevant literature. We reviewed the literature on the attempts to standardize the objective techniques for assessing nasal patency and their use in NPT. The best known, well-established technique for assessing nasal patency as part of NPT was rhinomanometry, followed by peak nasal inspiratory flow (PNIF) testing and acoustic rhinometry.

Local nasal immunotherapy for allergic rhinitis: A systematic review and meta‐analysis

“…This result supports the principle of LNIT, which directly triggers immunomodulation in NALT. Although NPT is used primarily in research rather than in everyday clinical practice, 51 it is a valuable test for assessing the response from LNIT. There was no significant difference between the indoor and outdoor allergen subgroups.…”

The role of the nasal allergen provocation test in local allergic rhinitis cases: a preliminary report

“…The most specific and sensitive techniques include: acoustic rhinometry, optical rhinomanometry and PNIF. In our report, we have proved, on the one hand, the specific usefulness and relatively good sensitivity and specificity of the technique employed in our study, namely rhinomanometry, and, on the other, the fact that it is technically difficult to obtain the following current values: nasal resistance in connection with nasal obstruction (in the case of highly positive results of the NAPT, nasal obstruction means failure to reach the required resistance value for the pressure values of 150 or 100 kPA, while watery discharge from the nose prevents patches from being stuck onto the nostrils) [ 16 , 17 ].…”

“…Allergic rhinitis is an IgE-dependent inflammation of the nasal mucosa. It is caused by exposure to an allergen and is the most common form of non-infectious rhinitis [ 16 , 23 , 24 ]. ARIA classifies allergic rhinitis by the duration of symptoms into: periodic allergic rhinitis (symptoms occurring for fewer than 4 days a week or for fewer than 4 weeks), which is normally caused by plant pollen allergens and/or mould spore allergens, and chronic allergic rhinitis (symptoms occurring for more than 4 days a week and/or more than 4 weeks).…”

“…The latter is usually caused by allergens permanently present in the patient’s environment (house dust mites, moulds, animal allergens). By the severity of symptoms, allergic rhinitis is classified into mild rhinitis (mild symptoms which do not significantly affect the patient’s quality of life and/or daily activities; medical advice is not usually sought); moderate rhinitis (symptoms affecting the patient’s daily activities (work, school, physical activity) and causing sleep problems); the patient is usually determined to seek medical advice); severe rhinitis (symptoms preventing the patient from going about their daily activities and causing serious sleep problems; the patient’s quality of life is clearly worse and the patient is determined to seek medical advice) [ 16 ].…”

“…If the medical history taken from a patient revealed that the patient had been having nasal complaints, mainly severe, persistent nasal obstruction (Allergic Rhinitis and its Impact on Asthma – ARIA) [ 16 ], the patient’s quality of life deteriorated. Furthermore, the family medical history taken from the patients confirmed a predisposition to atopy, including allergic rhinitis.…”