Clinical Relevance of Lepidoglyphus destructor Sensitisation in Allergic Rhinitis: Nasal Provocation Test as in vivo Assessment.

BACKGROUND: Dust mites are the leading cause of respiratory allergic diseases worldwide. Allergy to storage mites (SMs) has mostly been related to occupational exposures. However, recent studies have shown that sensitisation to SM, such as Lepidoglyphus destructor (Lep d), is of considerable importance also in urban populations, with high prevalence in dust samples of domestic environments. Co-sensitisation between house dust mites (HDMs) and SM is now regarded as very frequent in some regions, and cross-reactivity between them seems to be narrow. Therefore, SM allergenic capacity is increasingly a subject of study. The nasal provocation test (NPT), as an in vivo technique, could be considered the gold standard for the clinical relevance assessment of an allergen, in polysensitised rhinitis patients. OBJECTIVE: The objective of this study was to analyse the clinical relevance of the SM Lep d, by assessing the relationship between in vivo sensitisation and expression of allergic respiratory disease in an urban setting. PATIENTS AND METHODS: In our study, we enrolled a total of 32 allergic patients with rhinitis (with or without asthma) with proven sensitisation by skin prick test (SPT) and specific IgE (sIgE) to HDMs and/or SM. Patients underwent NPT with Lep d using subjective (Lebel Symptom Score Scale) and objective measurements (peak nasal inspiratory flow [PNIF]) for assessment of nasal response. RESULTS: Most of the patients with positive SPT and sIgE to Lep d had a positive NPT (24/27; 89%). True Lep d allergy, assessed by a positive NPT, could be predicted by a SPT wheal size >9.7 mm and a sIgE >0.42 kUA/L, with 100%/95.7% sensitivity and 75.0%/83.3% specificity, respectively. Co-sensitisation between Lep d and Der p was high, 75.0%. Asthma was more frequent in the positive Lep d NPT group (54 vs. 12%, p < 0.05). Significantly more patients from this group reported physical exercise, nonspecific irritants, and respiratory infections as relevant triggers of respiratory symptoms (p < 0.01-p < 0.05). CONCLUSIONS: To our knowledge, this is the first study to show that sensitisation to Lep d may have clinical relevance in a non-occupational setting. In this group, there seems to be a relationship between allergy to Lep d and severity of respiratory disease, with more bronchial inflammation, when comparing with mite-allergic patients sensitised only to HDM. Therefore, the authors consider that sensitisation to Lep d should be considered when assessing and treating allergic respiratory disease in urban environments.

Correlation of Multiple Allergen Simultaneous Test with Nasal Provocation Test of House Dust Mite.

Objectives: Compared with the skin prick test, relationship between the multiple allergen simultaneous test (MAST) and nasal provocation test (NPT) has rarely been evaluated. We evaluated the relationship between the results of the MAST and NPT against house dust mites in the Korean population. Methods: Medical records of patients who underwent both MAST and NPT were reviewed. Positive MAST was diagnosed when the levels of immunoglobulin E (IgE) specific for Dermatophagoides farinae (DF) and Dermatophagoides pteronyssinus (DP) were ≥2 positivity or ≥0.70 IU/ml. During the NPT, changes in subjective symptoms, including nasal obstruction, rhinorrhea, sneezing, itching, ocular discomfort, and peak nasal inspiratory flow (PNIF), were measured. The correlation between NPT and MAST results was statistically analyzed. Results: A total of 96 participants were enrolled in this study: 26 were assigned to the MAST-positive group, and 70 were assigned to the MAST-negative group. Changes in subjective symptoms before and after the nasal allergen challenge were significantly associated with the MAST results. Changes in PNIF before and after the nasal allergen challenge were also significantly associated with the MAST results. We found that a cutoff value of "a subjective total nasal symptom change" of more than 17.5 had a sensitivity of 68.6% and a specificity of 69.2%, while a cutoff value of "a PNIF change" of more than 6.51 had a sensitivity of 67.1% and a specificity of 69.2%. Conclusion: NPT was significantly associated with MAST, and further studies regarding the relationship between NPT using various allergen conditions and MAST are warranted.

Appropriate Antigen Concentrations and Timing of a Nasal Provocation Test.

PURPOSE: We aimed to determine appropriate antigen concentrations and the right time to evaluate intranasal changes when performing a nasal provocation test (NPT). Also, we sought to analyze the diagnostic usefulness of individual nasal symptom and peak nasal inspiratory flow (PNIF). MATERIALS AND METHODS: We divided 46 patients into allergic rhinitis (AR) group (n=19) and a non-allergic rhinitis (NAR) group (n=27). We performed intranasal challenge with 100 AU/mL of Dermatophagoides pteronyssinus (DP) and measured changes in nasal symptoms [scored using the visual analogue scale (VAS)] and PNIF%. If the patient showed significant changes, VAS and PNIF were assessed again after another 15 minutes. In patients without significant changes, we administered 1000 AU/mL and measured changes in nasal symptoms and PNIF% after 15 and 30 minutes. RESULTS: Fifteen minutes after the 100 AU/mL challenge, the AR group showed more significant VAS changes in all nasal symptoms, total nasal symptom score (TNSS), and PNIF% change than the NAR group. Among the AR group, patients who did not respond to 100 AU/mL exhibited less significant differences relative to the NAR group, even after 1000 AU/mL challenge. Receiver operating characteristic curve analysis for VAS changes 15 minutes after 100 AU/mL challenge revealed that all nasal symptoms had area under the curve (AUC) values of ≥0.84 (p<0.001). TNSS change had an AUC value of 0.929 (p<0.001), while PNIF% change had an AUC value of 0.834. CONCLUSION: We could determine the optimal concentration (100 AU/mL), timing (15 minutes after challenge), and parameters (changes in TNSS and PNIF%) when performing NPT.

Korean Modification of the Nasal Provocation Test With House Dust Mite Antigen Following the EAACI Guidelines.

OBJECTIVES: We evaluated the usefulness of the standardized nasal provocation test (NPT) protocol recently published by the European Academy of Allergy and Clinical Immunology (EAACI) and compared the utility of several parameters for diagnosing allergic rhinitis (AR) caused by house dust mites (HDM). Subjective parameters were nasal and ocular symptoms measured using a visual analog scale (VAS), and objective parameters were peak nasal inspiratory flow (PNIF), minimal cross-sectional area (MCA), and total nasal volume (TNV). METHODS: Before and after spraying Dermatophagoides pteronyssinus (DP) allergen (1,000 AU/mL, 100 µL) into both nostrils of 13 patients with AR (AR group) and 22 patients with non-AR (NAR group), we used VAS scores to measure nasal symptoms (nasal obstruction, rhinorrhea, sneezing, and itching) and ocular symptoms and assessed PNIF, MCA, and TNV. RESULTS: The AR group had significantly worse symptoms than the NAR group 15 minutes after DP challenge (P<0.001). After 30 minutes, nasal obstruction and rhinorrhea remained worse in the AR group (P<0.001); a similar but less marked difference was seen for sneezing (P=0.012) and itching (P=0.039). Ocular symptoms, PNIF, MCA, and TNV differed between groups after both 15 and 30 minutes (P<0.05). The area under the receiver operating characteristic curve was higher for nasal obstruction (0.977), rhinorrhea (0.906), and TNV (0.979) than for sneezing (0.755), itching (0.673), and MCA (0.836). CONCLUSION: NPT performed according to the EAACI guidelines could help diagnose AR caused by HDM. TNV and VAS changes in nasal obstruction and rhinorrhea had higher diagnostic accuracy than other parameters.

Occupational Rhinitis.

There is convincing evidence that tight relationships between the upper and lower airways also apply to the workplace context. Most patients with occupational asthma (OA) also suffer from occupational rhinitis (OR), although OR is 2 to 3 times more common than OA. OR most often precedes the development of OA, especially when high-molecular-weight protein agents are involved, and longitudinal cohort studies have confirmed that OR is associated with an increased risk for the development of OA. The level of exposure to sensitizing agents at the workplace is the most important determinant for the development of IgE-mediated sensitization and OR. Atopy is a risk factor for the development of IgE-mediated sensitization only to high-molecular-weight agents. In workers with work-related rhinitis symptoms, documentation of IgE-mediated sensitization to a workplace agent via skin prick testing or serum specific IgE confirms a diagnosis of probable OR, whereas specific nasal provocation testing in the laboratory remains the reference method to establish a definite diagnosis of OR. Complete avoidance of exposure to the causal agent is the most effective therapeutic option for controlling work-related nasal symptoms and preventing the development of OA. If complete elimination of exposure is expected to induce meaningful adverse socioeconomic consequences, reduction of exposure can be considered as an alternative approach, but it is important to consider the individual risk factors for the development of OA to implement a more personalized management of OR.

Nasal IgE in subjects with allergic and non-allergic rhinitis.

PURPOSE: The prevalence of "ocal allergic rhinitis" within individuals suffering from perennial rhinitis remains uncertain, and patients usually are diagnosed with non-allergic rhinitis. The aim of this study was to evaluate the prevalence of a potential "local allergic rhinitis" in subjects suffering from non-allergic rhinitis in a non-selected group of young students. METHODS: 131 students (age 25.0 ± 5.1 years) with a possible allergic rhinitis and 25 non-allergic controls without rhinitis symptoms (age 22.0 ± 2.0 years) were recruited by public postings. 97 of 131 students with rhinitis were tested positive (≥3 mm) to prick testing with 17 frequent allergens at visit 1. Twenty-four 24 subjects with a house dust mite allergy, 21 subjects with a non-allergic rhinitis, and 18 non-allergic controls were further investigated at visit 2. Blood samples were taken, and nasal secretion was examined. In addition, all groups performed a nasal provocation test with house dust mite (HDM). RESULTS: In serum and nasal secretion, total IgE and house dust mite specific IgE significantly differed between HDM positive subjects and controls. However, no differences between non-allergic subjects and control subjects were quantifiable. Neither a nasal provocation test nor a nasal IgE to HDM allergens showed a measurable positive response in any of the non-allergic rhinitis subjects as well as the healthy controls, whilst being positive in 13 subjects with HDM allergy. CONCLUSIONS: Nasal IgE is present in subjects with HDM allergy, but not in non-allergic rhinitis. In the investigated non-selected population, exclusive local production of IgE is absent. By implication, therefore, our findings challenge the emerging concept of local allergic rhinitis.Study identifier at ClinicalTrials.gov: NCT02810535.

Paradoxical Response to Cold Dry Air Provocation according to the Season in Allergic Rhinitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We investigated the seasonal variation of nonspecific hyperreactivity by performing the cold dry air (CDA) provocation test in both summer and winter in patients with rhinitis. SUBJECTS AND METHOD: We performed the CDA provocation test in 57 patients with allergic rhinitis (AR) or non-allergic rhinitis (NAR). Depending on the season and the type of rhinitis, we divided patients into four groups (Summer AR group, n=17; Winter AR group, n=15; Summer NAR group, n=18 and Winter NAR group, n=7) and compared the changes in nasal symptoms, total nasal volume (TNV), and minimal cross-sectional area (MCA) measured by acoustic rhinometry after CDA provocation in each group. RESULTS: When the CDA provocation was performed for AR patients in summer, nasal symptoms improved slightly, which was significantly different from those shown in winter (Summer AR vs. Winter AR, p=0.012). In addition, there was a significant difference in symptom change between AR and NAR patients in the summer (Summer AR vs. Summer NAR, p=0.033). There was no significant difference in TNV or MCA changes after CDA provocation depending on the type of rhinitis and season (p>0.05). CONCLUSION: When performing CDA provocation in AR patients in summer, the examiner should pay attention to the possible paradoxical response.

Clinical application of capsaicin cough challenge test / 中国基层医药

The capsaicin cough provocation test is the most commonly used test to objectively evaluate cough sensitivity.The mechanism is simple and the test can be accepted by a lot of patients, which could evaluate the degree of cough, guide medicine, promote new drug development, seek for the cause.This article mainly reviews the clinical application of capsaicin cough test to assess degree of cough and guide treatment.

Clinical application of capsaicin cough challenge test / 中国基层医药

The capsaicin cough provocation test is the most commonly used test to objectively evaluate cough sensitivity.The mechanism is simple and the test can be accepted by a lot of patients,which could evaluate the degree of cough,guide medicine,promote new drug development,seek for the cause.This article mainly reviews the clinical application of capsaicin cough test to assess degree of cough and guide treatment.

Usefulness of Allerkin House Dust Mite Extract for Nasal Provocation Testing.

OBJECTIVES: We evaluated the clinical usefulness of Allerkin (Lofarma) for nasal provocation testing (NPT) in patients with rhinitis symptoms, by examining changes in nasal symptoms and acoustic parameters after exposure to house dust mite (HDM) extract. METHODS: Twenty patients (16 males and 4 females, mean age: 29.6±14.6 years) were enrolled. We performed skin prick test (SPT) before and 15 and 30 minutes after intranasal challenge with Allerkin HDM extract, and we evaluated symptom changes (nasal obstruction, rhinorrhea, sneezing, and itching) using a visual analogue scale. We also evaluated changes in acoustic parameters such as total nasal volume (TNV) and minimal cross-sectional area (MCA) before and after challenge. RESULTS: Group A (the nonallergic group, n=8) showed negative results for all tested aeroallergens in SPT and nonprovocative results (<25% decrease of TNV and MCA from the baseline value) in NPT. Group B (the allergic group, n=7) exhibited strongly positive results (wheal size larger than that of histamine) for HDM allergens on SPT. Group C (the local allergic group, n=5) showed negative results on SPT, but a provocative response on NPT (>29% decrease in TNV/MCA from the baseline value). Patients in group C showed significant aggravation of nasal obstruction compared to those in group A (P<0.05). Thirty minutes after HDM challenge, patients in groups B and C showed significantly greater decreases in MCA compared to those in group A (P<0.01). CONCLUSION: Allerkin HDM extract can be a useful provocative agent in NPT for diagnosing allergic rhinitis and local allergic rhinitis.

Cold Dry Air Provocation and Immunoglobulin E in Nasal Fluid for Diagnosing Nonspecific Hyper-Reactivity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to evaluate the usefulness of cold dry air (CDA) provocation test in patients with non-allergic or allergic rhinitis. SUBJECTS AND METHOD: Twenty-one patients (13 males and 8 females, mean age 36.9±17.6 years) with symptoms of rhinitis were enrolled. We classified patients into groups A (control group, n=9) and B (allergic group, n=12) according to their skin prick test results. Before and after CDA provocation (0℃, relative humidity<10%, total 400 liters during 6 minutes), we evaluated changes in nasal symptoms. We collected serum, and nasal fluid before and after CDA provocation using the filter paper method. We measured serum and nasal fluid IgE levels, compared them between the groups, and evaluated the correlation between serum and nasal fluid IgE. RESULTS: After the CDA provocation, group B had more aggravation of symptoms than group A, with a statistical significance (for nasal obstruction, group A: 3.0±2.4, group B: 5.8±3.4, p=0.049; for itching, group A: 1.0±1.6, group B: 3.8±3.4, p=0.045). The level of serum total IgE was significantly higher in group B (group A: 152.7±67.3 ng/mL, group B: 612.1±291.4 ng/mL, p=0.001). The titer of nasal fluid IgE was higher in group B, before and after the CDA challenge (before CDA, group A: 91.7±52.6 ng/mL, group B: 810.0±1042.3 ng/mL, p=0.029, after CDA, group A: 55.8±43.8 ng/mL, group B: 354.9±236.7 ng/mL, p=0.003). There was a significant correlation between the serum IgE and nasal fluid IgE levels after the CDA provocation test (R2=0.749, p<0.001). CONCLUSION: The CDA provocation test and measurement of nasal fluid IgE level could be useful for the evaluation of nonspecific hyper-reactivity.

Usefulness of Allerkin House Dust Mite Extract for Nasal Provocation Testing

OBJECTIVES: We evaluated the clinical usefulness of Allerkin (Lofarma) for nasal provocation testing (NPT) in patients with rhinitis symptoms, by examining changes in nasal symptoms and acoustic parameters after exposure to house dust mite (HDM) extract. METHODS: Twenty patients (16 males and 4 females, mean age: 29.6±14.6 years) were enrolled. We performed skin prick test (SPT) before and 15 and 30 minutes after intranasal challenge with Allerkin HDM extract, and we evaluated symptom changes (nasal obstruction, rhinorrhea, sneezing, and itching) using a visual analogue scale. We also evaluated changes in acoustic parameters such as total nasal volume (TNV) and minimal cross-sectional area (MCA) before and after challenge. RESULTS: Group A (the nonallergic group, n=8) showed negative results for all tested aeroallergens in SPT and nonprovocative results ( 29% decrease in TNV/MCA from the baseline value). Patients in group C showed significant aggravation of nasal obstruction compared to those in group A (P < 0.05). Thirty minutes after HDM challenge, patients in groups B and C showed significantly greater decreases in MCA compared to those in group A (P < 0.01). CONCLUSION: Allerkin HDM extract can be a useful provocative agent in NPT for diagnosing allergic rhinitis and local allergic rhinitis.

Acoustic Rhinometry in Nasal Provocation Tests in Children and Adolescents.

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). RESULTS: Compared with controls, patients with rhinitis had significantly higher mean total nasal resistance (0.34 Pa/cm3/s vs 0.21 Pa/cm3/s; P=.01) and lower mean V5 values (8.20 cm3 vs 9.24 cm3; 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.

Evidences for Local Allergic Rhinitis

Local allergic rhinitis is defined as a localized allergic reaction of the nasal mucosa in the absence of systemic atopy. Its main pathophysiological mechanism can be summarized as: 1) increased specific immunoglobulin E in the nasal fluid, and 2) Th2 allergic mechanism localized in the nasal mucosa. In patients whose result of a skin prick test is totally negative for all antigens, practitioners could diagnose local allergic rhinitis using a nasal provocation test. Oral antihistamines and intranasal steroids can be an effective treatment. Subcutaneous immunotherapy can also be helpful. Further study is essential to further elucidate the detailed pathophysiologic mechanism and set up global standard diagnostic criteria.

Instrumentos objetivos tradicionais de avaliação respiratória em respiradores orais / Traditional instruments objectives of respiratory evaluation in mouth breathers

A obstrução nasal é uma das principais anormalidades que afetam a permeabilidade nasal (PN) e em consequência está associada à respiração oral. Considerando a importância das complicações respiratórias e sua relação com o mecanismo de obstrução nasal, ressalta-se a necessidade e importância desse tipo de avaliação na população pediátrica e adulta. Objetivo: apresentar uma atualização da literatura quanto aos instrumentos objetivos para avaliação da permeabilidade das vias aéreas superiores e sua aplicabilidade na avaliação respiratória de indivíduos RO. Síntese dos dados: a revisão bibliográfica foi realizada utilizando as palavras-chaves: mouth breathing, nasal obstruction, nasal patency evaluation e instrumentos objetivos tradicionais da permeabilidade das vias aéreas: rhinomanometry, sniff nasal inspiratory pressure nasal peak flow, acoustic rhinometry, rhinomanometry e nasal spirometry. Uma síntese dos trabalhos foi organizada apresentando os instrumentos objetivos mais tradicionais encontrados na literatura. Com base nos estudos selecionados, discutiu-se sobre a indicação destes recursos na avaliação da permeabilidade de vias aéreas superiores. Conclusões: a avaliação respiratória objetiva de RO pode ser realizada por diferentes instrumentos tradicionais, utilizados tanto na avaliação, diagnóstico e identificação de efeitos de intervenções de RO.

In vitro allergy testing.

BACKGROUND: History and physical examination are the first, and most important steps, in the evaluation of a patient suspected of having an allergy. The diagnosis can be confirmed with either skin or serum testing for evidence of immunoglobulin E (IgE)-mediated reactivity. METHODS: The recent literature on serum-based testing for the detection and quantitation of allergen specific IgE (sIgE) was reviewed, identifying where available the "best practices" from high level of evidence studies and/or physician organization guidelines. RESULTS: Current practices for documenting sIgE are detailed, including enzyme-linked immunoassays on conventional extracts (standardized or not), similar on microarrays of highly purified or recombinant allergens, and basophil activation testing. CONCLUSION: Serum testing is an equal alternative to skin testing for establishing the presence of IgE-mediated sensitivity and for identifying the allergens involved. Like skin testing, limitations include the availability of fully detailed allergenic extracts, particularly for foods, drugs, and occupational agents, and the possibility of non-IgE mediated issues.

Nonspecific hyper-reactivity and localized allergy: cause of discrepancy between skin prick and nasal provocation test.

OBJECTIVE: Disagreement between results of skin prick test (SPT) and nasal provocation tests (NPT) causes difficulty in differential diagnosis of allergic rhinitis (AR) and nonallergic rhinitis (NAR). We hypothesized this discrepancy could be due to the nonspecific hyper-reactivity (NHR) and localized allergy of the nasal cavity. STUDY DESIGN: Prospective pilot. SETTING: Academic tertiary rhinologic practice. SUBJECTS AND METHODS: Sixty patients with AR and 62 with NAR were enrolled. We categorized patients according to results of SPT and NPT. We compared: (1) the clinical characteristics and severity of the disease, (2) change of minimal cross-sectional area (MCA) and total nasal volume (TNV) after normal saline (NS) challenge, and (3) change of nasal symptoms and acoustic parameters after intranasal house dust mite (HDM) challenge between groups. RESULTS: Patients in groups A (SPT[+]/NPT[+]) and C (SPT[-]/NPT[+]) complained of more persistent discomfort than those in groups B (SPT[+]/NPT[-]) and D (SPT[-]/NPT[-]). The proportion of moderate to severe symptoms was significantly higher in groups A, B, and C compared to group D. After NS challenge, MCA/TNV showed a significantly greater decrease in groups A (MCA: 27.6% ± 21.3%, TNV: 24.6% ± 16.4%) and C (MCA: 31.2% ± 24.0%, TNV: 24.1% ± 23.4%) compared to groups B (MCA: 0.1% ± 13.2%, TNV: 3.9% ± 13.5%) and D (MCA: 2.1% ± 12.1%, TNV: 2.0% ± 17.2%) (P < .05). After HDM challenge, groups A/B showed a greater decrease in MCA (Group A: 62.4% ± 16.1%, Group B: 6.4% ± 11.3%) compared to groups C/D (Group C: 45.5% ± 14.4%, Group D: -3.0% ± 9.5%). CONCLUSION: NHR and/or localized allergy should be considered in patients with rhinitis whose SPT and NPT results are not in agreement.

The Current Knowledge of Allergen Nasal Provocation Test

Nasal provocation test (NPT) is a procedure used to evaluate the hyper-responsiveness of nasal mucosa after exposure to a provocative allergen. We aimed to identify the clinical indication and contra-indication for the use of NPT, and to introduce the actual NPT laboratory protocol in our clinical practice. We also provide clinical information which could be useful in conducting NPT. Finally, we discuss the current limitations of NPT and present a plan to overcome these difficulties.

Comparison of Collecting Methods of Nasal Fluids Using Albumin after Nasal Provocation in Allergic Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although different methods of collecting nasal fluid exist and can influence the result of the study, there have not been any studies made yet to compare the different methods. The authors aimed to evaluate the usefulness of these methods by comparing the albumin concentration of nasal fluid after nasal provocation in patients with allergic rhinitis. SUBJECTS AND METHOD: In 22 patients with allergic rhinitis, we measured the change of nasal obstruction and rhinorrhea after nasal provocation using Visual Analogue Scale (VAS). In Group A (n=10), the nasal lavage and direct suction method were used and in Group B (n=12), nasal lavage and filter paper method were used. Nasal fluids were obtained before, 20 min after and 8 hours after provocation. The concentration of albumin was calculated using rate nephelometry. RESULTS: Patients' nasal symptoms were aggravated in early allergic reaction but subsided in late reaction. There was meaningful increase of albumin concentration with the use of direct suction and filter paper methods. In contrast, there was no significant increase of concentration with the use of lavage method. CONCLUSION: The filter paper method is superior in the quantitative analysis of mediators in nasal fluid after nasal provocation in allergic patients. The lavage method, however, is considered inappropriate because of its dilution effect.

Função pulmonar e sintomas extra-nasais observados durante testes de provocação nasal com histamina em crianças e adolescentes / Lung function and non nasal symptoms observed during histamine nasal provocation tests in children and adolescents

Objetivo: Descrever o comportamento dos valores de função pulmonar e os sintomas extra-nasais induzidos pelo teste de provocação nasal (TPN) com histamina em crianças e adolescentescom rinite alérgica (RA) e em controles não alérgicos. Métodos: Vinte crianças e adolescentes com RA persistente (11 asmáticos) e 20 controles foram submetidos a TPN com histamina. Os pacientes com RA foram tratados com corticosteróide tópico nasal e re-provocados. Sintomas extra-nasaisforma registrados durante os TPN e função pulmonar (VEF1) foi mensurada antes e ao final da provocação. Resultados: Valores aceitáveis e reprodutíveis de função pulmonar foram obtidos em 32 dos TPN do grupo com rinite alérgica e em 15 de controles. Não houve diferença nos valores de VEF1 antes e após os TPN. Redução igual ou superior a 7% do valor basal de VEF1 foi encontrada em 7 pacientes com RA, todos asmáticos, e em um controle. Os pacientes asmáticos apresentaram variação VEF1 significantemente maior que os não asmáticos (diminuição de 4,2% versus 1,6%). Tosse foi observada em 12 TPN, sendo 11 em pacientes com RA (9 em asmáticos). Sintomas oculares foram observados em 18 TPN, 14 de pacientes com RA (10 antes do tratamento e 4 depois). Sintomas faríngeos foram desencadeados em 11 TPN, sendo 8 em pacientes com RA. Nenhuma reação grave foi observada. Conclusões: TPN com histamina são seguros, sem nenhuma reação adversa grave observada em 60 testes realizados. Queda dos valores de função pulmonar e sintomas respiratórios baixos podem ocorrer, particularmente em pacientes com asma concomitante. A indução de sintomas faríngeos e oculares em pacientes com RA é comum nesses testes e raramentese observa sintomas em outros órgãos.

Objective: To describe lung function and non nasal symptomsin histamine nasal provocation tests (NPT) in children and adolescents with allergic rhinitis (AR) and controls. Methods: Twenty children and adolescents with persistent AR (11 with asthma) and 20 controls were submitted to histamineNPT. Patients with AR were treated with topical nasal steroids and re-tested. Non nasal symptoms were recorded during NPT and lung function (FEV1) was measured before and after the provocation. Results: Acceptable and reproducible values of lung function were obtained in 32 NPT from the AR group and in 15 from the control group. No difference in pre and post NPT FEV1 was observed. Reduction of 7% or more from basal FEV1 was noted in 7 patients with AR, all asthmatics, and in one control. Asthmatic patients showed significantly higher FEV1 variation than non asthmatics (4.2% reduction versus 1.6%). Cough was observedin 12 NPT, 11 from AR patients (9 from asthmatics). Ocular symptoms were induced in 18 NPT, 14 from AR patients(10 before treatment and 4 after). Pharyngeal symptoms were observed in 11 NPT, 8 from AR patients. No severe adverse reaction was observed. Conclusions: Histamine NPT are safe without any severe adverse reaction observed in 60 provocations. Reduction of lung function values and lower respiratory symptoms can occur, particularly in patients with concomitant asthma. Pharyngeal and ocular symptoms are frequently induced in AR patients during NPT, but symptoms in other organs are rare.