Asthmatic Response Induced by Nasal Challenge with Allergen

Abstract

Background: There is a link between the upper and lower airways. Allergic rhinitis and bronchial asthma may coexist, but they can also affect each other. Objective: To investigate the possibility of nasal allergy being able to induce a secondary asthmatic response (AR). Methods: In 82 asthmatics responding insufficiently to standard antiasthmatic therapy and demonstrating negative ARs to bronchial challenge with allergen, 82 nasal challenges with various inhalant allergens were performed by means of rhinomanometry in combination with spirometry (vital capacity and forced expiratory volume in 1 s). In 33 control subjects suffering from allergic rhinitis (n = 18) or bronchial asthma (n = 15) only, 33 nasal challenges with inhalant allergens were performed by rhinomanometry and supplemented with spirometry. Results: Of the 82 nasal challenges, 69 produced a positive nasal response (p < 0.01) and 13 were negative (p > 0.05). In 58 cases with a positive nasal challenge, a secondarily induced AR was recorded (p < 0.01). The following types of ARs were documented: 17 isolated immediate ARs (p < 0.01), 24 isolated late ARs (p < 0.01), 12 dual late ARs (immediate + late, p < 0.05 and p < 0.01, respectively) and 5 isolated delayed ARs (p < 0.05). Conclusions: (1) An allergic reaction occurring initially in the nasal mucosa can play an important role in bronchial asthma by inducing a secondary AR, and (2) nasal challenge with allergen performed by rhinomanometry in combination with lung function recording (e.g. spirometry) may then determine the possible need for additional intranasal antiallergic treatment and sparing of antiasthmatic drugs.

Immediate and dual response to nasal challenge with Dermatophagoides pteronyssinus in local allergic rhinitis

“…These data are similar to those observed in previous studies in non‐allergic rhinitis [13–15], and allergic rhinitis and asthmatic patients [8, 22–27]. Although with a lower frequency, isolated late responses to NAPT have been reported in allergic rhinitis and asthmatic patients [28]. In a recent study, Wedback et al [29] described the presence of an isolated late response in 67% of non‐atopic rhinitis patients, and immediate and/or dual response in just 33%.…”

Aggravation of airway inflammation and hyper‐responsiveness following nasal challenge with Dermatophagoides pteronyssinus in perennial allergic rhinitis without symptoms of asthma

“…Relationship between the upper and lower airways in human subjects has been demonstrated by means of the challenge technique in many studies . Allergen can be administered using a variety of methods, although nasal spray devices are becoming the preferred method because they are capable of reaching the turbinate region with high deposition efficiencies without causing local irritation .…”

Nasal Airflow Measured by Rhinomanometry Correlates with FeNO in Children with Asthma

“…One study found the comorbidity of rhinitis and asthma to be as high as 100% [2]. Local allergen exposure in the nose of patients with allergic rhinitis can quickly lead to asthma or significant allergic inflammation in the lung [3], with an elevation of fractional exhaled nitric oxide (FeNO) [4]. It is important for pediatricians to understand the relationship between these two disorders that all children with rhinitis are evaluated for lower airway disease, and all patients with asthma are screened for upper airway conditions.…”