Comparison of Conjunctival and Nasal Provocation Test in Allergic Rhinitis to House Dust Mite

Abstract

Background: Nasal allergen provocation tests (NPTs) are useful in confirming the diagnosis of allergic rhinitis, if data obtained by clinical history, skin tests and specific IgE determinations are not conclusive. Since NPTs are laborious, conjunctival provocation tests (CPTs) appear as an attractive alternative. The concordance of CPTs and NPTs with house dust mite allergen extract in sensitized and nonsensitized subjects should be evaluated. Methods: 50 otherwise healthy subjects with self-reported house dust mite allergy and positive skin prick tests and serum specific IgE to Dermatophagoides pteronyssinus and 45 sex- and age-matched healthy controls without allergic symptoms were included. For NPTs, 100 µl allergen extract [10,000 allergy units (AU/ml)] were applied to the less congested nasal cavity. A clinical symptom score and active anterior rhinomanometry were employed to assess the response. For CPTs, 50 µl low-concentrated D. pteronyssinus extract (1,000 AU/ml), and if negative, 50 µl normally concentrated extract (10,000 AU/ml) were applied to the lower conjunctival sac. The response was assessed employing clinical symptom scores. Results: NPTs and CPTs yielded concordant results in 90% of the subjects successfully tested (Cohen’s kappa = 0.78, p < 0.0001). The diagnostic efficacy of the CPT, with the NPT as the reference method, was 89%, whether or not conjunctival symptoms had been reported in addition to rhinitis symptoms. Both techniques were judged almost equally uncomfortable. Conclusion: CPTs are an acceptable alternative to NPTs in patients with allergic rhinitis to house dust mite, even if they have no conjunctival symptoms.

Nasal Provocation Test in the Diagnosis of Allergic Rhinitis

“…On the other hand, CPT response was stronger at the 5 th minute when comparing to NPT, achieving borderline significance (p=0.05). This corroborates other results related to the evaluation of patient discomfort of NPT versus CPT using a visual-analogue scale, with a higher discomfort being appointed to CPT (Riechelmann et al, 2003). Apparently, these results are different from the study of Malmberg et al, 1978, in which the conjunctiva of 55% of the patients that underwent both NPT and CPT, using sequentially diluted allergen solutions, was less sensitive to allergen challenge than nasal mucosa.…”

“…According to our findings described previously, in respect to the symptoms scores pattern in response to NPT, we conducted a study to characterize the clinical response to NPT comparing to conjunctiva provocation test (CPT). As CPT is easy to perform and systemic reactions are uncommon, some authors have studied the concordance between NPT and CPT in the diagnosis of allergic rhinitis (Andersen et al, 1996;Leonardi et al, 1993;Malmberg et al, 1978;Petersson et al, 1986;Riechelmann et al, 2003) and asthma (Mosbech et al, 1987) using clinical score symptoms and/or objective methods. However, we are not aware of any publication describing the clinical pattern of NPT and CPT responses, neither about its comparison.…”

Objectifying the Conjunctival Provocation Test: Photography-Based Rating and Digital Analysis

“…The primary diagnosis of allergic rhinoconjunctivitis is usually made via skin prick testing or blood testing for specific IgE, methods which are approved and easy to apply in daily routine [5,6]. Mucosal provocation is an established diagnostic procedure especially for documenting the strength of the allergic sensitization directly at the organ level under specific immunotherapy and the patient's current reactivity to allergens, respectively, whereas the skin prick test and blood testing for specific IgE are not suitable for this indication [5,7]. Therefore, mucosal provocation tests are used in immunotherapy studies for documenting treatment effects and are accredited by regulatory agencies as a measure of outcome [5,7,8,9].…”

A randomized, double‐blind, placebo‐controlled, dose‐finding trial with Lolium perenne peptide immunotherapy

“…Conjunctival provocation tests (CPTs) were conducted11 and recorded12 as described before. The allergen extract ALK‐lyophilized grass (ALK‐Abelló, Wedel, Germany) was used in concentrations of 100, 1000 and 10 000 SQ‐U/mL.…”

“…The allergen extract ALK‐lyophilized grass (ALK‐Abelló, Wedel, Germany) was used in concentrations of 100, 1000 and 10 000 SQ‐U/mL. CPT responses ≥ stage II according to the Riechelmann scale11 were considered positive. If baseline CPT responses at V1 and V2 differed by one concentration stage, the higher concentration step was used for further analyses.…”