House-Dust Mite Nasal Provocation: A Diagnostic Tool in Perennial Rhinitis

Abstract

Background In perennial allergic rhinitis (PAR), the skin-prick test (SPT) is a good diagnostic tool to identify the specific allergens. A nasal provocation test (NPT) is used to identify allergens and to confirm the diagnosis. The aim of this study was to determine the optimal cutoff values of symptom and peak nasal inspiratory flow (PNIF) changes after dust-mite NPT for predicting PAR. We also studied the relationship of the changes of symptoms in NPT and the wheal size of SPT. Methods One hundred five patients with perennial rhinitis underwent the NPT to Dermatophagoides pteronyssinus and the SPT. The NPT was assessed by changes in symptoms and PNIF. The optimal cutoff values of the symptoms score and PNIF changes after the NPT for predicting the SPT were determined using a receiver operating characteristic (ROC) curve. The relationship of the wheal sizes of SPT and the changes from the NPT were analyzed. Results Forty-eight patients had a positive SPT to D. pteronyssinus, of whom 33 patients had a positive NPT by increases of the symptom score. Twenty patients had a positive NPT by decreases of PNIF. The area under the ROC curve was 0.85 for symptom score changes and it was 0.612 for PNIF changes. There was a significant correlation between the wheal size of the SPT and symptom changes in the NPT. Conclusion Nasal provocation is a valuable test to confirm the diagnosis of D. pteronyssinus allergy, especially when the wheal from the SPT is small. The symptom change after the house-dust mite NPT is better than the PNIF change for predicting the PAR.

Positive allergen reaction in allergic and nonallergic rhinitis: a systematic review

“…The included studies consisted of case‐controls (n = 33) or case series (n = 13). Case‐control studies compared either AR vs NAR populations (n = 21), AR vs healthy controls (n = 10), or NAR vs healthy control (n = 2) . The case series assessed either AR‐only (n = 12) or NAR‐only (n = 1) populations.…”

“…The case series assessed either AR‐only (n = 12) or NAR‐only (n = 1) populations. There were 43 studies that involved patients with AR and 24 studies that involved patients with NAR . There were 6 studies that involved exclusively children under 16 years of age.…”

“…NAPT was performed with either dust (n = 22), grass/tree pollens (n = 13), or Alternaria mold (n = 2) . Three studies used allergens dependent on the patient's most likely sensitization .…”

“…The measurement tools used to determine nasal reactivity were either subjective (n = 12), objective (n = 9), or a combination of both (n = 21) . The outcome measures were unclear for 4 studies .…”

The skin prick test response after allergen immunotherapy in different levels of tIgE children with mite sensitive Asthma/Rhinitis in South China

“…4 Moreover, the wheal size of the SPT and symptom changes in nasal provocation test were statistically correlated. 5 Skin prick test can be used to judge the allergen and evaluate allergy severity in children with atopic dermatitis. 6 However, not all allergic patients can benefit from AIT.…”