Clin Exp Otorhinolaryngol.  2017 Sep;10(3):254-258. 10.21053/ceo.2016.01137.

Usefulness of Allerkin House Dust Mite Extract for Nasal Provocation Testing

• Kim KS
• Jang TY
• Kim YH

• KMID: 2395740
• DOI: http://doi.org/10.21053/ceo.2016.01137

Abstract

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.

Keyword

Allergic Rhinitis; Nasal Provocation Tests; Dermatophagoides pteronyssinus; Acoustic Rhinometry

MeSH Terms

Acoustics
Allergens
Dermatophagoides pteronyssinus
Dust*
Female
Humans
Male
Nasal Obstruction
Nasal Provocation Tests*
Pyroglyphidae*
Rhinitis
Rhinitis, Allergic
Rhinometry, Acoustic
Skin
Sneezing
Allergens
Dust

Figure

• 

  Fig. 1. Change of nasal symptoms after provocation with Allerkin (Lofarma) house dust mite extract. Group A, non-allergic group; Group B, allergic group; Group C, local allergic group. Kruskal-Wallis and Mann-Whitney U-tests. TNSS, total nasal symptom score; VAS, visual analogue scale.

• 

  Fig. 2. Change in acoustic parameters after provocation with Allerkin (Lofarma) house dust mite extract. Group A: non-allergic group, group B: allergic group, group C: local allergic group. Kruskal-Wallis and Mann-Whitney U-tests. TNV, total nasal volume; MCA, minimal cross-sectional area; _15 min, 15 minutes after challenge; _30 min, 30 minutes after challenge.

Reference

1. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008; Apr. 63 Suppl 86:8–160.

2. Kim JH, Yoon MG, Seo DH, Kim BS, Ban GY, Ye YM, et al. Detection of allergen specific antibodies from nasal secretion of allergic rhinitis patients. Allergy Asthma Immunol Res. 2016; Jul. 8(4):329–37.

3. Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet. 2011; Dec. 378(9809):2112–22.

4. Cibella F, Ferrante G, Cuttitta G, Bucchieri S, Melis MR, La Grutta S, et al. The burden of rhinitis and rhinoconjunctivitis in adolescents. Allergy Asthma Immunol Res. 2015; Jan. 7(1):44–50.

5. Gosepath J, Amedee RG, Mann WJ. Nasal provocation testing as an international standard for evaluation of allergic and nonallergic rhinitis. Laryngoscope. 2005; Mar. 115(3):512–6.

6. Kim YH, Yang TY, Lee DY, Ko KJ, Shin SH, Jang TY. Evaluation of acoustic rhinometry in a nasal provocation test with allergic rhinitis. Otolaryngol Head Neck Surg. 2008; Jul. 139(1):120–3.

7. Rondon C, Romero JJ, Lopez S, Antunez C, Martin-Casanez E, Torres MJ, et al. Local IgE production and positive nasal provocation test in patients with persistent nonallergic rhinitis. J Allergy Clin Immunol. 2007; Apr. 119(4):899–905.

8. Rondon C, Fernandez J, Lopez S, Campo P, Dona I, Torres MJ, et al. Nasal inflammatory mediators and specific IgE production after nasal challenge with grass pollen in local allergic rhinitis. J Allergy Clin Immunol. 2009; 124(5):1005–11. e1.

9. Kim YH, Jang TY. Proposed diagnostic standard using visual analogue scale and acoustic rhinometry in nasal provocation test in allergic patients. Auris Nasus Larynx. 2011; Jun. 38(3):340–6.

10. Senna GE, Andri G, Dama AR, Falagiani P, Andri L. Local nasal immunotherapy: efficacy and tolerability of two different administration schedules in grass pollen rhinitis. Allergol Immunopathol (Madr). 2000; Jul-Aug. 28(4):238–42.

11. Palma-Carlos AG, Santos AS, Pregal A. Short-term efficacy of nasal immunotherapy. Allerg Immunol (Paris). 1998; Jan. 30(1):14–7.

12. Cserhati E, Mezei G. Nasal immunotherapy in pollen-sensitive children. Allergy. 1997; 52(33 Suppl):40–4.

13. Powe DG, Jagger C, Kleinjan A, Carney AS, Jenkins D, Jones NS. ‘Entopy’: localized mucosal allergic disease in the absence of systemic responses for atopy. Clin Exp Allergy. 2003; Oct. 33(10):1374–9.

14. Rondon C, Canto G, Blanca M. Local allergic rhinitis: a new entity, characterization and further studies. Curr Opin Allergy Clin Immunol. 2010; Feb. 10(1):1–7.

15. Huggins KG, Brostoff J. Local production of specific IgE antibodies in allergic-rhinitis patients with negative skin tests. Lancet. 1975; Jul. 2(7926):148–50.

16. Rondon C, Dona I, Lopez S, Campo P, Romero JJ, Torres MJ, et al. Seasonal idiopathic rhinitis with local inflammatory response and specific IgE in absence of systemic response. Allergy. 2008; Oct. 63(10):1352–8.

17. Jang TY, Kim YH. Nasal provocation test is useful for discriminating allergic, nonallergic, and local allergic rhinitis. Am J Rhinol Allergy. 2015; Jul-Aug. 29(4):e100–4.

18. Litvyakova LI, Baraniuk JN. Nasal provocation testing: a review. Ann Allergy Asthma Immunol. 2001; Apr. 86(4):355–64.