Clin Exp Otorhinolaryngol.  2021 Nov;14(4):382-389. 10.21053/ceo.2020.00563.

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

• Joo SH
• Hyun KJ
• Kim YH

• KMID: 2522429
• DOI: http://doi.org/10.21053/ceo.2020.00563

Abstract

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.

Keyword

Nasal Provocation Tests; Rhinitis, Allergic; Rhinometry, Acoustic; Visual Analog Scale

Figure

• 

  Fig. 1. Changes in symptoms measured with a visual analog scale (VAS) before and after a nasal challenge with Dermatophagoides pteronyssinus (DP) allergen extract. (A) Nasal obstruction. (B) Rhinorrhea. (C) Sneezing. (D) Itching. (E) Ocular symptom. (F) Total nasal symptom score (TNSS). VAS change: (post-challenge VAS)–(baseline VAS) of each symptom. DP_15 min, 15 minutes after the DP challenge; DP_30 min, 30 minutes after the DP challenge; AR, allergic rhinitis; NAR, non-allergic rhinitis. Unpaired t-test with Welch’s correction, statistical significance: P<0.05.

• 

  Fig. 2. %Change in peak nasal inspiratory flow (PNIF; A), minimal cross-sectional area (MCA; B), and total nasal volume (TNV; C) before and after a nasal challenge with Dermatophagoides pteronyssinus (DP) allergen extract. DP_15 min, 15 minutes after the DP challenge; DP_30 min, 30 minutes after the DP challenge; AR, allergic rhinitis; NAR, non-allergic rhinitis. Unpaired t-test with Welch’s correction, statistical significance: P<0.05.

• 

  Fig. 3. Receiver operating characteristic curve analysis for changes in symptoms before and after a nasal challenge with Dermatophagoides pteronyssinus (DP) allergen extract. (A) After 15 minutes. (B) After 30 minutes. NO, nasal obstruction; R, rhinorrhea; Sn, sneezing; It, itching; Ocular, ocular symptoms; TNSS, total nasal symptom score; _15, 15 minutes after the DP challenge; _30, 30 minutes after the DP challenge.

• 

  Fig. 4. Receiver operating characteristic curve analysis for the percent change in peak nasal inspiratory flow (PNIF; A), minimal cross-sectional area (MCA; B), and total nasal volume (TNV; C) before and after a nasal challenge with Dermatophagoides pteronyssinus (DP) allergen extract. _15, 15 minutes after the DP challenge; _30, 30 minutes after the DP challenge.

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