Nasal Provocation Tests

  • Duygu Zorlu
  • Nuray Bayar Muluk
  • Paloma Campo


Nasal provocation test (NPT) with allergens is a safe and simple technique recommended in different diagnostic and research settings. NPT is mostly used for diagnostic purposes in cases where patient’s symptoms do not agree with the results of skin or blood testing. Also, it has an important role in clinical trials. It is a test that can be used in routine clinical practice although must be conducted by properly trained personnel. Inhaled allergens have been epidemiologically determined as a significant factor leading to allergic rhinitis (AR) and asthma. Imitating the natural process, NPT allows gaining insights into how allergic respiratory inflammation and airway hyperresponsiveness (AHR) work. In the research field, NPT has been widely used in the study of mechanisms of inflammation and allergic response in subjects with allergic rhinitis (AR) and local allergic rhinitis (LAR), in the study of pathophysiological mechanisms of response allergens, and to evaluate the therapeutic effect of drugs or immunotherapy in controlled clinical trials. Daily clinical application of NPT as a method to recreate the nasal allergic reactions and to study the AR characteristics regarding its pathophysiology, immunology, and pharmacology became popular. As a method to determine the clinical role of allergens in patients with multiple sensitizations, NPT is suggested to validate AR diagnosis. In addition, NPT is recommended in case of inconsistencies or hardships between a patient’s medical history and the skin and/or blood serum test results. This chapter develops the most relevant aspects concerning NPT.


Nasal provocation test Allergic rhinitis Allergens Allergic respiratory inflammation Immunotherapy 


  1. 1.
    Gendo K, Larson EB. Evidence-based diagnostic strategies for evaluating suspected allergic rhinitis. Ann Intern Med. 2004;140(4):278–89.CrossRefGoogle Scholar
  2. 2.
    Sheikh J. Allergic rhinitis workup. In: Kaliner MA, editor. Medscape. Accessed online 16 Jan 2016.
  3. 3.
    Blackley C. Experimental researches on the causes and nature of catarrhus aestivus. London: Balliere, Tindall & Cox; 1873.Google Scholar
  4. 4.
    Aschan G, Drettner B. Nasal obstruction at provocation experiments in patients with hay-fever. Acta Otolaryngol. 1958;140:91–9.CrossRefGoogle Scholar
  5. 5.
    Bachert C, Gonsior E, Berdel D. Richtlinien für die durchfürung von nasalen Provokationen mit Allergen bei Erkrangungen der oberen Luftwege. Allergologie. 1990;13:53–6.Google Scholar
  6. 6.
    Druce HM, Schumacher MJ. Nasal provocation challenge. The Committee on Upper Airway Allergy. J Allergy Clin Immunol. 1990;86:261–4.CrossRefGoogle Scholar
  7. 7.
    Schumacher MJ. Nasal provocation test. Rhinology. 1992;14:242–6.Google Scholar
  8. 8.
    Lund VJ, Aaronson D, Bousquet J, Dahl R, Davies RJ, Durham SR, et al. International Consensus Report on the diagnosis and management of rhinitis. International Rhinitis Management Working Group. Allergy. 1994;49(Suppl 19):1–34.Google Scholar
  9. 9.
    Melillo G, Bonini S, Cocco G, Davies RJ, de Monchy JGR, Frolund L, Pelikan Z. EAACI provocation tests with allergens. Report prepared by the European Academy of Allergology and Clinical Immunology Subcommittee on provocation tests with allergens. Allergy. 1997;52(Suppl 35):1–35.PubMedGoogle Scholar
  10. 10.
    Malm L, Gerth Van Wijk R, Bachert C. Guidelines for nasal provocations with aspects on nasal patency, airflow, and airflow resistance. International Committee on Objective Assessment of the Nasal Airways, International Rhinologic Society. Rhinology. 2000;38:1–6.PubMedGoogle Scholar
  11. 11.
    Litvyakova LI, Baraniuk JN. Nasal provocation testing: a review. Ann Allergy Asthma Immunol. 2001;86:355–65.CrossRefGoogle Scholar
  12. 12.
    Litvyakova LI, Baraniuk JN. Human nasal allergen provocation for determination of true allergic rhinitis: methods for clinicians. Curr Allergy Asthma Rep. 2002;2:194–202.CrossRefGoogle Scholar
  13. 13.
    Gosepath J, Amedee RG, Mann WJ. Nasal provocation testing as an international standard for evaluation of allergic and nonallergic rhinitis. Laryngoscope. 2005;115:512–6.CrossRefGoogle Scholar
  14. 14.
    Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update. Allergy. 2008;63(Suppl 86):8–160.CrossRefGoogle Scholar
  15. 15.
    Dordal MT, Lluch-Bernal M, Sánchez MC, Rondón C, Navarro A, Montoro J, et al. Allergen-specific nasal provocation testing: review by the Rhinoconjunctivitis Committee of the Spanish Society of Allergy and Clinical Immunology. J Investig Allergol Clin Immunol. 2011;21(1):1–12.PubMedGoogle Scholar
  16. 16.
    Valero Santiago A, Amat Par P, Sanosa Valls J, Sierra Martínez P, Malet Casajuana A, García Calderón PA. Hypersensitivity to wheat flour in bakers. Allergol Immunopathol (Madr). 1988;16(5):309–14.Google Scholar
  17. 17.
    Desrosiers M, Nguyen B, Ghezzo H, Leblanc C, Malo JL. Nasal response in subjects undergoing challenges by inhaling occupational agents causing asthma through the nose and mouth. Allergy. 1998;53:840–8.CrossRefGoogle Scholar
  18. 18.
    Airaksinen L, Tuomi T, Vanhanen M, Voutilainen R, Toskala E. Use of nasal provocation test in the diagnostics of occupational rhinitis. Rhinology. 2007;45:40–6.PubMedGoogle Scholar
  19. 19.
    Hytonen M, Sala E. Nasal provocation test in the diagnosis of occupational allergic rhinitis. Rhinology. 1996;34:86–90.PubMedGoogle Scholar
  20. 20.
    Gorski P, Krakowiak A, Pazdrak K, Palczynski C, Ruta U, Walusiak J. Nasal challenge test in the diagnosis of allergic respiratory diseases in subjects occupationally exposed to a high molecular allergen (flour). Occup Med (Lond). 1998;48:91–7.CrossRefGoogle Scholar
  21. 21.
    Lavasa S, Kumar L, Kaushal SC, Ganguli NK. Wheat threshing dust—a “new allergen” in April-May nasobronchial allergy. Indian Pediatr. 1996;33:566–70.PubMedGoogle Scholar
  22. 22.
    Passalacqua G, Albano M, Pronzato C, Riccio AM, Scordamaglia A, Falagiani P, et al. Long-term follow-up of nasal immunotherapy to Parietaria: clinical and local immunological effects. Clin Exp Allergy. 1997;27:904–8.CrossRefGoogle Scholar
  23. 23.
    Braunstahl GJ. In vivo allergy diagnosis-nasal and bronchial provocation tests. In: Akdis CA, Agache I, editors. Global atlas of allergy. Part 2a. Published by the European Academy of Allergy and Clinical Immunology; 2014. p. 153–5.;
  24. 24.
    Sanico AM, Philip G, Proud D, Naclerio RM, Togias A. Comparison of nasal mucosal responsiveness to neuronal stimulation in non-allergic and allergic rhinitis: effects of capsaicin nasal challenge. Clin Exp Allergy. 1998;28:92–100.CrossRefGoogle Scholar
  25. 25.
    Tantilipikorn P, Vichyanond P, Lacroix JS. Nasal provocation test: how to maximize its clinical use? Asian Pac J Allergy Immunol. 2010;28:225–31.PubMedGoogle Scholar
  26. 26.
    Cimarra M, Robledo T. Aplicación en provocación nasal específi ca. In: Valero A, Fabra JM, Márquez F, Orus C, Picado C, Sastre J, Sierra JI, editors. Manual de rinomanometríaacústica. Barcelona: MRA Médica; 2001. p. 55–63.Google Scholar
  27. 27.
    Yuta A, Doyle WJ, Gaumond E, Ali M, Tamarkin L, Baraniuk JN, Van Deusen M, Cohen S, Skoner DP. Rhinovirus infection induces mucus hypersecretion. Am J Phys. 1998;274(6 Pt 1):L1017–23.Google Scholar
  28. 28.
    Solomon WR. Nasal provocation testing. In: Spector SL, editor. Provocation testing in clinical practice, vol. 5. New York: Marcel Dekker; 1995. p. 647–92.Google Scholar
  29. 29.
    Terrien MH, Rahm F, Fellrath JM, Spertini F. Comparison of the effects of terfenadine with fexofenadine on nasal provocation tests with allergen. J Allergy Clin Immunol. 1999;103:1025–30.CrossRefGoogle Scholar
  30. 30.
    Valero AL, Picado C. Pruebas de provocación nasal específi cas. In: Valero AL, Fabra JM, Márquez F, Orús C, Picado C, Sastre J, Sierra JI, editors. Manual de rinometría acústica. Barcelona: MRA Médica; 2000. p. 53–74.Google Scholar
  31. 31.
    Meltzer E, Schatz M, Zeiger R. Allergic and nonallergic rhinitis. In: Middleton E, editor. Middleton’s allergy principles and practice. 4th ed. St. Louis: Mosby; 1993. p. 1253–88.Google Scholar
  32. 32.
    Pastorello EA, Riario-Sforza GG, Incorvaia C, Segala M, Fumagalli M, Gandini R. Comparison of rhinomanometry, symptom score and inflammatory cell counts in assessing the nasal late phase reaction to allergen challenge. J Allergy Clin Immunol. 1994;93:85–92.CrossRefGoogle Scholar
  33. 33.
    Chusakul S, Phannaso C, Sangsarsri S, Aeumjaturapat S, Snidvongs K. House-dust mite nasal provocation: a diagnostic tool in perennial rhinitis. Am J Rhinol Allergy. 2010;24:133–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Duygu Zorlu
    • 1
  • Nuray Bayar Muluk
    • 2
  • Paloma Campo
    • 3
  1. 1.Department of Pulmonology, Medical FacultyAhi Evran UniversityKırşehirTurkey
  2. 2.Department of Otorhinolaryngology, Medical FacultyKırıkkale UniversityKırıkkaleTurkey
  3. 3.Allergy UnitIBIMA-Hospital Regional Universitario de Málaga, ARADyALMadridSpain

Personalised recommendations