Abstract
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.
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References
Gendo K, Larson EB. Evidence-based diagnostic strategies for evaluating suspected allergic rhinitis. Ann Intern Med. 2004;140(4):278–89.
Sheikh J. Allergic rhinitis workup. In: Kaliner MA, editor. Medscape. http://emedicine.medscape.com/article/134825-workup#c6 Accessed online 16 Jan 2016.
Blackley C. Experimental researches on the causes and nature of catarrhus aestivus. London: Balliere, Tindall & Cox; 1873.
Aschan G, Drettner B. Nasal obstruction at provocation experiments in patients with hay-fever. Acta Otolaryngol. 1958;140:91–9.
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.
Druce HM, Schumacher MJ. Nasal provocation challenge. The Committee on Upper Airway Allergy. J Allergy Clin Immunol. 1990;86:261–4.
Schumacher MJ. Nasal provocation test. Rhinology. 1992;14:242–6.
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.
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.
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.
Litvyakova LI, Baraniuk JN. Nasal provocation testing: a review. Ann Allergy Asthma Immunol. 2001;86:355–65.
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.
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.
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.
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.
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.
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.
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.
Hytonen M, Sala E. Nasal provocation test in the diagnosis of occupational allergic rhinitis. Rhinology. 1996;34:86–90.
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.
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.
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.
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. www.eaaci.org; http://www.eaaci.org/resources/global-atlas-of-allergy.html.
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.
Tantilipikorn P, Vichyanond P, Lacroix JS. Nasal provocation test: how to maximize its clinical use? Asian Pac J Allergy Immunol. 2010;28:225–31.
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.
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.
Solomon WR. Nasal provocation testing. In: Spector SL, editor. Provocation testing in clinical practice, vol. 5. New York: Marcel Dekker; 1995. p. 647–92.
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.
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.
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.
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.
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.
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Zorlu, D., Bayar Muluk, N., Campo, P. (2020). Nasal Provocation Tests. In: Cingi, C., Bayar Muluk, N. (eds) All Around the Nose. Springer, Cham. https://doi.org/10.1007/978-3-030-21217-9_16
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