Allergen identification is the first step for allergen-specific immunotherapy (AIT) of allergic rhinitis (AR). Currently, the diagnosis of AR is based mainly on the positive results of the skin prick test (SPT) and/or serum specific immunoglobulin E (sIgE) measurement. However, the results of these two tests may not always directly correlate with AR.
Objective
To investigate the importance of nasal provocation testing (NPT) in the diagnosis of Dermatophagoides pteronyssinus (Der p)-induced AR.
Methods
Rhinitis patients willing to undergo AIT (n = 171) were enrolled. The correlations of Der p SPT, sIgE, NPT, and clinical symptom severity were assessed.
Results
NPT-positive responses were more common in patients with higher SPT and sIgE levels. The optimal cut-off value for a NPT-positive response for SPT was 5.5 mm and for sIgE was 2.77 kUA/L, based on the respective receiver operating characteristic (ROC) curves. The area under the curve (AUC) of the ROCs was 0.814 (SPT only) and 0.794 (sIgE only) and increased to 0.828 with the combination of SPT and sIgE. The Der p-NPT concentration was inversely correlated with SPT and sIgE levels (r = −0.477, P < .001, and r = −0.461, P < .001, respectively), but none was correlated with the total nasal symptom score.
Conclusion
For patients who are willing to receive Der p AIT, NPT is a useful and safe test to confirm diagnosis prior to treatment initiation, especially in patients with lower levels of Der p SPT (< 5.5 mm) or sIgE (< 2.77 kUA/L).
BousquetJKhaltaevNCruzAA, 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;63(86 Suppl):8–160.
2.
WangXDZhengMLouHF, et al.An increased prevalence of self-reported allergic rhinitis in major Chinese cities from 2005 to 2011. Allergy. 2016;71(8):1170–1180.
3.
SupakthanasiriPKlaewsongkramJChantaphakulH. Reactivity of allergy skin test in healthy volunteers. Singapore Med J. 2014;55(1):34–36.
4.
RondónCCantoGBlancaM. Local allergic rhinitis: a new entity, characterization and further studies. Curr Opin Allergy Clin Immunol. 2010;10(1):1–7.
5.
ChauveauADalphinMLKaulekV, et al.Disagreement between skin prick tests and specific IgE in early childhood. Int Arch Allergy Immunol. 2016;170(2):69–74.
6.
RøADSaunesMSmidesangI, et al.Agreement of specific IgE and skin prick test in an unselected cohort of two-year-old children. Eur J Pediatr. 2012;171(3):479–484.
7.
De VosGNazariRFerastraoaruD, et al.Discordance between aeroallergen specific serum IgE and skin testing in children younger than 4 years. Ann Allergy Asthma Immunol. 2013;110(6):438–443.
8.
NamY-HLeeS-K. Comparison between skin prick test and serum immunoglobulin E by CAP system to inhalant allergens. Ann Allergy Asthma Immunol. 2017;118(5):608–613.
9.
ShamjiMHKappenJHAkdisM, et al.Biomarkers for monitoring clinical efficacy of allergen immunotherapy for allergic rhinoconjunctivitis and allergic asthma: an EAACI position paper. Allergy. 2017;72(8):1156–1173.
10.
AugéJVentJAgacheI, et al.EAACI Position paper on the standardization of nasal allergen challenges. Allergy. 2018;73(8):1597–1608.
11.
PapadopoulosNGBernsteinJADemolyP, et al.Phenotypes and endotypes of rhinitis and their impact on management. Allergy. 2015;70(5):474–494.
12.
LiJSunBHuangY, et al.A multicentre study assessing the prevalence of sensitizations in patients with asthma and/or rhinitis in China. Allergy. 2009;64(7):1083–1092.
13.
WangXYMaTTWangXY, et al.Prevalence of pollen-induced allergic rhinitis with high pollen exposure in grasslands of northern China. Allergy. 2018;73(6):1232–1243.
14.
DordalMTLluch-BernalMSanchezMC, 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.
15.
LebelBBousquetJMorelA, et al.Correlation between symptoms and the threshold for release of mediators in nasal secretions during nasal challenge with grass-pollen grains. J Allergy Clin Immunol. 1988;82(5 Pt 1):869–877.
16.
GosepathJAmedeeRGMannWJ. Nasal provocation testing as an international standard for evaluation of allergic and nonallergic rhinitis. Laryngoscope. 2005;115(3):512–516.
17.
RiechelmannHMewesTWeschtaM, et al.Nasal allergen provocation with Dermatophagoides pteronyssinus in patients with chronic rhinitis referred to a rhinologic surgical center. Ann Allergy Asthma Immunol. 2002;88(6):624–631.
18.
HaxelBRHuppertzTBoessertP, et al.Correlation of skin test results and specific immunoglobulin E blood levels with nasal provocation testing for house-dust mite allergies. Am J Rhinol Allergy. 2016;30(1):60–64.
19.
WanjunWQiurongHYanqingX, et al.Responsiveness of nasal provocation testing—but not skin test and specific immunoglobulin E blood level—correlates with severity of allergic rhinitis in dermatophagoides species-sensitized patients. Am J Rhinol Allergy. 2018;32(4):236–243.
20.
de VosG. Skin testing versus serum-specific IgE testing: which is better for diagnosing aeroallergen sensitization and predicting clinical allergy?Curr Allergy Asthma Rep. 2014;14(5):430.
21.
FernándezCCárdenasRMartínD, et al.Analysis of skin testing and serum-specific immunoglobulin E to predict airway reactivity to cat allergens. Clin Exp Allergy. 2007;37(3):391–399.
22.
RondonCCampoPEguiluz-GraciaI, et al.Local allergic rhinitis is an independent rhinitis phenotype: the results of a 10-year follow-up study. Allergy. 2018;73(2):470–478.
23.
HamizanAWRimmerJAlvaradoR, et al.Positive allergen reaction in allergic and nonallergic rhinitis: a systematic review. Int Forum Allergy Rhinol. 2017;7(9):868–877.
24.
RondónCEguiluz-GraciaICampoP. Is the evidence of local allergic rhinitis growing?Curr Opin Allergy Clin Immunol. 2018;18(4):342–349.
25.
ChengKJXuYYLiuHY, et al.Serum eosinophil cationic protein level in Chinese subjects with nonallergic and local allergic rhinitis and its relation to the severity of disease. Am J Rhinol Allergy. 2013;27(1):8–12.
26.
JangTYKimYH. Nasal provocation test is useful for discriminating allergic, nonallergic, and local allergic rhinitis. Am J Rhinol Allergy. 2015;29(4):e100–e104.
27.
ShinYSJungC-GParkH-S. Prevalence and clinical characteristics of local allergic rhinitis to house dust mites. Curr Opin Allergy Clin Immunol. 2018;18(1):10–15.
28.
RondonCCampoPTogiasA, et al.Local allergic rhinitis: concept, pathophysiology, and management. J Allergy Clin Immunol. 2012;129(6):1460–1467.
29.
CampoPEguiluz-GraciaIBogasG, et al.Local allergic rhinitis: implications for management. Clin Exp Allergy. 2019;49(1):6–16.
30.
Eguiluz-GraciaIPérez-SánchezNBogasG, et al.How to diagnose and treat local allergic rhinitis: a challenge for clinicians. J Clin Med. 2019;8(7):1062.
31.
RondónCRomeroJJLópezS, et al.Local IgE production and positive nasal provocation test in patients with persistent nonallergic rhinitis. J Allergy Clin Immunol. 2007;119(4):899–905.
32.
CampoPRondónCGouldHJ, et al.Local IgE in non-allergic rhinitis. Clin Exp Allergy. 2015;45(5):872–881.
33.
RondónCEguíluz-GraciaIShamjiMH, et al.IgE test in secretions of patients with respiratory allergy. Curr Allergy Asthma Rep. 2018;18(12):67.
34.
RondonCBlanca-LopezNArandaA, et al.Local allergic rhinitis: allergen tolerance and immunologic changes after preseasonal immunotherapy with grass pollen. J Allergy Clin Immunol. 2011;127(4):1069–1071.
35.
RondonCCampoPSalasM, et al.Efficacy and safety of D.pteronyssinus immunotherapy in local allergic rhinitis: a double-blind placebo-controlled clinical trial. Allergy. 2016;71(7):1057–1061.
36.
RondónCBlanca-LópezNCampoP, et al.Specific immunotherapy in local allergic rhinitis: a randomized, double-blind placebo controlled trial with Phleum pratense subcutaneous allergen immunotherapy. Allergy. 2018;73(4):905–915.
37.
MatsumotoFYGonalvesTRTSoleD, et al.Specific nasal provocation test with Dermatophagoides pteronyssinus, monitored by acoustic rhinometry, in children with rhinitis. Am J Rhinol Allergy. 2017;31(1):7–11.
38.
BousquetJVan CauwenbergePKhaltaevN, et al.Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108(5 Suppl):S147–S334.
