PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Nasal Provocation Tests”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed1995

Diagnostic value of the nasal provocation test with Dermatophagoides pteronyssinus in childhood asthma.

We aimed to determine whether the nasal provocation test (NPT) with allergen could be used as a diagnostic test in asthmatic children with or without allergic rhinitis, and whether it had any effects on pulmonary function tests and arterial oxygen saturation (SaO2) values. Therefore, 25 asthmatic outpatients sensitive to Dermatophagoides pteronyssinus (Dp), aged 6-17 years, 12 having allergic rhinitis, and 10 nonatopic children as a control group were challenged intranasally with solution containing Dp extract by administration of a total dose of 800-1000 AU to both nasal cavities. Before the test and 10 min and 20 min after the administration of the allergen intranasally, the nasal expiratory peak flow (NEPF), pulmonary function tests, and SaO2 were measured. In the NPT, a decrease of 20% or more in NEPF and occurrence of nasal symptoms were considered to be positive. NPT was positive in all the asthmatic patients with or without allergic rhinitis, while all the children in the control group had a negative test. Compared to values prior to the test, values of FEV1 (forced expiratory volume in 1 s) and SaO2 showed no statistically significant decrease, and no clinically significant asthmatic reaction was observed in any of the groups. Our study suggests that in asthmatic children with or without allergic rhinitis, the NPT with allergen is a simple, safe, and useful diagnostic test.

Adolescent↗
PubMed1998

Nasal provocation test with lysine-aspirin for diagnosis of aspirin-sensitive asthma.

Nasal provocation tests (NPTs) with lysine-aspirin (L-ASA) have been recently introduced for assessment of aspirin-induced asthma (AIA). They differ in dose and means of aspirin instillation, duration of observation period, and criteria for positivity. Thus far they have not become a routine part of clinical diagnosis. Fifty-one patients with AIA, confirmed by oral challenge test, were recruited to undergo diagnostic NPTs with L-ASA. In 10 of these patients (19.6%), NPTs could not be performed because of total obstruction of at least one nostril or marked fluctuations in nasal flows, leaving 41 patients with AIA for the study. Control groups consisted of 13 aspirin-tolerant asthmatic patients and 10 healthy subjects. L-ASA at a total dose of 16 mg of acetylsalicylic acid applied bilaterally into the inferior nasal conchae caused significant fall in inspiratory nasal flow in at least one nostril (>40%), which was measured by anterior rhinomanometry, and clinical symptoms of watery discharge and nasal blockage in 35 of 41 patients with AIA, one of 10 healthy subjects, and none of 13 aspirin-tolerant asthmatic patients. No relationship was found between the baseline nasal flow values and the intensity of response to L-ASA. No systemic reactions, including bronchospasm, were noticed, even in patients whose initial FEV1 was lower than 70% of predicted value. This test is highly specific (95.7%) and sensitive (86.7%), but negative results do not exclude possible intolerance to aspirin (predictive value of a negative result 78.6%). In conclusion, the NPT described is a simple, safe, and quick test for diagnosis of AIA. It can be used in patients with unstable asthma. It may be a method of choice to confirm hypersensitivity to aspirin manifested only by symptoms from the upper respiratory tract. Patients suspected of aspirin intolerance who have negative NPT results should undergo bronchial or oral challenge tests with aspirin.

Adult↗
PubMed1991

Nasal provocation test with lysine acetylsalicylate in aspirin-sensitive patients.

The authors have studied nasal provocation testing (NPT) with aspirin in 45 aspirin-sensitive patients (40 affected by nasal polyposis) and in 38 aspirin-tolerant patients (27 affected by nasal polyposis). The test was positive in 37.7% of aspirin-intolerant subjects, but only in 7.9% of subjects in the control group (P less than .01).

Adult↗
PubMed2002

Nasal provocation test (NPT) with aspirin: a sensitive and safe method to diagnose aspirin-induced asthma (AIA).

BACKGROUND: We have aimed to determine the sensitivity and specificity of a simpler technique with less risk than oral provocation to diagnose aspirin-induced asthma (AIA). METHODS: We studied a group of 20 AIA patients compared to a control group with 40 aspirin-tolerant patients (confirmed by oral provocation test): 10 asthmatic patients and 30 healthy subjects. A nasal provocation test (NPT) with lysine acetylsalicylic acid (L-ASA) was carried out. Nasal and pulmonary functions were monitored with anterior active rhinomanometry (AAR) and spirometry. An L-ASA solution (900 mg/ml L-ASA, equivalent to 500 mg/ml acetylsalicylic acid) was diluted with saline solution. We administered four increasing doses: 5, 25, 50 and 100 mg/ml acetylsalicylic acid (ASA) with saline solution control. Nasal and pulmonary functions were monitored with rhinomanometry and spirometry. The patients were controlled for nasal inspiratory peak flow and expiratory peak flow. RESULTS: The results showed high sensitivity and specificity: 80% and 92.5%, respectively, with an 84.2% positive predictive value and an 89.2% negative predictive value. The patients had no bronchial or systemic symptoms, and no decreases over 20% were recorded in the FEV1. CONCLUSION: NPT has a high sensitivity and specificity in the diagnosis of AIA. An oral provocation should be performed to confirm the result whenever the clinical situation of the patient permits it.

Adolescent↗
PubMed2006

Acoustic rhinometry in nasal provocation test in perennial allergic rhinitis.

Acoustic rhinometry is one method to evaluate nasal geometry by an acoustic reflection technique. The aim of this study was to investigate the changes in acoustic rhinometry after nasal provocation in patients with exclusively perennial allergic rhinitis. In 19 patients, acoustic rhinometry and active anterior rhinomanometry were performed before and after nasal provocation test. There was a statistically significant nasal flow reduction measured by active anterior rhinomanometry after nasal provocation (p < 0.05) and a median symptom score of four points, both indicating a positive response to nasal provocation. On the other hand, there was no statistically significant change in the values of acoustic rhinometry after nasal provocation (p > 0.05). In patients with exclusively perennial allergic rhinitis, acoustic rhinometry does not seem to significantly change after nasal provocation. In contrast, active anterior rhinomanometry values decreased significantly after nasal provocation. The presented results indicate that acoustic rhinometry does not seem to be a diagnostic method superior to active anterior rhinomanometry in this context.

Adolescent↗
PubMed2005

Nasal provocation testing as an international standard for evaluation of allergic and nonallergic rhinitis.

Standardized nasal provocation testing (NPT) has been shown to be a safe and very useful tool in the diagnosis of allergic and nonallergic rhinitis. However, in the United States, its use has been mostly limited to scientific investigations, and it has not yet been widely accepted as a standard diagnostic procedure in clinical practice. NPT aims to identify and quantify the clinical relevance of inhalant allergens or occupational irritants. During NPT, nasal respiratory mucosa is exposed to an airborne substance suspected to cause symptoms in the respective individual. Clinical reactions are monitored in a controlled and standardized fashion. Nasal secretions, symptoms such as itching, sneezing and, most importantly, nasal obstruction are assessed as well as ocular, bronchial, cutaneous, and systemic reactions. To achieve objective data on changes in nasal airflow and patency after the challenge, anterior rhinomanometry and acoustic rhinometry have been included in the standard protocol of NPT. By monitoring changes of nasal airflow on one hand and of nasal geometry on the other hand, these methods display nasal function in a graphic way just as speech and pure tone audiometry do for auditory function. Also, by their objective nature, these methods offer a clear and internationally comparable standard. This review outlines a protocol for NPT and discusses practical applications and clinical indications. The use of rhinomanometry and acoustic rhinometry as objective diagnostic tools is emphasized. For the diagnosis of allergic and occupational rhinitis, standardized NPT should be regarded as an international diagnostic standard.

Allergens↗
PubMed2002

[Specific nasal provocative test in allergic rhinitis diagnosis: reliability and standardization].

Specific vasomotorial rhinopathy, or allergic rhinitis is to be seen as a systemic pathology characterized by a condition of hyperactivity, the target organ of which is the nose. Particular attention, among the diagnostic tests, should be reserved to the specific nasal provocative test (sNPT), which has been part of the clinical routine for years but has nonetheless failed to achieve a suitable level of standardization. With this intent, we have devoted the present work to the assay of several phlogosis mediators (tryptase, specific IgE and ECP) before and after performing the sNPT. We have studied 20 patients affected by allergic rhinitis, aged between 13 and 61, with single or multiple allergen sensitivities, but in any case with a predominant sensitization, who underwent sNPT between October 2000 and July 2001. In every patients we performed ECP, tryptase and specific IgE assay via direct incubation in the nasal mucosa, before and after specific nasal provocation. The results of the sNPT (rhinomanometry and symptoms score) were compared with the variations in the phlogosis mediators assayed at nasal level. On the basis of the variations in the rhinomanometric resistance and symptoms score, the sNPT was positive in 10 patients (50%). Tryptase and specific IgE increased to a statistically significant degree (respectively, p = 0.01 and p < 0.05) in all of the patients; the ECP variations, instead, were not significant (p > 0.05). Overall, the simultaneous assay of ECP, tryptase and specific IgE, increasing the sensibility of the sNPT, enabled a positive result to be ascertained in 60% of the subjects examined. The method is furthermore based on the principle of local reactivity in that it assays the phlogosis mediators not at systemic level, but directly in the target organ, showing itself to be more specific than level I and II tests.

Adolescent↗
PubMed1978

Basic study of nasal provocative test. Second report: assessment method on provocative reaction.

Because no simple and precise method is available to test intensity of the reaction resulted from a nasal provocative test in diagnosis of nasal allergy, comparisons were made among the conventional test methods of rhinoscopy (RS), rhinomanometry (RM) and the carbon powder elimination test (CET) devised by the authors. The rhinoscopy shows high positive rates and has advantages being free from any special equipment, prolonged time or the patients' cooperation, but also had disadvantages such as requirement of skill of examiner and problems in objectivity. The carbon powder elimination test is a preferable method in that it is not only equipped with the advantages of the rhinoscopy but also makes up for its disadvantages, but a disadvantage of CET is requirement of longer time than RS. Rhinomanometry had lower positive rates and requires a special equipment, prolonged time and the skillful patients' cooperation. The disadvantage is that its impracticableness in many patients--26% impracticableness even in adult patients, but the method is fully objective. From these findings the value of Carbon Powder Elimination Test in judging provoked reactions is recognized.

Adolescent↗
PubMed2003

Comparison of conjunctival and nasal provocation test in allergic rhinitis to house dust mite.

BACKGROUND: Nasal allergen provocation tests (NPTs) are useful in confirming the diagnosis of allergic rhinitis, if data obtained by clinical history, skin tests and specific IgE determinations are not conclusive. Since NPTs are laborious, conjunctival provocation tests (CPTs) appear as an attractive alternative. The concordance of CPTs and NPTs with house dust mite allergen extract in sensitized and nonsensitized subjects should be evaluated. METHODS: 50 otherwise healthy subjects with self-reported house dust mite allergy and positive skin prick tests and serum specific IgE to Dermatophagoides pteronyssinus and 45 sex- and age-matched healthy controls without allergic symptoms were included. For NPTs, 100 microl allergen extract [10,000 allergy units (AU/ml)] were applied to the less congested nasal cavity. A clinical symptom score and active anterior rhinomanometry were employed to assess the response. For CPTs, 50 microl low-concentrated D. pteronyssinus extract (1,000 AU/ml), and if negative, 50 microl normally concentrated extract (10,000 AU/ml) were applied to the lower conjunctival sac. The response was assessed employing clinical symptom scores. RESULTS: NPTs and CPTs yielded concordant results in 90% of the subjects successfully tested (Cohen's kappa = 0.78, p < 0.0001). The diagnostic efficacy of the CPT, with the NPT as the reference method, was 89%, whether or not conjunctival symptoms had been reported in addition to rhinitis symptoms. Both techniques were judged almost equally uncomfortable. CONCLUSION: CPTs are an acceptable alternative to NPTs in patients with allergic rhinitis to house dust mite, even if they have no conjunctival symptoms.

Adult↗
PubMed1988

The effect of levocabastine nasal spray in nasal provocation tests.

The effect of levocabastine, a new specific H1 antagonist, has been investigated against a placebo in nasal provocation tests on 42 allergic patients divided into two parallel groups. The results obtained show that it significantly inhibited the nasal reaction to the allergen and seems to have a long-lasting effect in allergic patients.

Administration, Intranasal↗
PubMed1993

Facial thermography during nasal provocation tests with histamine and allergen.

Changes of skin temperature (T degree) of the nose area during nasal provocation tests with histamine and allergen were followed by means of an infrared thermography camera. By a colimator system in which temperatures measured on a given surface can be integrated and averaged, thermography allows the continuous and quantitative recording of the temperature during the whole procedure in a completely noninvasive way. In 10 normal subjects, increasing doses of histamine induced a dose-dependent rise of the nose external temperature. No significant change was observed with the vehicle solution. In six subjects allergic to grass pollen, the nebulization of increasing concentrations of a pollen extract induced a dose-dependent rise in T degree. The T degree rise observed after histamine or allergen corresponded to a marked nasal obstruction. The nebulization of the highest dose of the pollen extract did not induce any T degree rise in six nonallergic subjects. The continuous recording of the skin temperature by a noninvasive method might yield additional information on the vascular changes rapidly occurring during nasal challenges.

Adult↗
PubMedDate not supplied

[Carbachol nasal provocation test in vasomotor and polyposis rhinopathy].

A group of 117 subjects suffering from vasomotor rhinopathy (33 with nasal polyposis) were studied with the nasal provocation test with carbacholine in order to evaluate aspecific nasal reactivity. The results obtained by quantifying the variations in nasal secretions and rhinomanometric resistance after application of the test substance indicate the following: a marked hypersecretory response and obstruction in 80% of the vasomotor rhinitis cases; a more marked aspecific reactivity in perennial allergic rhinitis sufferers than in those with seasonal atopic rhinopathy; a lack of statistical significance between the group of those with atopic polyposis and those with a negative skin test. The authors conclude by confirming the usefulness of the test for aspecific reactivity in the diagnosis of vasomotor rhinopathy and propose its use for better screening those patients to undergo specific hyposensitivity therapy.

Adult↗
PubMed2004

Nasal provocation test (NPT) with isolated and associated dermatophagoides pteronyssinus (Dp) and endotoxin lipopolysaccharide (LPS) in children with allergic rhinitis (AR) and nonallergic controls.

BACKGROUND: Inhalation of endotoxin may enhance inflammatory airway response in sensitized asthmatics persons after allergen(s) inhalation. OBJECTIVE: To evaluate nasal response to intranasal instillation of Dermatophagoides pteronyssinus (Dp), endotoxin (LPS), and to Dp+LPS in children with perennial allergic rhinitis (PAR). METHODS: 10 PAR children (positive skin prick test to Dp) and 10 nonallergic controls (C) undergoing nasal provocation test (NPT), who were quantified by active anterior rhinomanometry and measurement of Total Nasal Resistance (TNR). The NPTs were initially performed with histamine (H; 0.03 to 16.0 mg/mL), and then, at least at weekly intervals, the NPTs were done with Dp (1/100,000 to 1/2.5), LPS (1 to 500 mg/mL) and to Dp+LPS. During NPT with Dp+LPS, Dp concentration was kept constant (1/100,000; 1/10,000; 1/1,000) and was combined with different concentrations of LPS (1, 5, 10, 20 mg/mL). The NPT was considered positive when TNR reached twice the basal TNR. RESULTS: H and Dp NPTs were positive in all AR children. In group C, H NPT was positive in 60% and Dp NPT was negative in all children. NPT with LPS was positive only in 30% of the AR children. NPT with Dp+LPS was positive in 90% of the AR patients in Dp concentration of 1/1,000 and in LPS concentrations of 5, 10, and 20 mcg/ mL. This positive association was observed with Dp concentrations lower than those obtained during NPT with Dp in 60% of AR patients. There were no changes in pulmonary function tests in all children after NPT. CONCLUSIONS: This study suggests that LPS enhances the effects of allergen challenges on nasal airflow. The daily inhalation of allergens plus endotoxin in AR patients does increase the nasal responsiveness.

Adolescent↗
PubMed1988

The nasal provocation test: response patterns.

We studied a group of allergic patients by active anterior rhinomanometry. We performed the nasal provocation test (NPT) and we observed two kinds of responses. The Type I pattern consists of an increase in delta P and an increase in resistance. The type II pattern consists of an increase in the flow value (V) and an increase in resistance. There are significant differences in the frequency of the two patterns among the allergens.

Adolescent↗
PubMed1984

Applicability of a simple nasal provocation test in etiologic diagnosis of bronchial asthma.

The applicability of nasal challenge for etiologic diagnosis of extrinsic asthma was evaluated by assessing easiness of performance, precision, and cost of a standardized test by metered nebulizer in 20 asthmatics with and without concurrent rhinitis submitted also to skin prick tests and RAST. Although less sensitive than in the group with rhinitis (where precision was 90.4%), the nasal provocation test proved to be an easy, inexpensive, and specific (82.3%) means for contributing to the identification of allergic sensitization in patients affected by asthma alone.

Administration, Intranasal↗
PubMed1984

The effect of beclomethasone dipropionate treatment on the nasal provocation test.

A total of 50 patients with hay fever of perennial rhinitis were treated for 14 days with beclomethasone dipropionate nasal spray. Dosage was one puff (50 micrograms) in each nostril four times a day to a total daily dose of 400 micrograms. Rhinomanometry was used to determine the efficacy of beclomethasone dipropionate in immediate type allergic responses provoked by a nasal challenge with either grass pollen or house dust/house mite allergen. Treatment with beclomethasone dipropionate nasal spray resulted in a significant increase in tolerance to both house dust/house mite allergen (P = 0.01) and grass pollen allergen (P = 0.005). Passive anterior rhinomanometry would seem to offer an easy suitable technique for measuring nasal resistance during nasal provocation tests.

Beclomethasone↗
PubMed2002

Nasal lavage concentrations of free hemoglobin as a marker of microepistaxis during nasal provocation testing.

BACKGROUND: The constituents of nasal mucus may be contaminated by plasma if there is epistaxis. Gross epistaxis is apparent as a red lavage fluid, while microepistaxis may yield a clear fluid. If gross or microepistaxis are present, it will be difficult to decide whether plasma protein concentrations are elevated because of plasma exudation or bleeding. In order to discriminate between these two possibilities, we measured erythrocyte-derived free hemoglobin (fHb) in nasal lavage fluids. METHODS: Single-blinded subjects underwent standard hypertonic saline nasal provocation. Unilateral hypertonic nasal provocation was performed in normal, allergic rhinitis (AR) and nonallergic rhinitis (NAR) subjects (total of 1316 specimens). fHb was measured using the Sigma-Aldrich kit (St. Louis, MO). Grossly bloody specimens were analyzed separately from the remainder. Statistical analysis defined the means and 95th percentiles for fHb and albumin in the nonbloody normal group. RESULTS: fHb concentrations ranged from below the limits of detection (< 1 microg/ml) to > 164 microg/ml fHb was 79.3 microg/ml +/- 4.7 (mean +/- SEM) in four normal, 31 AR and 25 NAR grossly bloody specimens. The 95th percentile of fHb in the nonbloody normal samples (n = 68 subjects, n = 681 specimens) was 16.5 microg/ml. This value was defined as the threshold to detect potential microepistaxis, and corresponded to approximately 245 000 erythrocytes per ml of lavage fluid. Total protein (P < 0.05) and albumin (P < 0.001), but not markers of glandular secretion, were significantly increased in samples with fHb > 16.5 microg/ml compared to those < or = 16.5 microg/ml. Elevations of fHb without changes in albumin were more prevalent in nonallergic rhinitis. CONCLUSIONS: Significant bleeding into nasal lavage samples can contaminate the specimens and increase the concentrations of both fHb and plasma proteins. Increased albumin alone would indicate increased vascular permeability. The mechanism(s) leading to elevated fHb without increased plasma proteins require further investigation.

Adult↗