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PubMed1993

[Diagnosis of NARES by methacholine nasal provocative test].

Non-allergic rhinitis with eosinophilia syndrome (NARES) is defined as chronic rhinitis in which no specific allergens are identified although allergic symptoms occur throughout the year and nasal smears are positive for eosinophils. This rhinitis is not type I allergy, and the methacholine provocative test for the lower airways is negative. In this study, we performed the nasal methacholine provocative test using an astrograph, as well as allergen skin testing, IgE RAST determination, assessment of eosinophil counts in nasal smears, and the allergen nasal provocative test in 101 patients with perennial chronic rhinitis. This study attempted to make a differential diagnosis of NARES and to characterize this disease in comparison with other types of chronic rhinitis. Among the 101 subjects, 58 patients (57.4%), 17 (16.8%), and 26 (25.8%) were respectively classified into Group I (the nasal allergy group), Group II (the NARES group), and Group III (the vasomotor rhinitis group: VMR group). Blood eosinophil counts and serum IgE RIST levels were lower in Group II than in Group I. There were no differences in respiratory function among the 3 groups before the nasal methacholine provocative test. Respiratory function decreased in Group I with methacholine provocation, but remained unchanged in Groups II and III. Based on the above findings, hypersensitivity to methacholine was noted in both the upper and lower airways of patients with nasal allergy, only in the upper airway of VMR patients, but in neither the upper nor the lower airways of NARES patients. This indicates that the nasal methacholine provocative test may be useful in waking a differential diagnosis in cases of chronic rhinitis.

Adolescent↗
PubMed1989

Histamine nasal provocation test. An evaluation of active anterior rhinomanometry and of threshold criteria of provocative dose.

This study is a methodological approach to histamine nasal provocation. The test uses active anterior rhinomanometry and a histamine titration method, challenging both nasal cavities with a metered dose pump. It has been confirmed that the histamine nasal provocation test can differentiate between controls and non-allergic rhinitis patients. This study shows, moreover, that the method is more sensitive in assessing response to histamine provocation when a 25% increase of post-saline nasal airway resistance (PD25) is considered than a PD50 or PD100 criterion. The histamine response, was found to be independent of the baseline nasal airway resistance value. Pronounced unilateral responsiveness was frequently noticed. Both nasal cavities should be challenged and the most reactive side considered.

Airway Resistance↗
PubMed1991

[Nasal provocation test with hyperosmolar solutions: normal values].

Hyperosmolar solutions have recently been introduced as test-substances in the nasal provocation of vasomotor rhinitis subjects. In order to establish a norm, the test was carried out in 40 subjects without nasal pathologies, stimulating with solutions at increasing level of concentrations of NaCl (0.9% - 1.8 - 3.6% - 5.4% - 7.2% - 9%). In all subjects an increase in nasal secretion was verified in proportion to the concentration of the solutions and this increase was statistically significative, with respect to the base, from the concentration 3.6% (p less than 0.001) on words. The statistical analysis has not, however, evidenced any significant differences in secretion between male or female subjects. As far as the variation of nasal resistance is concerned, the rhinomanometric registration has revealed that the hypertonic solutions modify such resistances in a rather casual, absolutely irregular and unimportant way. These results lead to believe that the test is extremely useful in the study of the secretion component of vasomotor rhinopathy.

Adolescent↗
PubMed1986

Comparison of levocabastine, a new selective H1-receptor antagonist, and disodium cromoglycate, in a nasal provocation test with allergen.

The effect of intranasal administration of levocabastine, a new selective H1-receptor antagonist, was investigated in a nasal provocation test (NPT) performed with allergens. The NPT allowed a quantitative estimation of the nasal allergic threshold (concentration of allergen necessary to trigger the reaction). In addition, the intensity of the three major rhinitis symptoms (obstruction, rhinorrhea and sneezing) was determined. Twelve adult patients, allergic to grass pollen, underwent a first NPT without pretreatment ('initial NPT'); the NPT was then repeated after the single intranasal administration of either placebo, 8 mg disodium cromoglycate (DSCG) or 0.2 mg levocabastine in a double-blind random order. The NPTs gave reproducible results since both the threshold and symptom intensities were similar in the initial NPT and in the NPT performed after placebo. The reaction threshold increased in 8/12 patients after DSCG (0.05 less than P less than 0.1) and in 9/12 patients after levocabastine (P less than 0.05). Levocabastine clearly inhibited rhinorrhea (P less than 0.001) and sneezing (P less than 0.02) but did not influence the nasal obstruction. DSCG inhibited rhinorrhea only (P less than 0.01). The intranasal administration of levocabastine might be useful in the treatment of allergic rhinitis.

Administration, Inhalation↗
PubMed1997

The role of acoustic rhinometry in nasal provocation testing.

Geometric changes of the nasal airway in response to allergen challenge were measured by acoustic rhinometry (AR) and the sensitivity of the method was compared with that of rhinomanometry. Ten asymptomatic patients who suffered from ragweed allergic rhinitis were challenged out of season. The use of a custom-made noninvasive nasal adapter was an important feature of the measurement technique. A dose-dependent decrease in nasal cross-sectional area was found at and posterior to the entrance to the nasal valve. Both rhinometric and rhinomanometric methods were equivalent in sensing the changes in nasal patency due to allergen exposure (p = 0.73). Acoustic rhinometry, however, was simpler, more quickly performed and more comfortable for the subjects than was rhinomanometry by body plethysmography. AR is an alternative objective method for measurement of nasal mucosal responses, as in allergen challenge.

Acoustics↗
PubMedDate not supplied

Diagnostic value of nasal provocation testing and rhinomanometry in allergic rhinitis.

We studied 32 patients, aged 7 to 17 years, with clinical symptoms of perennial allergic rhinitis, isolated (n = 21) or associated with asthma (n = 11), all of them with positive skin test and specific serum IgE for Dermatophagoides pteronyssinus (Dpt). The control group consisted of 10 children aged 7 to 16 years, with no personal or family history of allergy and with negative skin tests and negative specific serum IgE for mites. Total and specific IgE measurements in nasal secretion and nasal provocation testing (NPT) were also performed with increasing concentrations of Dermatophagoides pteronyssinus (Dpt) extracts. The nasal response was evaluated using a clinical score and active anterior rhinomanometry. The levels of total and specific IgE in nasal secretion were higher in patients with allergic rhinitis than in individuals from the control group. The NPT presented a significant correlation with clinical symptoms, skin tests and specific serum IgE. None of the individuals from the control group presented a positive NPT. No generalized reactions or bronchial response at the immediate phase of NPT were observed. The NPT constitutes a safe, dependable investigative procedure of nasal reactivity to a specific allergen, presenting a good sensitivity and specificity when compared to the other methods classically used in allergy studies.

Adolescent↗
PubMed2006

[Nasal provocation test with lysine-aspirin in diagnosis of nonallergic rhinitis with eosinophilia].

Nonallergic rhinitis with eosinophilia is characterized by persistent nasal symptoms without allergy and by a marked eosinophil recruitment in the nasal cavities. The incidence of it is more than 15% among all types of rhinitis. A part of them is caused by nonsteroidal anti-inflammatory drugs hypersensivity. For this study 114 patients were selected on the basis of perennial rhinitis, the absence of allergy and with an eosinophil count higher than 10% of total leukocytes in nasal cytology. In all of them the nasal provocation test with lysine-aspirin was made. The clinical response was evaluated based on nasal symptoms (sneezes, itching, secretion and blockage). The nasal response was measured by acoustic rhinometry. The results of the test was positive in 19 cases, mostly in patients with nasal polyps, bronchial asthma and higher level of nasal eosinophilia (differences statistically significant). The count of nasal eosinophilia corresponded better with the decrease of nasal volume in acoustic rhinometry (r = 0,84) then with the clinical score (r = 0,52). The nasal challenge was well tolerated by almost all subjects. We conclude that the nasal challenge with lysine-aspirin is safe and can be helpful as a diagnostic test in patients with nonallergic rhinitis with eosinophilia.

Administration, Intranasal↗
PubMedDate not supplied

The behaviour of non-specific nasal provocation tests in subjects with allergic rhinitis and not, in and out of crisis. A longitudinal study.

The non specific nasal hypersensitivity (N.S.N.H.) is characterized by an exaggerated reaction towards various non-specific stimuli in rhinopathic subjects. This N.S.N.H. involves the afferent structure of nasal mucosa, the effector organ and the central modulation system. The physiopathogenetic and clinical implications induced the authors to study the N.S.N.H. behaviour in 218 subjects divided into 5 groups, as follows: control group, subjects with perennial rhinitis of non allergic origin, subjects with seasonal rhinitis due to allergy towards Graminaceae during seasonal crisis and not, subjects with perennial rhinitis due to allergy towards Dermatophagoides pteronissinus. All subjects moreover have been subdivided according to the years of illness. The N.S.N.H. behaviour has been studied with non-specific nasal provocation tests with methacholine, cold water solution and histamine, so the amount of sneezes were assessed. The results show a reduction of the reaction, previously high, to methacholine and cold water solution tests after 6-12 years of illness in subjects with perennial rhinitis, while the test with histamine always gives higher results. This could mean a reduction of N.S.N.H. during the years of illness, probably connected to the answer of the effector organ, without involvement of that afferent portion of nasal mucosa.

Adolescent↗
PubMed2006

Changes in urinary LTE4 and nasal functions following nasal provocation test with ASA in ASA-tolerant and -intolerant asthmatics.

UNLABELLED: Aspirin-induced asthma (AIA) is a syndrome characterized by intolerance to aspirin (ASA), nasal polyps and bronchial asthma, the metabolic shift of arachidonic acid towards the lipoxygenase pathway and hyper-production of cysteinyl-leukotrienes (cys-LTs) being the current pathogenetic hypothesis. The research for both sensitive indicators and safe diagnostic tests is still attracting. Aim of the study was to measure changes in urinary LTE4 excretion and in nasal function (Resistance-Req, and Volume-Vol, assessed by acoustic rhinomanometry (AR)) following a nasal provocation test (NPT) with ASA:LTE4 measurements have been never previously used to our knowledge for assessing nasal responsiveness to ASA. METHODS: After written consent, 118 mild-to-moderate asthmatics (48 males, mean age 41.8 years+/-11.9SD, range 25-70 years; basal FEV1=80.1% pred.+/-5.8SD) underwent NPT by nasal instillation of ASA (total maximal dose 25 mg). Spirometry, acoustic rhinomanometry (AR; TM Hood Lab., USA) and urinary LTE4 (pg/mg creatinine; Cayman Chemical, MI, USA) were measured in baseline and 2h after the ASA challenge. STATISTICS: t-Test between means+/-sd, assuming P<0.05, and linear regression between all variables considered. RESULTS: In 67 ASA-intolerant asthmatics, FEV1 did not change significantly following NPT (81.7% pred.+/-5.1SD in baseline, 80.5% pred.+/-4.1 after NPT, P=ns) even in the presence of a significant decrease of Vol (11.3 cm3+/-4.1SD in baseline, 5.9 cm3+/-4.2SD after NPT, P=0.003), a substantial increase of Req (0.88 cmH2O/l/min+/-0.11SD in baseline, 2.41 cmH2O/l/min+/-0.77 after NPT, P=0.002), and urinary LTE4 excretion (433.0 pg/mg+/-361.7 in bsln, 858.0 pg/mg+/-471.6 90 min after NPT with L-SA, P=0.04). NPT did not affect FEV1 also in 51 ASA-tolerant asthmatics (89.7% pred.+/-6.9 in bsln, 86.6% pred.+/-4.3 after NPT), but in these subjects also Vol (from 14.9 cm3+/-4.2sd to 14.6 cm3+/-3.8SD), Req (0.38 cmH2O/l/min+/-0.14 in bsln, 0.26 cmH2O/l/min+/-0.2 after NPT, P=ns), and urinary LTE4 (333.1 pg/mg+/-202.8 in bsln, 318.0 pg/mg+/-198.7 after NPT, P=ns) remained unchanged. Only pre-NPT LTE4 values proved related to pre-NPT Req and Vol values (r=0.54 and r=-0.71, respectively), but not to patients' age (R=-0.05), and basal FEV1 (r=0.01). CONCLUSIONS: In ASA-intolerant patients, NPT with lysine-aspirin (L-ASA) only induces a substantial nasal obstruction and enhances urinary LTE4 excretion in the absence of any significant bronchial obstruction. Nasal ASA challenge proves a test absolutely safe for asthma patients suspected of ASA intolerance. Measures of urinary LTE4 excretion contributed significantly to magnify the discriminant and the diagnostic value of NPT.

Administration, Intranasal↗
PubMed1997

Nasal provocation test in the diagnostics of hairdressers' occupational rhinitis.

Hairdressers are exposed daily at their work to many different hair chemicals and dandruff. The work-related nasal symptoms are common, especially with hair bleaching and striping. There are some reports on hairdressers asthma, but publications concerning occupational rhinitis among hairdressers are very few. The purpose of this study is to investigate the work-related rhinitis symptoms of hairdressers, and to study whether nasal provocation tests (NPTs) can be applied in diagnostics. The study subjects were 40 hairdressers having work-related rhinitis symptoms. Detailed work and exposure histories and work-related symptoms were inquired of using a questionnaire. Prick tests were done. Altogether 142 NPTs were done: 40 placebo, 36 dandruff, 35 ammonium persulphate (APS), and 31 ammonium thioglycolate (ATG). To register the nasal response rhinorrhea and nasal blockage were scored. In 3 allergen NPTs there was an essential change in the nasal status: in 2 APS and in 1 dandruff tests. Three patients were diagnosed as having an occupational rhinitis. The low number of positive reactions in NPTs and few positive reactions in skin prick tests verified that immediate allergy caused by hairdressers' work substances is uncommon. However, in cases of clear work-related rhinitis, there is a need to perform examinations to find the probable allergy.

Adult↗
PubMed1999

Comparison of the effects of terfenadine with fexofenadine on nasal provocation tests with allergen.

BACKGROUND: Fexofenadine, the hydrochloride salt of terfenadine active metabolite, is a nonsedative, noncardiotoxic antihistamine derivative for the treatment of allergic rhinitis. OBJECTIVE: We sought to compare the effects of terfenadine and fexofenadine on nasal provocation tests with allergen. METHODS: A preliminary provocation test (screening phase) was performed in 25 patients with a history of seasonal allergic rhinitis to grass pollen to determine the combined nasal reaction threshold, which was defined as 2 of the 3 following criteria: (1) at least a 40% decrease in peak nasal inspiratory flow and/or a 30% decrease in minimal cross-sectional area as measured by acoustic rhinometry, nasal secretions of 0.5 g, and 5 to 10 sneezes per minute. Patients were then included into a double-blind, randomized, 2-way crossover study to receive terfenadine or fexofenadine 120 mg 2 hours before provocation. Rhinorrhea, sneezing, peak nasal flow, and minimal nasal cross-sectional area, as well as symptom scores for nasal congestion and itchiness, were recorded at each allergen concentration up to the reaction threshold. The whole study was performed out of allergy season. RESULTS: Fexofenadine was as potent as terfenadine in limiting pruritus and nasal congestion. Rhinorrhea and sneezing were better controlled by fexofenadine than by terfenadine. Overall, the allergen concentration necessary to reach the combined reaction threshold was increased after treatment with both drugs. Comparison between screening and each treatment phase indicated that the shift in allergen concentration to reach the reaction threshold was significantly greater after fexofenadine than after terfenadine (P =. 033). CONCLUSION: After oral administration, fexofenadine provided better protection than terfenadine against the immediate allergic reaction.

Adult↗
PubMed1997

Specific nasal provocation test with powder allergen.

Reported here are the results of a large-scale trial conducted under the guidance of Prof. Giovanni Motta, which I coordinated. A total of 656 patients with nasal hyperreactivity were recruited in 51 Italian centres (18 in the north of Italy, 20 in central Italy and 13 in the south). The trial's results were as follows. 1) A clear clinical prevalence of sensitization to different allergens in the different areas of Italy, which could be roughly classified thus: a) in Northern Italy birch and grasses were in the main species; b) in Central Italy mites prevailed but oleaceae were also significant; c) in Southern Italy parietaria and oleaceae were the prevailing species. 2) Most cases were sensitive to several allergens, although a considerable proportion (22%) actually presented reactions only to one allergen and those responding account of the patients sensitive to only one allergen and those responding to a main allergen, the proportion of patients reacting clinically to only one allergen rises to 64%. 4) The specific nasal provocation test (sNPT) offers specificity comparable to in vivo diagnostic methods such as the prick test, and in vitro methods such as RAST, but is much more sensitive. 5) The sNPT can be done in any season. 6) The sNPT is highly specific below a threshold value of nasal reactivity, which can be identified for each allergen studied and expressed in Allergenic Units. 7) In patients in whom the prick test shows multiple sensitivity, the specific NPT identifies the allergen presumably responsible for the nasal reactions (main allergen). In the light of these findings double-blind specific immunotherapy was started, to last 1 year, in 107 patients (49 given placebo and 58 active treatment), with nasal allergy to grasses, parietaria and mites. The results of this treatment were as follows: 74.1% of patients presented a reduction in nasal resistance, measured by dynamic anterior rhinomanometry, indicating relief of nasal obstruction; mucociliary transport time became normal in 81% of patients, meaning that rhinorrhoea had become less marked; there was significant rise in the nasal reactivity threshold in 74.1% of patients, illustrating the degree of desensitization achieved; nasal IgA increased by 62.5% of patients and IgG in 55.2% indicating improvement in the local immunological picture. No such improvements were detectable in the patients given placebo. In conclusion, therefore, the findings of this trial in allergic rhinitis underline that the specific NPT proved more sensitive than other in vivo and in vitro diagnostic methods and is unquestionably a fundamental investigational approach for assessing nasal allergies, identifying the allergens causing the symptoms and setting up rational local immunotherapy. The sNPT also showed the efficacy of specific intranasal immunotherapy.

Administration, Intranasal↗
PubMed1992

Effect of H2-blockers, cimetidine and famotidine, on histamine nasal provocative test.

The H2-receptor is considered to mediate the stabilization of the membrane of mast cells by enhancing cAMP synthesis. In the present study, we investigated the effect of H2-receptor antagonists, i.e. H2-blockers, on nasal hypersensitivity using a histamine nasal provocative test. A 7-day administration of cimetidine tended to lower the histamine threshold. Famotidine administered in the same way caused no significant decrease in the histamine threshold. Based on the above results, we postulate that famotidine should be preferred to cimetidine as an H2-blocker in patients with gastric and/or duodenal ulcers.

Adult↗