Abstract
PurposeFor perennial inhalant allergens such as house dust mite (HDM), the German guideline on allergen-specific immunotherapy explicitly recommends provocation testing. This procedure is time-consuming, expensive, and potentially dangerous for the patient. Recently it has been discussed whether provocation tests are really necessary for diagnosing allergy to Dermatophagoides species. Thus, our study aimed to analyze the concordance between nasal provocation tests with Dermatophagoides species and anamnestic data.MethodsWe retrospectively analyzed the concordance between patients’ histories including self-reported symptom scores and the results of provocation testing in 471 individuals with proven sensitization to Dermatophagoides species.Results248 patients had a positive nasal provocation test (NPT) result to Dermatophagoides species and 223 individuals a negative NPT result. Patients allergic to HSM suffered significantly more often from atopic dermatitis (14% vs. 7%, p = 0.046) and more from asthma (20% vs. 19%, p = 0.851). Moreover, individuals with clinically silent sensitization complained less about nasal secretion (37% vs. 45%, p = 0.244) but significantly more about nasal dryness (46% vs. 34%, p = 0.046) whereas rates of nasal airway obstruction, ocular complaints and sleep quality were comparable in both groups. Allergic patients reported more often perennial (34% vs. 30%, p = 0.374) and location-dependent (39% vs. 31%, p = 0.090) symptoms. However, the discrepant prevalence of atopic dermatitis was the only statistically significant difference between both groups.ConclusionDespite slight differences between both patient groups, clinical data are not sufficient to distinguish between silent sensitization and clinically relevant allergic rhinitis to HDM. Therefore, nasal provocation testing remains the gold standard for assessing clinical relevance in patients sensitized to Dermatophagoides species.
Highlights
House dust mite (HDM) is the most important indoor allergen and one of the three most relevant aeroallergens responsible for the development of allergic symptoms such as allergic rhinitis or allergic asthma worldwide [1, 2]
Based on the above-mentioned inclusion criteria, the database search yielded 471 patients with proven sensitization to D. pteronyssinus or D. farinae. 90% of patients were sensitized to D. pteronyssinus and 93% were sensitized to D. farinae. 85% were sensitized to both, D. pertonyssinus and D. farinae
6% of the individuals were monosenitized to D. farinae
Summary
House dust mite (HDM) is the most important indoor allergen and one of the three most relevant aeroallergens responsible for the development of allergic symptoms such as allergic rhinitis or allergic asthma worldwide [1, 2]. Blomme et al in which the prevalence of silent sensitization and allergy to HDM in an unselected population in Belgium was analyzed by SPT and an interview of the participants about possible allergic symptoms. It has been demonstrated that untreated HDM allergy of the upper airway has the risk of transforming into a disease of the lower airways with full symptoms of allergic asthma [2, 6,7,8]. These results clearly underline the socio-economic impact of HDM allergy as a relevant disease generating high costs for the health care systems and severe complaints for lots of patients
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