Skin Prick Test and Serum Specific IgE May Not Be Sufficient for the Diagnosis of Perennial Allergic Rhinitis in Atopic Patients

Abstract

The aim of this study was to evaluate the usefulness of nasal allergen provocation test (NAPT) in the detection of non-seasonal clinically relevant aeroallergens in atopic perennial rhinitis patients with skin prick test (SPT) positivity to seasonal pollens. A total of 19 perennial rhinitis patients with clinical history of more than 2 years of evolution and positive SPT to seasonal pollens were included. Clinical questionnaire, SPT, serum determination of total and specific IgE to aeroallergens, and NAPT were carried out in all subjects. Response to NAPT was assessed by appearance of nasal-ocular symptoms, changes in nasal patency evaluated by acoustic rhinometry, and determination of specific IgE, and inflammatory mediators (tryptase and ECP) in nasal secretions. Clinical data showed a mean evolution of 7,6 years in these patients, with a worsening of symptoms during spring in 26% and after natural exposure to house dust in 52,6% of cases. SPT was positive to olive and/or grass pollen in 68% and 37% of patients respectively. SPT and serum specific IgE were negative to perennial allergens (house dust mite, molds, and dander epithelia) in all cases. However NAPT induced a nasal allergic response to D. Pteroyssinus in 94.7%, and to Alternaria alternata in 63.2% of patients. According to these data SPT and serum specific IgE can be not sufficient to detect relevant aeroallergens implicated in perennial allergic rhinitis in spite of evidence of positive response to seasonal aeroallergens.