Abstract

BackgroundAllergen inhalation tests are a valuable research tool. The allergen dose producing an early asthmatic response (EAR) can be predicted from methacholine responsiveness and allergen skin test endpoint (STE). The Wright® jet nebulizer, which is both inefficient and increasingly difficult to obtain, has been used historically. We assessed the Solo® vibrating mesh nebulizer as an alternative for allergen and methacholine challenges.MethodsEighteen mild atopic asthmatics completed the study. Doubling concentration allergen prick skin tests were performed to determine the STE in allergen units/mL. The Wright® protocol was used to measure the methacholine provocation dose causing a 20% forced expired volume in one second (FEV1) fall (PD20) (μg) and the allergen PD20 (units). The Solo® protocol (0.5 mL nebulized to completion, tidal breathing inhalation) was used to determine both methacholine PD20 and allergen PD20. The nebulizer order was randomized and separated by ≥ 2 weeks.ResultsAll data were log transformed. The allergen PD20, predicted from the methacholine PD20 and the STE, was within 2 doubling doses of the PD20 measured with the Wright® and 2.64 doubling doses of that measured with Solo®. The Wright® allergen PD20 correlated with the Wright® methacholine PD20 (r = 0.74) and the STE (r = 0.78) and more strongly with the product of the two (Wright® methacholine PD20 × STE, r = 0.91, p < 0.00001). The Solo® allergen PD20 showed similar relationships with the Solo® methacholine PD20 (r = 0.61), the STE (r = 0.75) and the product of the two (Solo® methacholine PD20 × STE, r = 0.83, p < 0.00002). The Wright® and the Solo® methacholine geometric mean PD20s were not significantly different (49.3 and 54.5 μg respectively, p = 0.62). The Wright® allergen PD20 was slightly but significantly lower than the Solo® allergen PD20 (geometric means 6.7 and 10.5 units respectively, p = 0.003).ConclusionThe Solo® allergen PD20 showed the same relationship with methacholine responsiveness and STE as did the Wright®. The Solo® allergen PD20 was slightly but significantly higher than the Wright® allergen PD20. The Solo® vibrating mesh nebulizer was well tolerated and is an acceptable alternative for allergen challenge.Trial registration clinicaltrials.gov: NCT03491358

Highlights

  • IntroductionThe allergen dose producing an early asthmatic response (EAR) can be predicted from methacholine responsiveness and allergen skin test endpoint (STE)

  • Allergen inhalation tests are a valuable research tool

  • It has been previously demonstrated that the concentration/dose of allergen required to produce a threshold early asthmatic response (EAR) of a 20% decline in forced expired volume in one second ­(FEV1) can be predicted within 2–3 concentrations using the level of airway responsiveness measured by methacholine or histamine provocation and the level of allergen specific IgE assessed by the allergen skin test endpoint titration (STE) [3]

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Summary

Introduction

The allergen dose producing an early asthmatic response (EAR) can be predicted from methacholine responsiveness and allergen skin test endpoint (STE). It has been previously demonstrated that the concentration/dose of allergen required to produce a threshold EAR of a 20% decline in forced expired volume in one second ­(FEV1) can be predicted within 2–3 concentrations using the level of airway responsiveness measured by methacholine or histamine provocation and the level of allergen specific IgE assessed by the allergen skin test endpoint titration (STE) [3]. The current study was designed to assess the S­ olo® vibrating mesh nebulizer for use in the standardized allergen challenge protocol performed in AllerGen National Centres of Excellence (NCE) Clinical Investigator Collaborative (CIC) studies and to compare it to the current W ­ right® jet nebulizer protocol

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