Positive Nasal Challenge Research Articles

Nasal allergen-neutralizing antibodies correlate closely with tolerated intranasal allergen challenge dose following grass pollen subcutaneous immunotherapy in patients with local allergic rhinitis.

Local allergic rhinitis (LAR) is defined by chronic nasal symptoms, absence of atopy, positive nasal allergen challenge (NAC) and a good response to subcutaneous allergen immunotherapy (SCIT). We sought to investigate SCIT capacity to induce local and systemic blocking antibodies in LAR patients. A RDBPC study of grass SCIT was performed, with participants receiving either SCIT (Group A; n = 10) or placebo (Group B; n = 14) in the first 6 months. Both groups subsequently received SCIT for 12 months at Year 2. Nasal and serum antibodies (IgG4, IgA1 and IgA2) and their inhibitory capacity were measured at multiple timepoints. The allergen concentration tolerated increased significantly at 6 months (Group A; p = .047) and 24 months (Group B; p = .049) compared with baseline and persisted until the end of the study. Induction of serum sIgA1 to Phl p was seen in Groups A and B, albeit the former being induced earlier (1.71-fold, p = .027). A significant induction in sIgG4 to Phl p 1 and 5 was observed in serum of Group A (p = .047 and p = .0039) and sIgA2 to Phl p in Group B (p = .032 and p = .0098) at 18 and 24 months, respectively. Both local and systemic blocking antibodies can inhibit allergen-IgE complexes binding to CD23 on B cells, and this correlated with level of allergen tolerated intra-nasally in Group A (serum; 𝜌 = -.47, p = .0006, nasal; 𝜌 = -.38, p = .0294). Grass pollen SCIT induced functional systemic blocking antibodies that correlate with the concentration of allergen tolerated following NAC, highlighting their potential as a biomarker of SCIT in LAR.

Allergic sensitization to lipocalins reflects asthma morbidity in dog dander sensitized children.

BackgroundSensitization to dog is an important risk factor for asthma in children, but the clinical relevance of IgE to available dog‐ and furry animal allergen molecules is uncertain.MethodsSpirometry, methacholine challenge, fraction of exhaled nitric oxide, nasal challenge with dog extract and questionnaires were performed in 59 dog‐sensitized children (age 10–18 years). Serum IgE to dog‐, cat‐, horse extracts and the allergen molecules Can f 1–6, Fel d 1, Fel d 2, Fel d 4 and Equ c 1 were evaluated.ResultsMedian numbers of positive IgE results to furry animal allergen molecules among children without asthma was 3, with asthma 5.5 and with troublesome asthma 9 (asthma vs. no asthma; p = 0.039; troublesome asthma vs. no asthma; p = 0.009). The odds ratio for asthma if sensitized to any lipocalin was 7.2 (95% confidence Interval: 1.44–35.9). Children with troublesome asthma had higher IgE levels to the lipocalins Can f 2, Can f 4 and Can f 6 compared to the rest of the study population (44 vs. 4.1 kUA/L, p = 0.015; 5.8 vs. 0.9 kUA/L, p = 0.018 and 1.3 vs. 0.7 kUA/L, p = 0.03 respectively). Furthermore, a positive nasal challenge was more common among children with troublesome asthma (83% vs. 36%, p = 0.036).ConclusionsPolysensitization to furry animal allergens and lipocalins is associated with asthma in dog‐sensitized children. Children with troublesome asthma have higher IgE levels to several dog lipocalins than other dog sensitized children.Key messagePolysensitization to furry animal allergens and high IgE levels to the dog lipocalins Can f 2, Can f 4 and Can f 6 is associated with asthma severity in dog dander sensitized children. Molecular allergy diagnostics may thus help the clinicians to evaluate the impact of allergic sensitization on asthma morbidity.

Nasal specific IgE to Der p is not an acceptable screening test to predict the outcome of the nasal challenge test in patients with non-allergic rhinitis

ObjectivesNasal specific IgE (NsIgE) is the most common marker to identify type-2 inflammation in local allergic rhinitis (LAR). However, the comparison of NsIgE in different types of rhinitis, its frequency in tropical countries, and its diagnostic performance for predicting the outcome of a nasal challenge test (NCT) has had limited study. The main objective of this study was to explore the diagnostic performance of NsIgE to Dermatophagoides pteronyssinus (Der p) among different types of rhinitis and control subjects in a tropical population. MethodsWe evaluated the frequency of NsIgE, systemic atopy (serum sIgE and Skin Prick Test), and nasal eosinophils, and we performed nasal challenge tests (NCTs) with Der p in 3 groups of patients; rhinitis without atopy (RWoA) (n = 25), rhinitis with atopy (RWA) (n = 25), and control subjects (n = 18). ResultsNsIgE had a low sensitivity and specificity to predict a positive NCT in the RWoA group: 48% had NsIgE, but only 28% had a positive NCT. Among the RWA group 84% had NsIgE and 80% had a positive NCT; the association of NsIgE and positive NCT was high (>80%). In the control group 27.8% had NsIgE, but none had a positive NCT. ConclusionsNsIgE performs poorly in predicting NCT results in patients with non-allergic rhinitis. More methodical investigations are needed in this complex area of rhinitis. In patients with allergic rhinitis, NsIgE was useful in predicting a positive nasal challenge, but not superior to the systemic atopic test.

Nasal polyposis is a risk factor for having positive lysine-aspirin nasal challenges in aspirin-exacerbated respiratory disease

Nasal polyposis is a risk factor for having positive lysine-aspirin nasal challenges in aspirin-exacerbated respiratory disease

Recent advances in allergic rhinitis.

Allergic rhinitis affects 20 to 30% of adults in both the United States and Europe and perhaps a somewhat higher percentage of children. In addition to nasal and ocular symptoms directly related to the allergic process, interference of these symptoms with sleep leads to daytime sleepiness and impaired quality of life. Patients miss work because of symptoms but an even greater problem is interference with work productivity, or presenteeism, which has been reported to be the biggest contributor to the total economic cost of allergic rhinitis. There has been increasing awareness that many patients with either seasonal or perennial symptoms but negative skin and in vitro tests for allergen sensitivity have local nasal allergy, diagnosable by the presence of allergen-specific IgE in their nasal secretions or a positive nasal allergen challenge or both. The pharmaceutical management of allergic rhinitis rests on symptomatic treatment with antihistamines that perhaps are more effectively administered intranasally than orally and intranasal corticosteroids. Allergen immunotherapy is very effective, even for local allergic rhinitis, and the shortcomings of subcutaneous immunotherapy of inconvenience and safety are reduced by the introduction of sublingual immunotherapy (SLIT). Use of the latter is currently somewhat limited by the lack of appropriate dosing information for SLIT liquids and the limited number of allergens for which SLIT tablets are available.

Molecular allergy diagnostics refine characterization of children sensitized to dog dander

Sensitization to dog dander is an important risk factor for rhinoconjunctivitis and asthma but is not sufficient for diagnosing dog allergy. Molecular allergy diagnostics offer new opportunities for refined characterization. We sought to study the association between sensitization to all presently known dog allergen components and clinical symptoms of dog allergy in children evaluated by using nasal provocation tests (NPTs). Sixty children (age, 10-18years) sensitized to dog dander extract underwent NPTs with dog dander extract. Measurement of IgE levels to dog dander and to Can f 1, Can f 2, Can f 3, and Can f 5 was performed with ImmunoCAP, and measurement of IgE levels to Can f 4 and Can f 6 was performed with streptavidin ImmunoCAP. An IgE level of 0.1 kUA/L or greater was considered positive. There was an association between sensitization to an increasing number of dog allergen components and a positive nasal challenge result (P=.01). Sensitization to lipocalins (odds ratio [OR], 6.0; 95% CI, 1.04-34.5), inparticular Can f 4 (OR, 6.80; 95% CI 1.84-25.2) and Can f 6 (OR, 5.69; 95% CI, 1.59-20.8), was associated with a positive NPT result. Monosensitization to Can f 5 was related to a negative NPT result (OR, 5.78; 95% CI, 1.01-33.0). Sensitization to an increasing number of dog allergen components and to lipocalins is associated with dog allergy. Monosensitization to Can f 5 should not be regarded primarily as a marker for dog allergy.

Unilateral nasal allergic reactions increase bilateral sinus eosinophil infiltration

We have previously shown that unilateral nasal challenge with antigen causes an increase in the number of eosinophils in the ipsilateral maxillary sinus. Here we aimed to determine whether there was an eosinophil response in the contralateral maxillary sinus after unilateral nasal challenge with antigen. Twenty subjects with a history of seasonal allergic rhinitis and a positive nasal challenge to ragweed or grass allergens were studied outside of their allergy season. Catheters were placed in both maxillary sinuses and the subjects were challenged with antigen via the left nostril. The subjects recorded nasal symptoms before and after each allergen challenge and hourly for 8 h afterward. We performed nasal lavages of the nose and sinuses at the same time as symptoms were recorded. The lavages were analyzed for the number of eosinophils and levels of albumin. Subjects showed a symptomatic response to challenge accompanied by an influx of eosinophils into the nose and increased vascular permeability. The number of eosinophils increased in both maxillary sinuses. The total change from diluent in eosinophils during the late phase response was higher in the ipsilateral maxillary sinus (median = 8,505; range = 0-100,360) compared with the contralateral sinus (median = 1,596; range = -13,527-93,373; P = 0.03). We conclude that eosinophils increase in both maxillary sinuses after unilateral nasal challenge. We speculate that a central neurologic reflex initiated in the nose by the nasal challenge contributes to the bilateral eosinophil response in the maxillary sinuses. We further speculate that, since there are more eosinophils in the ipsilateral compared with the contralateral maxillary sinus, there is also an axonal reflex into the ipsilateral maxillary sinus that contributed to the eosinophil response.

Use of nasal inspiratory flow rates in the measurement of aspirin-induced respiratory reactions

BackgroundNasal ketorolac challenge with modified oral aspirin challenge is a safe and effective alternative for desensitizing patients with aspirin-exacerbated respiratory disease. In addition to clinical judgment, objective tests assessing nasal flow may help in diagnosing nasal reactions. ObjectiveTo evaluate the feasibility of peak nasal inspiratory flow (PNIF) as an objective measurement in the assessment of a reaction to nasal ketorolac and to determine changes in PNIF that have adequate sensitivity and specificity. MethodsOne hundred fifty-one patients referred to the Scripps Clinic for aspirin challenge and desensitization and 14 healthy controls participated in the study. Percentages of decrease in PNIF during reactions were compared with the nonreactors' measurements. A receiver operating characteristic curve was constructed to assess the diagnostic performance of PNIF measurement during a clinically positive nasal challenge. ResultsA total of 165 subjects participated in the study. One hundred fourteen patients (69.1%) clinically reacted to the nasal ketorolac challenge. There was no statistical difference between nasal reactors and nonreactors regarding sex, baseline forced expiratory volume in 1 second, and use of systemic steroid before challenge. The mean percentage of decrease in PNIF was significantly higher in the reactor group (−0.30 ± 0.29 vs −0.07 ± 0.16, P < .001). A cutoff value of 25% decrease in PNIF had the maximum sensitivity and specificity (56.1% and 94.1%). ConclusionThe high specificity of a 25% decrease in PNIF found in receiver operating characteristic curve analysis indicated that PNIF measurements can be useful for assessing nasal reactions during nasal ketorolac challenges in the diagnosis of aspirin-exacerbated respiratory disease.

Evaluation of in Vivo and in Vitro Responses to Nole e1 in Systemic and Local Allergic Rhinitis

The aim of this study is evaluating in vivo and in vitro responses to purified allergen nOle e1 in local allergic rhinitis (LAR) compared to systemic allergic rhinitis (SAR). nOle e1 was purified from olive tree pollen by RP-HPLC chromatography. Subjects with positive skin prick test (SPT), specific IgE (sIgE) to olive >0.35 kU/L, and positive nasal challenge with commercial olive pollen extract were recruited (SAR subjects). Also, subjects with negative SPT, sIgE to olive <0.35 kU/L, and positive nasal challenge with commercial olive pollen extract were selected (LAR subjects). All subjects underwent SPT and nasal challenge with nOle e1 (0.5,1,5 and 10 mcg/ml) monitored by acoustic rhinometry. Basophil activation test (BAT) was performed at 0.1, 0.5,1 and 5 mcg/ml with nOle e1 and whole commercial extract (≥ 2 SI). Ethical committee approved the study. Six SAR subjects and 4 LAR subjects were selected for the study. SPT with nOle e1 was positive in 100% SAR subjects and all LAR subjects had negative skin tests. All SAR and LAR subjects had positive responses to nOle e1 nasal challenge. Of SAR subjects, 100% of them had positive BAT with whole commercial olive extract and 75% with nOle e1. LAR subjects showed a 75% positive BAT responses to whole commercial olive extract but no positive responses to nOle e1. Subjects with LAR showed positive responses to nOle e1 in vivo. In vitro responses to whole olive pollen extract were detected in a significant percentage of subjects with LAR.

Is a positive nasal lysine‐aspirin challenge test associated with a more severe phenotype of chronic rhinosinusitis and asthma?

Current guidelines recommend a greater use of aspirin challenge testing in the diagnosis of aspirin-intolerant rhinosinusitis and asthma, a disorder with high burden of illness and resistance to treatment. The indications for these tests and their clinical significance remain unclear. This study was designed to characterize the phenotype of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) with or without asthma undergoing a nasal lysine-aspirin (L-ASA) challenge to evaluate which factors strongly predict a positive test. Seventy-five patients with CRSwNP underwent nasal challenge with 16 mg (total) of L-ASA after 30 minutes of acclimatization and diluent challenge. A positive challenge was defined as a 25% drop in total nasal volume measured by acoustic rhinometry. Twenty-three (31%) participants gave a history of aspirin intolerance and 38 (51%) had a positive nasal L-ASA challenge. Upper airway measures (CT scan score, olfaction, polyp grading, peak nasal inspiratory flow, nasal symptoms, etc.) and lower airway measures (methacholine provocative concentration required to produce a 20% drop in forced expiratory volume in 1 second, effective special airway resistance, and spirometry) were not significantly worse in patients with a positive aspirin challenge. Test sensitivity was 48%, specificity was 52%, positive predictive value was 29%, and negative predictive value was 68%. A regression analysis identified forced expiratory flow at 25-75% (FEF(25-75)), history of aspirin intolerance, and duration of rhinosinusitis as significant predictors of a positive aspirin challenge. A positive response to nasal L-ASA challenge is not associated with a more severe phenotype of CRSwNP with or without asthma. A history of aspirin intolerance, duration of rhinosinusitis, and FEF(25-75) predict a greater response to aspirin.

Allergic Rhinitis with Negative Skin Tests

Recently, several studies have revealed a subset of patients who have positive nasal provocation to allergens despite having a negative skin prick test. It has been hypothesized that these patients have localized allergic rhinitis. However, the prevalence varies greatly, ranging from 0% to 100% of skin test-negative individuals. This wide range in prevalence is likely related to differences in methodology, including differences in allergen manufacturers, concentrations, and numbers of allergens tested and, perhaps most importantly, criteria for a positive nasal challenge. Despite the evidence to date, many challenges exist with regard to the concept of localized nasal allergy. Further studies will be required to further define the immunopathology, prevalence, practical diagnostic tests, and management.

Skin test sensitivity to mouse predicts allergic symptoms to nasal challenge in urban adults

Epidemiologic studies have shown an association between mouse allergen exposure and asthma morbidity among urban populations, but confirmatory challenge studies in community populations have not been performed. This study was designed to examine the clinical relevance of mouse sensitization using a nasal challenge model. Forty-nine urban adults with asthma underwent skin-prick testing (SPT) and intradermal testing (IDT) with mouse epithelia extract. A positive SPT was defined as a net wheal size ≥3 mm and a positive IDT was defined as a net wheal size ≥6 mm using a 1:100 dilution of extract (1:10 w/v was obtained from Greer Laboratories (Lenoir, NC) as a single lot [Mus m 1 concentration = 2130 ng/mL]). Mouse-specific IgE (m-IgE) was measured by ImmunoCAP (Phadia, Uppsala, Sweden). Nasal challenge was performed with increasing concentrations of mouse epithelia extract and symptoms were assessed by visual analog scale. A positive challenge was defined as a 20-mm increase in the scale. The age range of the 49 participants was 18-50 years; 41% were men and 86% were black. Fourteen participants were SPT(+) to mouse, 15 participants were SPT(-) but (IDT(+)), and 20 participants were negative on both SPT(-) and IDT(-) (SPT(-)/IDT(-)). Sixty-four percent of the SPT(+) group, 40% of the IDT(+) group, and 20% of the SPT(-)/IDT(-) group had a positive nasal challenge. Sixty-seven percent (10/15) of those who were either SPT(+) or m-IgE(+) had a positive nasal challenge. SPT or the combination of SPT plus m-IgE performed best in diagnosing mouse allergy. The great majority of mouse-sensitized urban adults with asthma appear to have clinically relevant sensitization. Urban adults with asthma should be evaluated for mouse sensitization using SPT or SPT plus m-IgE testing.

A Positive Skin Prick Test to Mouse is a Strong Predictor of a Positive Nasal Challenge in Urban Residents with Asthma

A Positive Skin Prick Test to Mouse is a Strong Predictor of a Positive Nasal Challenge in Urban Residents with Asthma

Asthmatic Response Induced by Nasal Challenge with Allergen

Background: There is a link between the upper and lower airways. Allergic rhinitis and bronchial asthma may coexist, but they can also affect each other. Objective: To investigate the possibility of nasal allergy being able to induce a secondary asthmatic response (AR). Methods: In 82 asthmatics responding insufficiently to standard antiasthmatic therapy and demonstrating negative ARs to bronchial challenge with allergen, 82 nasal challenges with various inhalant allergens were performed by means of rhinomanometry in combination with spirometry (vital capacity and forced expiratory volume in 1 s). In 33 control subjects suffering from allergic rhinitis (n = 18) or bronchial asthma (n = 15) only, 33 nasal challenges with inhalant allergens were performed by rhinomanometry and supplemented with spirometry. Results: Of the 82 nasal challenges, 69 produced a positive nasal response (p < 0.01) and 13 were negative (p > 0.05). In 58 cases with a positive nasal challenge, a secondarily induced AR was recorded (p < 0.01). The following types of ARs were documented: 17 isolated immediate ARs (p < 0.01), 24 isolated late ARs (p < 0.01), 12 dual late ARs (immediate + late, p < 0.05 and p < 0.01, respectively) and 5 isolated delayed ARs (p < 0.05). Conclusions: (1) An allergic reaction occurring initially in the nasal mucosa can play an important role in bronchial asthma by inducing a secondary AR, and (2) nasal challenge with allergen performed by rhinomanometry in combination with lung function recording (e.g. spirometry) may then determine the possible need for additional intranasal antiallergic treatment and sparing of antiasthmatic drugs.

Occupational rhinitis in workers investigated for occupational asthma

Background:The links between asthma and rhinitis are now referred to as united airways disease (UAD). Current evidence shows that the UAD model seems to be applicable to occupational rhinitis (OR)...

Prick puncture skin tests and serum specific IgE as predictors of nasal challenge response to Dermatophagoides pteronyssinus in older adults

The ability of prick puncture skin test (PPST) results and the presence of serum specific IgE (sIgE) to Dermatophagoides pteronyssinus to predict positive or negative nasal challenge (NC) results has not been determined in older adults. To determine if allergy skin test and/or serum sIgE is diagnostic of allergic rhinitis in older adults. Forty-eight adults (20 younger and 28 older) with rhinitis underwent NC to D. pteronyssinus 1 to 4 weeks after PPST and sIgE to D. pteronyssinus. Patients were not aware of their in vivo or in vitro results at the time of their NC. Fourteen of 48 adults (10 younger and 4 older) were NC positive. The positive predictive values for older adults with positive NC results ranged from 28.57% to 42.86% for PPST and was 16.67% for sIgE. In contrast, positive predictive values in younger adults ranged from 76.92% to 100% for PPST and was 100% for sIgE. However, negative PPST results and sIgE had high predictive values for a negative NC result to D. pteronyssinus in older adults (90.48%-95.24% for PPST and 89.47% for sIgE). Although PPST and sIgE negative results were good predictors of negative NC outcomes, neither positive PPST results nor serum sIgE to D. pteronyssinus predicted positive NC results in older adults. PPST and sIgE to D. pteronyssinus were excellent predictors of both positive and negative NC outcomes in younger adults.

Multiallergen nasal challenges in nonallergic rhinitis

It has been proposed that some patients with nonallergic rhinitis may have "localized allergy" of the nasal mucosa. Nasal challenges with aeroallergens can help determine whether a patient is clinically allergic via an IgE-mediated pathway. To determine the prevalence of localized allergy in patients with negative skin prick test results via nasal challenges with an array of allergens. Twenty individuals with perennial rhinitis and negative epicutaneous test results to common perennial aeroallergens underwent nasal challenges to glycerin, Alternaria, cockroach, timothy grass, cat hair, and Dermatophagoides pteronyssinus. Total symptom scores, peak nasal inspiratory flow rates, and nasal eosinophil counts were determined. Of 20 patients with nonallergic rhinitis, 4 were hyperresponsive to glycerin and were not subsequently challenged. Eleven patients had negative nasal challenges. Five patients developed positive challenges (total symptom score > or = 5) to 7 allergens. These 5 patients returned for nasal provocation testing to their offending allergens, and these repeated challenges were negative. Three control subjects with allergic rhinitis developed positive challenges after nasal allergen challenge. Although some individuals with nonallergic rhinitis can have positive nasal allergen challenges, these results were not reproducible in the present patient population.

A comparison of skin prick tests, intradermal skin tests, and specific IgE in the diagnosis of mouse allergy

Mouse sensitization is assessed by using skin testing and serum levels of mouse allergen-specific IgE (m-IgE). However, it is unknown whether a positive skin test response or m-IgE result accurately identifies those with clinically relevant mouse sensitization. We sought to compare skin testing and m-IgE measurement in the diagnosis of mouse allergy. Sixty-nine mouse laboratory workers underwent skin prick tests (SPTs), intradermal tests (IDTs), and serum IgE measurements to mouse allergen, followed by nasal challenge to increasing concentrations of mouse allergen. Challenge response was assessed by nasal symptom score. Thirty-eight women and 31 men with a mean age of 30 years were studied. Forty-nine workers reported mouse-related symptoms, of whom 10 had positive m-IgE results and 12 had positive SPT responses. Fifteen had negative SPT responses but positive IDT responses. Positive nasal challenges were observed in 70% of workers with positive m-IgE results, 83% of workers with positive SPT responses, 33% of workers with negative SPT responses/positive IDT responses, and 0% of workers with negative IDT responses. SPTs performed best, having the highest positive and negative predictive values. Among participants with a positive challenge result, those with a positive SPT response or m-IgE result had a significantly lower challenge threshold than those with a positive IDT response (P = .01). Workers with a positive challenge result were more likely to have an increase in nasal eosinophilia after the challenge compared with those with a negative challenge result (P = .03). SPTs perform best in discriminating patients with and without mouse allergy. Mouse-specific IgE and IDTs appear to be less useful than SPTs in the diagnosis of mouse allergy.

Increased Levels of RANTES in Induced Sputum of Chronic Asthma but Not in Seasonal Grass Pollen-Induced Rhinitis

[corrected] Allergic rhinitis is one of risk factors for development of allergic asthma. 9 patients with asthma, 16 patients with seasonal allergic rhinitis (SAR) due to grass or rye pollen sensitization and 17 healthy control subjects were recruited to the study. SAR patients were identified by history, skinprick test, specific IgE and positive nasal allergen challenge. Every subject underwent the methacholine bronchial provocation test and sputum induction. Levels of RANTES were measured in supernatant of induced sputum. Increased percentage of eosinophils in induced sputum in asthma compared to control group (p=0.01) but not in SAR patients compared to healthy subjects (p=0.13) were found. Similarly, asthmatic patients (p=0.01) but not SAR patients had increased levels of RANTES in sputum compared to healthy subjects. Increased levels of RANTES in induced sputum of patients with chronic asthma but not in SAR patients indicate that RANTES is important in pathogenesis of chronic airway inflammation.

Role of intradermal skin tests in the evaluation of clinically relevant respiratory allergy assessed using patient history and nasal challenges

Skin testing, correlated with patient history, is the accepted method of identifying clinically relevant aeroallergen sensitivity. Traditionally, intradermal tests are believed to be more sensitive in identifying aeroallergen sensitivity than the epicutaneous and percutaneous methods. Therefore, many allergy practitioners use the epicutaneous or percutaneous method first and, if the results are negative, follow up with intradermal tests. To compare the epicutaneous, percutaneous, and intradermal methods to determine their sensitivity to patient history and to evaluate the value of intradermal tests when epicutaneous and percutaneous test results are negative. Participants were evaluated for rhinoconjunctivitis symptoms and then were skin tested using the prick and Multi-Test II (MTII) methods. Intradermal tests were performed when prick and MTII test results were negative to an aeroallergen. Participants with negative prick and MTII test results and corresponding positive intradermal test results underwent nasal challenges with evaluation by anterior rhinomanometry. Compared with patient history, average sensitivity for MTII was 77% and for the prick method was 62%. When MTII results were negative, 17% of intradermal tests corresponded with probable patient histories of allergy but none with positive nasal challenge results. Nasal challenge results were similar to those of the negative control group and significantly different from those of the positive control group (P < .001). The MTII tests are more sensitive and equally specific compared with the prick method. When MTII results are negative, positive intradermal test results are unlikely to identify clinically relevant aeroallergen sensitivity. Routine performance of intradermal tests when MTII results are negative is likely to be of low clinical yield.