Positive Nasal Responses Research Articles

Nasal response in patients with diisocyanate asthma.

To date, no studies have assessed nasal and bronchial response to diisocyanates during specific inhalation challenges (SIC). This study was performed to assess nasal response during SIC with diisocyanates (nasal and oral breathing) in patients with suspected occupational asthma due to these agents. Fourteen patients with suspected clinical history of diisocyanate-induced asthma were challenged with diisocynates in a 7m3 chamber. Nasal response testing during challenges was assessed by acoustic rhinometry, peak nasal inspiratory flow (PNIF), and visual analog scale (VAS), alongside bronchial responses. Eleven patients had a significant asthmatic response to diisocyanates. None reported clear work-related nasal symptoms. In patients with positive bronchial response to diisocyanates, nasal mean minimal cross-sectional area (MCA) decreased by 26.9%, nasal volume at 5 cm decreased by 33.5%, and PNIF decreased by 28.3%, all from baseline. A positive nasal response was elicited in 45%, 54%, and 45% of patients, respectively. A significant increase in VAS was observed in 4 patients. Three patients with negative bronchial response had a negative nasal response. SIC revealed an objective nasal response in around 50% of patients with occupational asthma due to diisocyanates, in spite of the fact that none of them reported work-related nasal symptoms. The clinical significance of this finding is a poor association between nasal symptoms at work and an objective nasal response during positive SIC with diisocyanates.

Nasal response in patients with diisocyanate asthma

To date, no studies have assessed nasal and bronchial response to diisocyanates during specific inhalation challenges (SIC). This study was performed to assess nasal response during SIC with diisocyanates (nasal and oral breathing) in patients with suspected occupational asthma due to these agents. Fourteen patients with suspected clinical history of diisocyanate-induced asthma were challenged with diisocynates in a 7m3 chamber. Nasal response testing during challenges was assessed by acoustic rhinometry, peak nasal inspiratory flow (PNIF), and visual analog scale (VAS), alongside bronchial responses. Eleven patients had a significant asthmatic response to diisocyanates. None reported clear work-related nasal symptoms. In patients with positive bronchial response to diisocyanates, nasal mean minimal cross-sectional area (MCA) decreased by 26.9%, nasal volume at 5 cm decreased by 33.5%, and PNIF decreased by 28.3%, all from baseline. A positive nasal response was elicited in 45%, 54%, and 45% of patients, respectively. A significant increase in VAS was observed in 4 patients. Three patients with negative bronchial response had a negative nasal response. SIC revealed an objective nasal response in around 50% of patients with occupational asthma due to diisocyanates, in spite of the fact that none of them reported work-related nasal symptoms. The clinical significance of this finding is a poor association between nasal symptoms at work and an objective nasal response during positive SIC with diisocyanates.

Provocation test in patients with different phenotypes of aspirin hypersensitivity

Background Aspirin (ASA) hypersensitivity has a complex clinical presentation with three major phenotypes: aspirinexacerbated respiratory disease (AERD; asthma and/or nasal polyps), chronic urticaria and aspirin-induced anaphylaxis. In patients with AERD asthma is often severe and difficult to control. Moreover, NSAID ingestion may provoke life-threatening attack. Thus, diagnosing of ASA hypersensitivity is an important issue. In everyday practice ASA hypersensitivity is confirmed by oral (OPT), nasal (NPT) or bronchial provocation tests. However their protocols vary in terms of maximum cumulative dose. Besides, phenotype of hypersensitivity is not taken into consideration when choosing the protocol. Aim of the study The aim of this study was to compare responsiveness to ASA in patients with different phenotypes of ASA hypersensitivity (AERD, chronic urticaria, anaphylaxis). Patients and methods 238 patients (179 women, 59 men) aged 19-71 with the history suggesting hypersensitivity to NSAIDS were provoked with aspirin. The group comprised 92 patients with AERD, 83 with chronic urticaria and 63 with suspicion of anaphylaxis caused by ASA. Single-blind oral provocation test was performed according to two-day protocol (day 1placebo, day 2- increasing doses of ASA: 50, 100, 150, 300, 400 mg). Anterior rhinomanometry, spirometry and clinical monitoring were used to assess the reaction. The test was considered positive in case of clinical symptoms of hypersensitivity, significant decline of FEV1 or positive nasal response in anterior rhinomanometry. Results Provocation test was positive in 81 (34%) patients, including 26 with chronic urticaria, 45 with asthma and/or nasal polyps and 10 with history of anaphylaxis. Proportions of positive results in the subgroups were 31%, 49% and 16%, respectively. The mean dose provoking reaction was significantly lower in AERD group compared to patients with chronic urticaria (212 mg vs. 604 mg, p<0.05). 36% of positive responders with asthma reacted to doses iU200 mg. 19 subjects (8%) responded to placebo making the provocation impossible to evaluate. Conclusions Patients with AERD usually respond to smaller doses of ASA compared to patients with chronic urticaria. As an oral provocation test is associated with the risk of anaphylactic reaction and its severity is dose-dependent it may be suggested to introduce new protocol for patients with severe asthma, based on lower first doses of ASA.

Comparative responses to nasal allergen challenge in allergic rhinitic subjects with or without asthma

BackgroundNasal allergen challenge (NAC) is useful to study the pathophysiology of rhinitis, and multiple challenges may more adequately approximate natural exposure.ObjectiveTo determine the effect of 4 consecutive daily NAC, on clinical and inflammatory parameters in rhinitics with or without asthma.MethodsRhinitic subjects were recruited: 19 with mild asthma and 13 without asthma. Subjects underwent a control challenge (normal saline) followed by 4 consecutive daily NAC. Allergen challenge consisted of spraying the chosen allergen extract into each nostril until a positive nasal response occurred. Symptoms were recorded on a Likert scale, and oral peak expiratory and nasal peak inspiratory flows allowed assessment of a nasal blockage index (NBI), for a period of 7 hours. Induced sputum and nasal lavage were performed on control day and after 1 and 4 days of NAC.ResultsCompared with the control day, there was a significant increase in symptom scores and NBI 10 minutes after each last daily NAC in both groups (p < 0.05). Symptom scores and NBI were similar for the 2 groups, except for nasal obstruction and rhinorrhea, which were more marked in subjects with asthma and rhinitis, respectively. Nasal lavage eosinophils were increased after 4 days of challenges in both groups, but there was no change in sputum eosinophils. No cumulative effect or any late response were observed in any of the groups over the challenge period.ConclusionMultiple NAC may be a useful tool to study the pathophysiology of allergic rhinitis or its relationships with asthma.Trial registrationClinicalTrials.gov NCT01286129

Role of aeroallergen nasal challenge in asthmatic children

Background The majority of allergic asthmatic patients are sensitised to several aeroallergens. Discrimination of the clinically relevant allergen is essential for the correct use of immunotherapy. Objective To investigate nasal challenge and its role in screening clinically relevant allergens in asthmatic children. Methods Aeroallergen nasal challenge was performed in five different groups of patients (asthma; asthma & rhinitis; rhinitis; atopic controls; and non-atopic controls). Differences between groups after challenge were evaluated by means of spirometry and acoustic rhinometry. Results Nasal challenge was performed in 125 patients, 25 per group. The positive nasal response of immediate type was recorded in 21 patients with asthma only ( P<0.001), 18 with asthma and rhinitis ( P<0.001), 19 with rhinitis ( P<0.001), two atopic control patients and in no healthy control patients. However, no differences were observed between the asthma group and the groups with rhinitis symptoms. The risk of a positive challenge was much higher in the asthma without rhinitis group compared to atopic controls (OR 29.57; 95%CI: 5.47–159.97). Conclusion Aeroallergen nasal challenge is a safe technique in asthmatic children and could be useful in establishing the clinically relevant allergen even in the absence of rhinitis.

Diagnostic Value of Nasal Allergen Challenge Combined With Radiography and Ultrasonography in Chronic Maxillary Sinus Disease

To investigate the possible role of nasal allergy in chronic disease of the maxillary sinuses (CDMS) by means of nasal provocation test (NPT) with allergen combined with radiography and ultrasonography. Prospective clinical controlled study. Academic referral center. Seventy-one patients with CDMS and 16 control subjects with allergic rhinitis but no history of sinus disease. In the 71 patients, a total of 135 NPTs and 71 control challenges with phosphate-buffered saline were performed by rhinomanometry combined with radiography and ultrasonography. In the control patients, 16 positive NPTs were repeated and combined with radiography and ultrasonography. Number, type, and timing of nasal responses with accompanying changes on radiographs and ultrasonograms. Of the 71 patients, 67 developed 104 positive nasal responses of various types (P < .001), 89 of which were accompanied by significant changes on radiographs (P = .008), whereas 83 were also associated with significant changes on ultrasonograms (P = .007). No significant changes on the radiographs or the ultrasonograms were recorded during the 71 phosphate-buffered saline control tests in the patients with CDMS (P = .14 and .06, respectively) or during the 16 NPTs in control subjects (P = .15 and .12, respectively). The radiographic and ultrasonographic findings were significantly correlated (r = 0.81; P < .01). Nasal allergy may be involved in some patients with CDMS, resulting in appearance of a maxillary sinus response. Monitoring this response by means of serial ultrasonography and, if necessary, also by conventional radiography or computed tomography simultaneously with the nasal challenge with allergen seems to be a very useful diagnostic supplement allowing additional therapeutic measures focused on the nasal allergy.

Audiometric Changes in Chronic Secretory Otitis Media Due to Nasal Allergy

To investigate the possible role of nasal allergy on hearing levels in chronic otitis media with effusion (OME). In 87 adults who had chronic OME, 185 nasal challenges with allergen were performed using rhinomanometry combined with tympanometry and pure-tone audiometry (PTA). Of the 87 patients, 71 developed 131 positive nasal responses (NRs; p < 0.01), 119 of which were associated with significant changes in middle ear pressure (p < 0.01) and 96 with significant changes in PTA (p < 0.01). The hearing threshold increased significantly (>30 dB) at tone frequencies of 2,000 Hz during 63 NRs (p < 0.05) and at tone frequencies of 4,000 Hz during 93 NRs (p < 0.01). Nasal allergy can affect Eustachian tube function, leading to the changes in the middle ear pressure and resulting in hearing impairment. Nasal challenges with allergen performed using rhinomanometry combined with tympanometry and PTA may be a useful diagnostic supplement in chronic OME patients.

Seasonal and perennial allergic conjunctivitis: the possible role of nasal allergy

There is a link between conjunctiva and nose. Nasal allergy is suspected to be involved in some cases of conjunctivitis. This work aims to investigate the possible role of nasal allergy in seasonal (SAC) and perennial (PAC) allergic conjunctivitis and the value of nasal challenges with allergens (nasal provocation tests [NPTs]) for the diagnostic procedures of the conjunctivitis. In 61 adults suffering from SAC or PAC with a positive history and skin tests, but responding insufficiently to the local treatment, 122 NPTs and 61 control nasal challenges with phosphate-buffered saline (PBS) were performed using rhinomanometry combined with recording of ocular response. In 16 control subjects suffering only from allergic rhinitis without a history of conjunctivitis, 16 positive NPTs were repeated and supplemented with registration of ocular features. Of the 61 patients, 55 developed 103 positive nasal responses of various types (P < 0.01), 82 of which were accompanied by significant conjunctival response (P < 0.01) without any corneal involvement. No significant ocular responses were recorded during 61 control PBS challenges (P > 0.05) as well as during 16 challenges in control subjects (P > 0.1). These results illustrate a possible involvement of nasal allergy in some patients with allergic conjunctivitis (SAC and PAC) and the value of the nasal challenges with allergen combined with registration of the ocular features in the diagnostic approach to these disorders.

The possible involvement of nasal allergy in allergic keratoconjunctivitis

Allergic keratoconjunctivitis coexists regularly with allergic rhinitis. However, little is known about the relationship between these conditions. The purpose of this study was to investigate the possible involvement of nasal allergy in keratoconjunctivitis by means of nasal challenge with allergen (NPT), in combination with recording of the ocular symptoms. In 26 patients suffering from atopic (n=15) or vernal (n=11) keratoconjunctivitis showing positive history and skin tests, but responding insufficiently to the local ophthalmologic therapy, 71 NPTs with inhalant allergens were performed and combined with the recording of the ocular response. In 11 control subjects with allergic rhinitis, but without ocular disease history, 11 positive NPTs were repeated and supplemented with the registration of the ocular features. Of the 26 patients, 24 developed 51 positive nasal responses (NRs; P<0.01), 43 of which were accompanied by significant ocular response (P<0.01). No ocular responses were measured during the 26 PBS control challenges (P>0.05) or during 11 repeated NPTs in control subjects (P>0.2). These results give evidence for possible involvement of nasal allergy in some cases of keratoconjunctivitis. They also show diagnostic value of nasal challenges with allergen in combination with registration of the ocular symptoms in such patients, allowing then consideration of additional therapeutic measures concerning the nasal allergy.

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.

The role of nasal allergy in chronic secretory otitis media

Chronic secretory otitis media (SOM) has multifactorial causes, and nasal allergy is suspected as one of these causative factors. To investigate the possible role of nasal allergy in SOM in adults and to determine the diagnostic value of nasal challenges with allergens (nasal provocation tests) combined with tympanometry for the diagnosis of this disorder. In 69 young adults with chronic or recurrent SOM, 173 nasal challenges with allergens were performed by anterior rhinomanometry combined with tympanometry (pure-tone air conduction tympanometry). In 42 control subjects with only allergic rhinitis and no history of middle ear disease, 42 nasal challenges with allergens were repeated and combined with tympanometry. The study design was a placebo-controlled comparison. Of the 69 patients, 54 developed 129 positive nasal responses of various types (P < .01), 117 of which were accompanied by significant changes in middle ear pressure (P < .01). No significant tympanometric changes (P > .10) were recorded during the 42 positive nasal responses in control subjects. These results may confirm the occurrence of chronic SOM in some adult patients and the possible involvement of nasal allergy in chronic SOM. The nasal challenges with allergen performed by rhinomanometry, combined with tympanometry, seem to be a valuable supplementary tool for the diagnosis of this disorder.

Role of nasal allergy in chronic maxillary sinusitis—Diagnostic value of nasal challenge with allergen

The role of nasal allergy in chronic maxillary sinusitis without an air-fluid level was studied in 37 patients. Seventy-three nasal provocation tests with various inhalant allergens were performed in 37 patients by means of rhinomanometry, and maxillary sinus radiographs were performed before and repeatedly after the allergen challenge. Forty-one positive nasal responses (NRs) occurred in 29 patients; 13 were immediate only, 18 were late only, and 10 NRs were dual responses. Of these responses, 32 demonstrated radiographic changes, primarily an increase in mucosal edema and/or opacification. These responses were accompanied by increased pressure in the maxillary sinuses, acute headache, and sometimes otalgia. Eight patients did not develop any NRs; however, increased thickening of the mucosal membrane of the maxillary sinuses, accompanied by subjective symptoms, was recorded in three of these nonresponders. These results demonstrate the role of nasal allergy in some patients with chronic maxillary sinusitis, which may affect the diagnostic and therapeutic approaches to this disorder.

Nasal response to food ingestion challenge.

A routine diagnostic procedure, the food-focused history, intracutaneous tests with food extracts, and ingestion challenge with selected foods in combination with rhinomanometry were performed in 142 patients suffering from perennial allergic rhinitis. Forty-one of the 47 patients with a "positive food allergy history" developed 65 (90%) positive nasal responses during 72 food ingestion challenges. Of the 95 patients with an "unknown food allergy history," 54 developed 68 (50%) positive nasal responses during 132 food ingestion challenges. The following responses were recorded: 29 isolated immediate (within three hours), 38 isolated late (six to 24 hours), 42 dual late (immediate + late), 11 isolated delayed (28 to 52 hours), and 13 dual delayed (immediate + delayed). It can be concluded that the involvement of foods in allergic rhinitis is more frequent than is usually expected. The definite confirmation of the role of a certain food in these patients should be provided by the food ingestion challenge demonstrating one of the clinical types of nasal response. The mechanisms underlying the nasal response to foods are not yet fully clarified. The involvement of different types of hypersensitivity in the individual types of nasal response cannot be excluded.