Specific Nasal Provocation Research Articles

Occupational Rhinitis

There is convincing evidence that tight relationships between the upper and lower airways also apply to the workplace context. Most patients with occupational asthma (OA) also suffer from occupational rhinitis (OR), although OR is 2 to 3 times more common than OA. OR most often precedes the development of OA, especially when high-molecular-weight protein agents are involved, and longitudinal cohort studies have confirmed that OR is associated with an increased risk for the development of OA. The level of exposure to sensitizing agents at the workplace is the most important determinant for the development of IgE-mediated sensitization and OR. Atopy is a risk factor for the development of IgE-mediated sensitization only to high-molecular-weight agents. In workers with work-related rhinitis symptoms, documentation of IgE-mediated sensitization to a workplace agent via skin prick testing or serum specific IgE confirms a diagnosis of probable OR, whereas specific nasal provocation testing in the laboratory remains the reference method to establish a definite diagnosis of OR. Complete avoidance of exposure to the causal agent is the most effective therapeutic option for controlling work-related nasal symptoms and preventing the development of OA. If complete elimination of exposure is expected to induce meaningful adverse socioeconomic consequences, reduction of exposure can be considered as an alternative approach, but it is important to consider the individual risk factors for the development of OA to implement a more personalized management of OR.

Specific nasal provocation test with Dermatophagoides pteronyssinus, monitored by acoustic rhinometry, in children with rhinitis.

Currently, the diagnosis of allergic rhinitis (AR) is arrived at predominantly by a clinical history and by systemic sensitization tests, but specific nasal provocation tests (NPT) may establish a better direct correlation between etiologic surveyed allergens and nasal symptoms. To standardize the specific NPT with one of the most important house-dust mites, Dermatophagoides pteronyssinus, monitored by acoustic rhinometry, in children and adolescents, and propose a simplified specific NPT to improve its clinical applicability as a diagnostic tool. Sixteen controls (group 1) and 17 patients with an AR diagnosis sensitized to D. pteronyssinus (group 2) underwent a specific NPT with D. pteronyssinus. The acoustic rhinometry was performed after instillation of 0.15 mL of increasing concentrations of D. pteronyssinus (5000 BU/mL). The test was finalized after (1) instillation of the final concentration of D. pteronyssinus, or (2) after a 20% or more reduction in the volume of the first 5 cm of the nasal cavity (V5), or (3) a score of >3 in the symptoms questionnaire (a score from 0 to 7). A simplified specific NPT with two concentrations was proposed and implemented in a group of 10 patients with AR (group 3). At the end of the specific NPT, the median (range) variation in V5 was -5.7% (-9 to 4%) in the control group and -22.8% (-24 to -20%) in group 2. None of the patients in the control group and 88% of group 2 (15/17) showed positive specific NPT results. The simplified specific NPT triggered a positive response in 80% of patients in group 3, with median (range) V5 variation of -30.4% (-36 to -20%). This protocol has been proven safe and useful to differentiate between children and adolescents with AR and controls. Concentrations of 1:1000 and 1:100 D. pteronyssinus were the best for use in simplified specific NPT, which made it simpler and faster, and expanded its clinical applicability.

Occupational Exposure to Urban Air Pollution and Allergic Diseases.

Exposure to air pollution is associated with increased morbidity from cardiovascular diseases, lung cancer, respiratory and allergic diseases. The aim of this study was to investigate allergic diseases in 111 traffic wardens compared to a control group of 101 administrative employees. All participating subjects underwent a physical examination, in which a complete medical history was taken and a dedicated allergological questionnaire administered. Spirometry, Specific IgE dosage (RAST) and skin prick tests (SPT) were done. Diagnostic investigations such as the nasal cytology, a specific nasal provocation test and rhinomanometry were also performed. Statistical analyses were performed using STATA version 11. The percentage of subjects with a diagnosis of allergy was higher in the exposed workers than in the controls. As regards the clinical tests, the positivity was higher for the group of exposed subjects. Among the exposed workers, those who worked on foot or motorcycle had a higher positivity in clinical trials compared to the traffic wardens who used the car. Our study showed a higher percentage of allergic subjects in the group of workers exposed to outdoor pollutants than in the controls. These results suggest that allergological tests should be included in the health surveillance protocols for workers exposed to outdoor pollutants.

Specific Nasal Provocation Test with Dermatophagoides Pteronyssinus Monitored By Acoustic Rhinometry in Children and Adolescents with Allergic Rhinitis and Controls

Specific nasal provocation tests (NPTs) are indicated in confirming clinically relevant allergy and in the diagnosis of allergic rhinitis. Our objective was to evaluate a Dermatophagoides pteronyssinus (Dp) NPT protocol monitored by Acoustic Rhinometry (AR) and nasal symptom score in children and adolescents.

Specific nasal provocation test with dermatophagoides pteronyssinus monitored by acoustic rhinometry in children and adolescents with allergic rhinitis and controls

Results Median age was 122 months (108 to 143 months) in controls and 142 months (117 to 156 months) in allergic rhinitis group. At the end of the NPT, the mean V5 fall was 5.7% (-8.7% to 4%) in controls and 22.8% (-24% to -20%) in allergic rhinitis group. None of the 15 controls and 88% (15 of 17 patients) of the allergic rhinitis group had a positive Dp NPT. Considering positive NPTs, 23.5% (4/15) were positive at 1:10000, 35% (6/15) at 1:1000, 23.5% (4/15) at 1:100 and 6% (1/15) at 1:10 concentration. One NPT was considered positive due to symptom score. None of the 32 patients presented bronchial reactions or any pulmonary symptom after NPT. Conclusions This protocol has showed to have good specificity and sensitivity to discriminate patients with allergic rhinitis from controls. A simplified protocol with two Dp concentrations (1:1000 and 1:100) seems to be less expensive and less time consuming NPT protocol to be applied in the clinical practice.

Poster 1000: Efficacy and safety of specific sublingual immunotherapy with carbamylated allergoid tablets of ragweed pollen: a dose-ranging study

Methods A prospective multicenter double-blind randomized dose-ranging study (EudraCT number 2011-004522-10) was conducted following GCP rules in patients with history of ragweed-related moderate-to-severe allergic rhinoconjunctivitis for at least 2 years, with or without controlled seasonal allergic asthma, and positive response to allergen specific nasal provocation test (NPT). Before the 2013 ragweed pollen season adult patients were assigned to different daily dosages (3001000-2000 UA) of tablets of ragweed pollen carbamylated extract given for 4 months. The primary end-point was the individual change in the response to NPT before and after the treatment (allergic symptoms and threshold provocative dose to identify improved, unchanged, worsened subjects). Secondary end-points included the analysis of this improvement considering the severity level (depending on symptoms score and provocative dose), the change of nasal peak inspiratory flow (NPIF) in response to NPT, and the incidence of adverse events. Results Seventy-three subjects were enrolled and 52 were randomized (1:1:1) and treated. The proportion of improved patients was 77%, 88% and 81% in the 300 UA, 1000UA and 2000 UA groups respectively. A progressive trend to increased efficacy with flattening of the slope (mean severity level improvement: +1.38, +1.71 and +1.90 respectively) and a statistically significant difference between 300 UA and 2000 UA (p = 0.0187) were found. NPIF improved in all groups at the end of the study without significant differences among treatments (p = 0.41). One probable treatment-related AE occurred in group 1, 3 probable and 1 certain (mild) in group 2, 3 possible and 1 certain (moderate) in group 3. No serious treatment-related AEs occurred.

Specific Nasal Provocation Test With Predator Mites

RationalePredator Cheyletidae mites are frequently found in house dust samples in our subtropical area (Canary Islands, Spain). The potential allergenicity of this mites family is still unknown in humans.MethodsWe selected 14 non consecutive adult patients (5 males/9 females; mean age: 34.6 y.-o.) with persistent rhinoconjunctivitis and sensitized to a Cheyletus eruditus extract i.e. showing a positive skin prick test with a wheal of at least 3 mm. Six adult subjects with non allergic persistent rhinitis were selected as control group. The objective measurement of the clinical response was assessed by specific nasal provocation test (NPT) with Cheyletus eruditus. The NPT was considered positive with a decrease above 25% in the MCA and/or VOL 2-5.5 cm3 measured by acoustic rhinometry or a clinical score above 5 points.ResultsAll 14 sensitized subjects showed a positive NPT to Cheyletus eruditus. The six patients of the control group had a negative NPT. As 12 out of the 14 Cheyletus e.-sensitized were also allergic to Pyroglyphidae mites different patterns of dust mite sensitization have been found.ConclusionsThis is, to our knowledge, the first study to show a specific nasal response to the predator mite Cheyletus eruditus in a selected population with persistent respiratory symptoms. Further work is still needed to evaluate both clinical relevance and the degree of immunologic cross-reactivity with other mites, specially Dermatophagoides spp. RationalePredator Cheyletidae mites are frequently found in house dust samples in our subtropical area (Canary Islands, Spain). The potential allergenicity of this mites family is still unknown in humans. Predator Cheyletidae mites are frequently found in house dust samples in our subtropical area (Canary Islands, Spain). The potential allergenicity of this mites family is still unknown in humans. MethodsWe selected 14 non consecutive adult patients (5 males/9 females; mean age: 34.6 y.-o.) with persistent rhinoconjunctivitis and sensitized to a Cheyletus eruditus extract i.e. showing a positive skin prick test with a wheal of at least 3 mm. Six adult subjects with non allergic persistent rhinitis were selected as control group. The objective measurement of the clinical response was assessed by specific nasal provocation test (NPT) with Cheyletus eruditus. The NPT was considered positive with a decrease above 25% in the MCA and/or VOL 2-5.5 cm3 measured by acoustic rhinometry or a clinical score above 5 points. We selected 14 non consecutive adult patients (5 males/9 females; mean age: 34.6 y.-o.) with persistent rhinoconjunctivitis and sensitized to a Cheyletus eruditus extract i.e. showing a positive skin prick test with a wheal of at least 3 mm. Six adult subjects with non allergic persistent rhinitis were selected as control group. The objective measurement of the clinical response was assessed by specific nasal provocation test (NPT) with Cheyletus eruditus. The NPT was considered positive with a decrease above 25% in the MCA and/or VOL 2-5.5 cm3 measured by acoustic rhinometry or a clinical score above 5 points. ResultsAll 14 sensitized subjects showed a positive NPT to Cheyletus eruditus. The six patients of the control group had a negative NPT. As 12 out of the 14 Cheyletus e.-sensitized were also allergic to Pyroglyphidae mites different patterns of dust mite sensitization have been found. All 14 sensitized subjects showed a positive NPT to Cheyletus eruditus. The six patients of the control group had a negative NPT. As 12 out of the 14 Cheyletus e.-sensitized were also allergic to Pyroglyphidae mites different patterns of dust mite sensitization have been found. ConclusionsThis is, to our knowledge, the first study to show a specific nasal response to the predator mite Cheyletus eruditus in a selected population with persistent respiratory symptoms. Further work is still needed to evaluate both clinical relevance and the degree of immunologic cross-reactivity with other mites, specially Dermatophagoides spp. This is, to our knowledge, the first study to show a specific nasal response to the predator mite Cheyletus eruditus in a selected population with persistent respiratory symptoms. Further work is still needed to evaluate both clinical relevance and the degree of immunologic cross-reactivity with other mites, specially Dermatophagoides spp.

Nasal blown secretion evaluation in specific occupational nasal challenges

To investigate the usefulness of nasal blown secretion evaluation during specific nasal provocation test (sNPT) in diagnosing occupational rhinitis (OR). To validate the method, nasal blown secretions from 103 healthy subjects and 30 allergic rhinitis patients were analyzed. Furthermore, we analyzed nasal blown secretions, collected before and after sNPT, of 29 subjects with work-related rhinitis symptoms (WRRS) who underwent the diagnostic pathway for OR. Rhinoscopy and nasal symptom score were used to define a positive sNPT. A total of 89.6% WRRS subjects provided suitable nasal secretions. Eosinophils significantly increased after positive sNPTs compared to negative ones (P = 0.006). Four percent and/or 1 x 10(4) eosinophils/ml was the cut-off for a significant post-sNPT eosinophil increase. A total of 4/13 (33%) WRRS subjects with negative sNPT, assessed by rhinoscopy and nasal symptom score, presented a significant post-sNPT nasal eosinophil increase, and were identified as possible OR. Eosinophil evaluation in nasal blown secretions is an important tool in monitoring the response to occupational specific nasal challenges.

Cluster immunotherapy with a glutaraldehyde‐modified mixture of grasses results in an improvement in specific nasal provocation tests in less than 2.5 months of treatment

Cluster immunotherapy is becoming increasingly used. It allows for a rapid build up phase and the administration of higher doses of allergen in a shorter period of time. To evaluate the effect of short-term pre-seasonal immunotherapy using a glutaraldeyde-modified allergen vaccine in reducing specific nasal hyperreactivity in nasal challenge tests. Thirty-three patients were selected. All patients had a positive history of allergic rhinitis and skin tests to grass pollen, although most of them (72.7%) were sensitized to other allergens as well. The study was conducted outside of the pollen season and the patients did not receive any pharmacological treatment during this period of time. Two randomized groups of patients were established; Group A: 22 patients (13 females and nine males) and Group B, 11 control patients (seven females and four males). Patients in Group A received immunotherapy with a vaccine containing 50% of the wild grasses Trisetum paniceum and Dactylis glomerata. All patients underwent titrated nasal provocation tests (NPT) before and after completion of the study (2.3 and 2.8 months for Groups A and B, respectively). The administration schedule consisted of 0.1 and 0.2 mL at day 1, followed by 0.3 and 0.5 mL at day 7, 0.5 mL after 2 weeks followed by 0.5 mL monthly. A single vial was used containing an allergen concentration of 10 000 TU/mL (105 microg of total protein and 24.6 microg of Group 1 plus 5 allergens/mL). A mean of 6.5 injections were administered to Group A patients between NPTs. There were no significant differences between both groups at the beginning of the study (P=0.48). At the end, only Group A patients needed significant greater threshold concentrations for a positive NPT than at the beginning (P=0.002). A short-term cluster pre-seasonal inmunotherapy with a modified vaccine containing a mixture of grass pollen is effective as determined by an objective measure after only a mean 2.3 months of treatment.

The influence of birch pollination on the adenoid size in children with intermittent allergic rhinitis

Allergic sensitization of the airways occurs not only in the mucosa of the shock organ, but also in the lymphatic stations draining these structures. The lymphatic structure closest to the nasal mucosa in humans is the adenoid. Many researches show that in part of children allergic rhinitis can be a risk factor for adenoid hypertrophy. We used acoustic rhinometry and endoscopy to evaluate the influence of the birch pollination on the adenoid size in 67 children between 5 and 12 years old. Four separate groups of children were examined. The study group consisted of 28 children hypersensitive to tree pollen with seasonal allergic rhinitis (interview, positive skin prick test results, presence of sIgE in the serum and positive nasal provocation test with birch pollen allergens). The first control group consisted of 14 atopic children hypersensitive to motherwort pollen. The second control group consisted of 15 non-atopic children. The third control group consisted of 10 children hypersensitive to tree pollen, they have got anti-allergic treatment (topical nasal steroid and antihistaminic) a week before birch pollination. In all of the groups the adenoid size was examined before, during and after birch pollination. In the study group, we examined the influence of specific nasal provocation test on the adenoid size too. In most children from the study group (71.4%) we observed the significant increase of adenoid size in endoscopic examination and decrease of nasopharyngeal cavity volume in acoustics rhinometry (92.9%) during the birch pollination. The changes returned after pollination period in most children (90%). In the first and the second control group there were almost no changes observed (p>0.05). The medical treatment used in the third control group avoided the increase of adenoid size during birch pollination season. In the study group there was no statistically significant correlation between the changes in nasopharyngeal volume during the pollination period and the results of nasal provocation test (r=0.18). The result of our study suggests that in children with seasonal allergic rhinitis the exposure on the allergenic factor can influence the adenoid size. Properly administered nasal glucocorticoid together with antihistaminic in standard doses can probably avoid this effect.

Three‐year follow‐up of clinical and inflammation parameters in children monosensitized to mites undergoing sub‐lingual immunotherapy

Parallel follow-up of clinical and inflammatory markers during sub-lingual immunotherapy (SLIT) is highly beneficial. Twenty-four children (age 4-16) monosensitized to house dust mite were randomized to receive either active or placebo SLIT for 1 yr in a double-blind placebo controlled design (Marcucci et al., Allergy 2003: 58: 657-62). Thereafter, for 2 yr they all received active treatment. Symptom scores for rhinitis, asthma, and drug usage were daily recorded. Eosinophil cationic protein (ECP) and tryptase in sputum and nasal secretions, serum and nasal mite-specific immunoglobulin E (IgE) were recorded before treatment and at 10-12 months intervals. Nasal ECP and nasal tryptase after specific nasal provocation tests were significantly reduced as compared to baseline values (p = 0.0043 and 0.0195, respectively) in the third year of active treatment. None of the other inflammatory parameters was increased. In placebo treated patients all these parameters tended to decrease only after switching to active treatment. Clinical scores did not improve in treated vs. placebo patients in the double-blind placebo-controlled phase of the study. In both cohorts a clinical benefit was observed as intra-group score reduction as compared to baseline. A significant difference was reached in patients treated for 2 yr for rhinitis and asthma (p = 0.0009 and 0.0019, respectively) but not for drug usage and in patients treated for 3 yr for rhinitis, asthma, and drug usage (p = 0.0105, 0.0048, and 0.02, respectively). SLIT in children monosensitized to mites reverted the spontaneous increase in nasal IgE and in local parameters of allergic inflammation. These outcomes were followed by a consolidated clinical improvement in the second and third year of treatment.

Do tryptase, ECP and specific IgE measurement by nasal incubation increase the specific nasal provocation test sensitivity?

The specific Nasal Provocation Test (sNPT) is a third level diagnostic tool. Fitted to reproduce natural exposure condition to pick the responsible allergen for nasal symptoms out, it is applied when prick test and RAST responses are doubtful. SNPT results have been evaluated measuring nasal resistance (anterior rhinomanometry) and nasal symptoms (clinical score), reaching 50% of sensitivity. This study focused on the determination of allergic response markers, triggered by nasal challenge: tryptase levels in the nose, specific IgE and ECP (Eosinophil Cationic Protein). The aim was to increase sNPT sensitivity. Twenty patients suffering from allergic rhinitis and 16 age-matched-nonallergic subjects were enrolled in the study. Tryptase, specific IgE and ECP were determined in nasal mucosa applying a new method, based on in situ incubation, before and after sNPT. The latter was performed following a standardized method. Tryptase levels increased in 13 patients (65%), were unchanged in four patients (20%), and slightly decreased in three patients (15%). The increase recorded was significant in mite allergic patients (p=0.005), but not significant (p> 0.05) in pollen allergic patients. ECP values increased in 13 patients (65%), were unchanged in two patients (10%), and highly decreased in five patients (25%). ECP increase was not significant (p> 0.05). Specific IgE levels increased in seven patients (35%), were unchanged in 11 patients (55%) and decreased in two patients (10%). The IgE increase was significant in pollen-allergic patients (p<0.05), while it was not significant in mite-allergic patients (p>0.05). Tryptase, ECP, and specific IgE were not detected in the control group. The data obtained showed a positive sNPT response in 12 patients (60%). Comparing our results with those derived from classical-parameter employment, we gathered an improvement of 10%. On the basis of the usual parameters, in fact, we recorded 50% positivity, while the use of mediators provided an additional 10% improvement in sNPT sensitivity: taking together the usual parameters and nasal allergic mediators values, we reached an sNPT over-all sensitivity of 85%.

Klasifikacija hronicnih inflamacija gornjih disajnih puteva na bazi alergijskog statusa

Almost one third to one half of all patients in otorhinolaryngologic practice experience some kind of inflammation of the upper respiratory tract out of which allergic mechanisms, either as primary factors or secondary ones, appear in 30-40% of adults and 60-80% of children and adolescents. The objective of this study was to analyse inflammatory conditions of the upper airways on the basis of allergic state of the patient and to establish the classification that will respect the actual immunological alteration level (subclinical allergy, clinical allergy) and spreading (localized allergy, generalized allergy). Inclusion criteria for all sixty nine patients were the diagnosis of chronic upper airway inflammation and their exposition just to ubiquitous allergens. Diagnostic procedure included anamnesis, physical examination and allergic in vivo testing of the skin and nasal mucosa to inhalant allergens. The certain categories of results were established for the skin prick-test (positive, negative, indefinite), specific nasal provocation test (positive, negative, hyperreactive) and nasal symptoms (present, absent). By using a strictly determined combination of results, we were able to define the six groups in our classification: nasal clinical allergy (30% of patients), non-nasal clinical allergy (19% of patients), localized nasal allergy (11% of patients), latent allergy (3% of patient), nonspecific nasal hyperreactivity (12% of patient) and non-allergic inflammation (25% of patients). Our classification takes into consideration the modern knowledge in the field of allergology and may bring an additional quality in respect to selection of therapy options, long-term follow-up of allergy status evolution in the individual person as well as intragroup and intergroup analysis of parameters important to evaluate the effects of antiallergic prevention or therapy.

LOW-DOSE LOCAL NASAL IMMUNOTHERAPY IN CHILDREN WITH PERENNIAL ALLERGIC RHINITIS DUE TO DERMATOPHAGOIDES

Marcucci F, Sensi L, Carrarelli C, et al. Allergy. 2002;57:23–28To assess the safety and clinical efficacy of low-dose nasal immunotherapy (LNIT) in children with dust mite allergy.Thirty-two symptomatic children between the ages of 4 and 14 years with perennial allergic rhinitis to dust mites.This was a multicenter, randomized, double-blind, placebo-controlled study conducted over a 2-year period. After baseline evaluation and 1-month washout period, participants were randomized to the placebo or modified LNIT group. Participants in the active group received increasing nasal doses of dust mite allergen to a maintenance dose of 80 allergen units (AU). The maintenance dose was given at home on a weekly basis for 18 months. Clinical symptoms, medication scores, threshold dose with specific nasal provocation test (NPT) (dose required to elicit 2 of 4 nasal symptoms including itching, sneezing, rhinorhea, and obstruction), and serum immunoglobulins IgE and IgG4 were followed. Statistical analyses were done to compare symptom and medication scores during period 1 (November 1994-March 1995) and period 2 (November 1995-March 1996). Results of NPTs and immunologic assays were compared at baseline, 5 and 18 months.Twenty-six participants completed the study (12 active and 14 placebo), and there were no serious local or systemic reactions. At baseline, the groups were similar in age, sex, duration of rhinitis, and results of NPT. There was no significant difference between groups in symptom or medication scores during the first period, however, participants in the active treatment group had significantly lower mean nasal symptom scores and mean medication scores during the second period. The threshold dose of allergen at NPT was significantly increased in the active treatment group when baseline and 18-month NPT results were compared. Also, the increase in the NPT threshold dose was significantly higher in the active treatment group when compared with placebo at the end of therapy. There was no statistically significant difference observed in IgE or IgG4 immunoglobulin levels between groups throughout the trial.LNIT may be a safe and effective alternative to traditional immunotherapy in children with mild allergic rhinitis attributable to dust mites.Few studies have assessed the clinical efficacy of nasal immunotherapy in children, and previous adult studies have had limited success resulting from increased symptoms of rhinitis associated with high-dose nasal immunotherapy. The current study utilizes a low maintenance dose in children with perennial allergic rhinitis and suggests a clinically significant reduction in symptoms and medication use as well as a significant increase in allergen threshold dose. The participants in this study had very mild symptoms of rhinitis, and it is unclear if similar results would be found in patients with moderate to severe disease. Additionally, participants were told to follow their normal cleaning habits and dust mite exposure was not assessed in either group. Therefore, it is difficult to say whether the apparent improvement observed in the active treatment group was entirely attributable to the effect of LNIT rather than differences in exposure between groups or changes in the level of exposure during the study.

A pre-seasonal birch/hazel sublingual immunotherapy can improve the outcome of grass pollen injective treatment in bisensitized individuals. A case-referent, two-year ontrolled study

BackgroundThe study tests the hypothesis of a reduction of priming due to tree allergy in patients sensitised to both birch/hazel and grass pollen undergoing an associated preseasonal Sublingual/Injective immunotherapy Methods36 out of 49 bisensitized candidates were pair-matched into 18 case-referent couples. During two years all patients were administered preseasonal grass-SIT and one patient in each couple received also birch/hazel-SLIT. Diary cards were fulfilled for three consecutive grass pollen seasons. Specific Nasal Provocation Test (NPT) for grass and aspecific bronchial challenge were done; sera were analyzed for specific IgE and IgG ResultsDuring the peak of the grass pollen season both groups showed a significant improvement in total symptom-score. Conjunctivitis and cough improved significantly more in patients with associated therapies. While antihistamine score decreased significantly in both groups, antiasthmatics did only in the SLIT-SIT group. The follow-up documented a significant increase in grass- and birch-specific IgG and a decrease in grass-specific IgE. Grass-NPT threshold was clearly higher in SLIT-SIT-group (p = 0.01) and only in this group PD20 methacholine improved significantly (p < 0.05) ConclusionsCombined birch/hazel-SLIT and grass-SIT are safe and improve clinical outcomes of SIT alone in young bisensitized patients. Priming reduction is supported by specific NPT and bronchial hyperresponsiveness

Nasal immunotherapy is effective in the treatment of rhinitis due to mite allergy. A double-blind, placebo-controlled study with rhinological evaluation.

The aim of this paper is to evaluate the efficacy of intranasal hyposensitizing therapy in perennial rhinitis. 36 patients suffering from perennial allergic rhinitis (Dermatophagoides-sensitive) underwent a double blind placebo-controlled trial for a period of 8 months. The efficacy of nasal immunotherapy was evaluated by collecting symptoms score and evaluating objective rhinological parameters (nasal resistance, cross areas and volumes, mucociliary clearance times, specific nasal provocation threshold). A significant improvement (p&amp;#x003C0,01) of symptom score of active against placebo group was observed after treatment. Also objective nasal parameters (total nasal resistances, mucociliary clearance, C-notch area, and provocative threshold) significantly (p&amp;#x003C0,01) improved after treatment. Adverse local reactions were rare and did not interfere with the protocol. The results underline the efficacy and quickness of local nasal immunotherapy in the treatment of perennial allergic rhinitis documented by the improvement of subjective and objective parameters.

Low‐dose local nasal immunotherapy in children with perennial allergic rhinitis due to Dermatophagoides

Allergen specific immunotherapy was known to be useful in the treatment of respiratory allergic disease. Local nasal immunotherapy (LNIT) offers advantages such as a good efficacy/safety ratio and a more convenient allergen delivery. The aim of this study was to assess the safety and clinical efficacy of a modified scheduling of LNIT in 32 children with allergic rhinitis due to Dermatophagoides. A multicentre, randomized, double-blind placebo controlled study carried out for two years, with a modified schedule of LNIT treatment: a build-up phase at increasing dosages from 2.5 AU to 80 AU and a maintenance period at low dosage (80 AU) once a week. Symptom and medication scores. threshold dose with specific nasal provocation test (NPT) and immunological parameters (IgE and IgG4) were evaluated. No important local or systemic side-effects were observed in children who completed the study. Compared to placebo, the active treatment group showed significant improvement in rhinitis symptoms and a reduction of drug consumption after 18 months of LNIT. These results were confirmed by a significant reduction of allergen specific nasal reactivity. Serum and nasal specific IgE and IgG4 did not show any difference in the two groups. The safety and clinical efficacy of low-dose LNIT suggests that this therapy may be useful in the treatment of allergic rhinitis disease in children.

Effect of specific immunotherapy in eosinophil cationic protein release after specific nasal provocation

Specific immunotherapy (SIT) is effective in the treatment of allergic rhinitis but its mechanisms of action are still not completely understood, particularly in regard to eosinophil activation mechanisms. The purpose of this research was to study if the inhibition of eosinophil activation, demonstrated through the reduction of eosinophil cationic protein [ECP] release, is involved in the therapeutic actions of specific immunotherapy. We analyzed ECP concentrations in nasal lavage fluid of 21 patients with allergic rhinitis, before and after specific nasal provocation. These results were compared to controls, treated without specific immunotherapy. ECP concentrations in nasal lavage fluid were significantly reduced after two years of specific injectable immunotherapy. These reductions were demonstrated both in pre-provocation [basal] values and after specific nasal provocation. Specific immunotherapy can reduce ECP in nasal lavage fluid of in house dust mite allergic rhinitis patients, both before and after allergen nasal challenge, with significant changes in the kinetic of ECP release, a fact which suggests that specific immunotherapy can influence eosinophil activation or its releasability.

Sublingual immunotherapy in tree pollen allergy. Double-blind, placebo-controlled study with a biologically standardised extract of three pollens (alder, birch and hazel) administered by a rush schedule

sublingual immunotherapy has been recognised as safe and effective but it is still poorly documented in tree pollen allergy. Allergy to alder, birch and hazel is important in Northern European countries but its clinical relevance is increasing in Southern Europe. thirty patients, selected and observed for one pollen season, were randomised to receive placebo (15 patients) or active treatment (15 patients). Twenty-seven patients completed the first year and 24 of them were treated with active therapy during the second year of the study in comparison to a parallel group of ten patients treated only with drugs. Symptom and drug scores during each pollen season, birch-specific IgE, changes in skin test reactivity, changes in specific Nasal Provocation Test and the daily average pollen count for the relevant trees were considered for the assessment of the efficacy of the treatment. both active and placebo group showed a statistically significant improvement in scores in comparison to the previous year, under a lower allergenic pressure. The improvement was higher in the active group (76.04 % reduction of drugs) but not significantly different from that registered in the placebo group (37.05 % reduction). In the open phase of the study, treated patients showed significantly better scores in comparison to the control group. No significant changes in skin reactivity, specific IgE and Nasal Provocation Test were registered. SLIT tolerance was very good. our data show a better but not statistically significant clinical outcome for patients actively treated with SLIT, but the placebo effect and the year-by-year variability of the environmental allergenic load in our small-size pilot study do not allow for a conclusive statement about the efficacy of this form of therapy.

The anti‐inflammatory effects of the second‐generation antihistamines

ABSTRACT: Second-generation histamines are widely used and effective drugs for the treatment of urticaria, atopic dermatitis, and in both seasonal and perennial allergic rhinitis. It has been recognized for some years that the newer antihistamines have a number of additional anti-inflammatory effects which appear to be independent of their H1 receptor antagonist effect. These include in vitro inhibitory effects on eosinophil activation, chemotaxis, and on platelet, lymphocyte, or neutrophil activation, while in vivo several researchers have documented protective effects on the changes induced by skin prick test with histamine or allergen, in the specific nasal provocation test, and also limited protection to the specific bronchial provocation test. Other effects are inhibition of the accumulation of proinflammatory cells at allergen-challenged skin sites and downregulation of allergen-induced expression of the adhesion molecule ICAM-1 by epithelial cells. These additional properties may enhance the effects of these drugs in the treatment of allergic disease.