Specific Nasal Provocation Research Articles

Monitoring methods of nasal pathology

The importance of correct clinical and therapeutic monitoring of allergic rhinitis is understandable in the light of the social and economic impact of this pathology: its prevalence is over 10% of the total population all over the world. For the evaluation of the local nasal pathology we include: (1) anterior rhinoscopy, (2) active anterior rhinomanometry, (3) positioned acoustic rhinometry, (4) determination of mucociliary transport time, (5) specific nasal provocation test. Active anterior rhinomanometry allows reliable assessment of the nasal respiratory function, acoustic rhinometry shows the geometry of nasal cavity, mucociliary transport time is an indicator of the mucosa eutrophism. In our experience, the specific nasal provocation test is one of the most important tests in this field. It is more sensitive than the skin test and the radioallergosorbent test (RAST) in the asymptomatic phase and it is able to show organ allergies. In this study we review the importance of this test and the methodology we commonly use.

Occupational allergy caused by carnation ( Dianthus caryophyllus)

Background: Occupational respiratory symptoms caused by decorative flowers are seldom reported in the literature. In our area a large portion of the population works in carnation (Dianthus caryophyllus) winter quarters, and many workers have symptoms of rhinitis and asthma related to exposition. Objective: The purposes of this study were to investigate whether the symptoms induced by carnation were IgE-mediated and to study the possible allergens involved. Methods: A total of 16 subjects employed in indoor carnation cultivation with symptoms during exposition time were studied along with 15 patients with allergic asthma who were not exposed to carnations and 15 healthy carnation workers used as control subjects. Skin prick tests with carnation extract and RASTs were performed. Protein bands were isolated by SDS-PAGE, and afterwards immunoblotting was performed to characterize the extract. Specific nasal provocation and nonspecific bronchial provocation tests were performed for all the asthmatic patients. Diurnal variation in peak expiratory flow was also measured. Results: Skin prick test responses with carnation extract were positive in 15 of the 16 patients and negative in all control subjects. Nasal provocation test responses with carnation extract were positive in 13 of 16 patients. A significant correlation was seen between RAST and nasal provocation results ( P < .01). Immunoblotting of sera from 13 patients showed 2 major IgE-binding fractions of 34 and 35 kd in most of the patients, which could constitute the major allergen. Methacholine PD 20 showed a variable degree of nonspecific bronchial hyperresponsiveness in all asthmatic subjects. Conclusion: Data demonstrate the involvement of carnation in occupational allergy, mediated by an IgE-dependent mechanism. (J Allergy Clin Immunol 1999;104:181-5.)

Long‐term follow‐up of nasal immunotherapy to Parietaria: clinical and local immunological effects

Local nasal immunotherapy (LNIT) with extracts in powder has been demonstrated clinically effective and devoid of side-effects in several controlled trials; nevertheless, no data concerning the long-term effects of LNIT are presently available. In a recent double-blind, placebo-controlled study of LNIT to Parietaria pollen we observed, by means of specific nasal provocation test (SNPT) that LNIT is able to modify the local allergic inflammatory response. In the present study we followed up the same patients in open fashion for 2 further years. The results confirmed the clinical efficacy of LNIT and showed that it is strictly dependent on pre-seasonal administration: in fact, after LNIT discontinuation a clinical relapse was observed. A certain long-lasting protective effect on SNPT parameters (nasal symptoms and neutrophils infiltration) was also observed, whereas an increase of eosinophils count and ICAM-1 expression on nasal epithelial cells appeared as possible markers of clinical relapse. The present study suggests that pre-seasonal LNIT can be taken in consideration in selected subjects as prophylactic treatment for pollen-induced rhinitis. In addition, the results obtained provide informations about the duration of clinical efficacy and add data about the local allergic inflammation and its modulation.

The perennial pattern of clinical symptoms in children monosensitized to Olea europaea pollen allergens in comparison with subjects with Parietaria and Gramineae pollinosis.

Because the pediatric age represents a good model to study the correlation between the exposure to allergens and development of respiratory allergy, we investigated the occurrence of a perennial type of symptomatology in children monosensitized to Olea europaea (O.e.) pollen allergens compared with subjects with monosensitization to Parietaria (P) and Gramineae (G) in order to confirm our previous observations in adults. We selected a group of 52 children with rhinitis and/or bronchial asthma and a SPT positivity only to pollens (30 to P, 15 to G, and 7 to O.e.). Using commercially available allergenic extracts and reagents, the following diagnostic procedures were performed: skin prick test (SPT), specific IgE assays (RAST), nonspecific bronchial provocation test (NsBPT) and specific nasal provocation test (sNPT), respectively, in patients with bronchial asthma and rhinitis. Pollen counts and a statistical analysis using Spearman's correlation test were also carried out. Six of seven children with monosensitization to O.e. allergens showed a perennial pattern of symptoms in comparison to 7 of 23 and 3 of 12, respectively, in subjects with P and G pollinosis. All patients with perennial nasal symptoms of O.e. group exhibited a late nasal response after sNPT. Although these findings on nasal response may partially explain the occurrence of a prolonged inflammation of the nose induced by O.e. allergens, we think that other possibilities could be investigated. In our opinion, further studies are necessary using better purified and standardized diagnostic materials and, moreover, a greater number of O.e. monosensitized children living in other geographical areas need to be examined for a comparison of our results with theirs.

Monitoring methods for local nasal immunotherapy.

When a patient is affected by specific vasomotor rhinopathy (allergic rhinitis), both perennial and seasonal, all the nasal functions are altered to various degrees. For this reason, in the evaluation of the efficacy of an antiallergic therapy we include: 1) anterior rhinoscopy; 2) active anterior rhinomanometry; 3) positioned acoustic rhinometry; 4) determination of mucociliary transport time; and 5) specific nasal provocation test. Active anterior rhinomanometry performed according to the directions of the International Committee on Standardization allows reliable assessment of the nasal respiratory function. Acoustic rhinometry is an objective method to assess the geometry of nasal cavities but, as a new method, needs more standardization with particular care in connecting the nose-piece to the nostril. Both these tests performed before and after local administration of nasal decongestants allow quantification of the congestion degree of the nasal mucosa. Determination of mucociliary transport time, according to the method of coloured tracer, is easy to perform and may be considered a reliable indicator of the mucosa eutrophism. In our clinical experience we have often found mucociliary transport times delayed or even blocked, especially in patients affected by perennial allergic rhinitis. According to our experience the specific nasal provocation test is one of the most important tests in this field: it is more sensitive than skin tests and RAST in the asymptomatic phase and it is able to show organ allergies. In this paper we review the importance of this test, the methodology we currently use as well as changes after local nasal immunotherapy.

Minor pollinosis fromCryptomeria japonica in Varese, northern Italy. Aerobiological monitoring and main clinical features

In the last 2 years, we have conducted an aerobiological monitoring program ofCryptomeria japonica, a plant belonging to the family of Taxodiaceae that sometimes causes pollinosis in the period from February to April. Throughout 1994, we checked the incidence of its sensitization and the clinical effects in 85 subjects with correlated seasonal symptoms, who gave a positive skin prick test (SPT) for Betulaceae and/or Corylaceae. Twenty-five patients (29.4%; 19 M; 6 F; mean age, 38.8 years) all with oculorhinitis, were SPT positive to an allergenic extract ofCryptomeria. RAST confirmed this positivity in 44% of the cases. No patients showed monosensitization forCryptomeria to either SPT or RAST. Two subjects gave a positive result on specific nasal provocation. RAST inhibition showed no cross-reaction betweenCryptomeria and birch pollen. During the pollen season each patient made a list, scoring symptoms and specifying any drugs used, so we could correlate these elements with aerobiological observations. The pollen concentration probably exceeded the allergizing threshold forCryptomeria on 8 days during 3 months of recording. The intensity and duration of symptoms seemed to be mainly influenced by sensitization to Betulaceae and Corylaceae. It is thus possible that a combination of ‘minor’ pollinosis may produce seasonal symptoms in allergic patients.

特異抗原と非特異的刺激に対する鼻粘膜反応の相違について

To examine the difference between response of nasal mucosa to specific antigen and that to non-specific stimulus in the same patient, specific nasal provocation was performed using the house dust antigen disk while nasal respiratory resistance was continuously measured by Rhinograph. On the other hand, non-specific nasal provocation was performed with inhalation of methacholine while nasal respiratory resistance was continuously measured with Astograph. Thereafter the resulting response curves were analyzed. Subjects were 12 males and 9 females, who had nasal obstruction, watery rhinorrhoea and sneeze, and were proved to have allergic rhinitis by house dust. To analyze specific response curve, primary nasal respiratory resistance (Rrs.N), reacting time (Ta) and slope signifying increase of nasal respiratory resistance (delta Rrs.N) were used as parameters. To analyze non-specific response curve, primary nasal respiratory resistance (Rrs.N.cont), minimum dose of methacholine that caused an increase of nasal respiratory resistance (Dmin.N) and slope signifying increase of nasal respiratory resistance (Sd.N) were used as parameters. Ta and Dmin.N reflect sensitivity of nasal mucosa. Their values become smaller, it means sensitivity of nasal mucosa becomes higher. Delta Rrs.N and Sd.N reflect reactivity of nasal mucosa. Their values become larger, it means reactivity of nasal mucosa becomes larger.(ABSTRACT TRUNCATED AT 250 WORDS)

Salsola kali: a new etiology of pollinosis in the mediterranean area of apulia — italy

Abstract Pollen grains of Gramineae, Urticaceae, Compositae, Oleaceae and Cupressaceae represent the etiologic factors of the most common allergic diseases in Apulia. This study describes the relative frequency of allergic sensitization to pollen from Salsola kali (Chenopodiaceae), based on results obtained with skinprick tests, specific serum IgEs evaluation and nasal provocation tests. 23 out of 240 patients suffering of pollinosis resulted positive. It is suggested that these allergens should be taken in consideration during patients investigation in the Mediterranean area.