Nasal provocation test (NPT) is a procedure used to evaluate the hyper-responsiveness of nasal mucosa after exposure to a provocative allergen. We aimed to identify the clinical indication and contra-indication for the use of NPT, and to introduce the actual NPT laboratory protocol in our clinical practice. We also provide clinical information which could be useful in conducting NPT. Finally, we discuss the current limitations of NPT and present a plan to overcome these difficulties.
Nasal Mucosa ; Nasal Provocation Tests* ; Rhinometry, Acoustic

BACKGROUND AND OBJECTIVES: We aimed to evaluate the effects of septal deviation on patient symptoms and acoustic rhinometry measurements in patients with allergic rhinitis and to determine which side of the septum is the better choice. MATERIALS AND METHODS: The bilateral nasal provocation test with acoustic rhinometry was performed on patients with septal deviation and allergic rhinitis (Group A, n=25) and in patients with allergic rhinitis alone (Group B, n=26). Fifteen to 60 minutes after provocation, the change in symptoms as measured by the visual analogue scale, the change in total nasal volume (TNV) and minimal cross-sectional area (MCA) were compared between the concave and convex septal sides. The degrees of change in TNV and MCA were also compared between the groups. RESULTS: Group A had higher basal values and more changes in nasal obstruction than did Group B. Changes in TNV and MCA were most prominent after 30 minutes on both sides, without significant differences. By summing the sides together, we were able to obtain more stable results without paradoxical increase. CONCLUSION: Septal deviation itself has little effect on the result of nasal provocation in patients with allergic rhinitis. By summing the parameters of acoustic rhinometry from both nasal cavities, clinicians can achieve more stable results.
Acoustics ; Humans ; Nasal Cavity ; Nasal Obstruction ; Nasal Provocation Tests ; Rhinitis ; Rhinitis, Allergic, Perennial ; Rhinometry, Acoustic

BACKGROUND AND OBJECTIVES: There are evidences that allergic rhinitis and asthma represent a continuity of disease. It is known that bronchial hyperreactivity is a most contributing factor for asthma, yet it remains controversial whether there is a direct cause-and-effect relationship between the upper and lower airway. This study was performed to evaluate a direct cause-and-effect relationship between the two diseases by using early allergic responses and to define the clinical factors for predicting bronchial hyperreactivity in allergic rhinitis patients. SUBJECTS AND METHOD: Seventy three patients with allergic rhinitis and 36 patients without allergic rhinitis were included in this study, where exclusion criteria were diagnosed asthma, chronic obstructive pulmonary diseases, nasal polyp and chronic paranasal sinusitis. Nasal provocation tests with allergen were applied to 29 allergic rhinitis patients. After 30 minutes, we investigated lower airway using symptom scores, bronchial provocation test with methacholine and pulmonary function test. Bronchial provocation test with methacholine was applied to 44 allergic rhinitis patients and 36 non-allergic rhinitis patient. We checked nasal symptom scores and the change of nasal volume by VAS and acoustic rhinometry, respectively. We also investigated the incidence and the predictive factors of bronchial hyperreactivity in allergic rhinitis patients. RESULTS: The early allergic response provocated at nasal cavity had little effect on bronchus. Bronchial stimuli with methacholine did not affect nasal cavity. The incidence of bronchial hyperreactivity is significantly higher in allergic rhinitis patients than in non-allergic rhinitis patients. Type of allergic rhinitis (especially persistent, moderate-severe group) and the disease-durations are valuable predictive factors of the bronchial hyperreactivity. CONCLUSION: Although early allergic response has little effect on the nasobronchial relationship, there may be a significant correlation between allergic rhinitis and bronchial hyperreactivity. The correlation is more significant in the persistent, moderate-severe group of allergic rhinitis with long disease duration.
Asthma ; Bronchi ; Bronchial Hyperreactivity* ; Bronchial Provocation Tests ; Humans ; Incidence ; Lung Diseases, Obstructive ; Methacholine Chloride ; Nasal Cavity ; Nasal Polyps ; Nasal Provocation Tests ; Respiratory Function Tests ; Rhinitis* ; Rhinometry, Acoustic ; Sinusitis

BACKGROUND AND OBJECTIVES: Correct diagnosis for allergic rhinitis is important for optimal management. A thorough history should be taken, followed by general and endoscopic examinations and confirmatory investigations. The role of diagnostic tests in the evaluation of patients with allergic rhinitis continues to evolve. This clinical study was performed to identify the relationship between clinical history and diagnostic tests. MATERIALS AND METHODS: Questionnaire surveys for clinical history, skin test, RAST, and nasal provocation test (acoustic rhinometry and symptom score) to the house dust mites (Dermatophagoides pteronyssinus) were performed in 100 patients from July, 1996 to August, 1998 at Inha University Hospital. The relationship between clinical history (change of syagoides pteronyssinus antigen (Allergopharma, Reinbeck, USA) was sprayed and 15 with PC-SAS. (ver 6.120) RESULTS: There was no correlation between clinical history and the diagnostic tests. However there was a correlation between the results of either skin or RAST testing and those of nasal provocation test. CONCLUSIONS: More careful and complete history taking is needed for diagnosis of allergic rhinitis. The combined use of RAST, skin testing and nasal provocation test yields more information.
Diagnosis ; Diagnostic Tests, Routine ; Humans ; Nasal Provocation Tests* ; Pyroglyphidae ; Rhinitis* ; Skin Tests* ; Skin* ; Surveys and Questionnaires

BACKGROUND & OBJECTIVES: Allergic diseases are considered to be systemic diseases. Atopic diseases are the first manifestation among allergic diseases, with the suggested relation to allergic rhinitis and asthma, as reported in several studies. The objective of this study was to evaluate the responses to allergic tests in children who have atopic dermatitis or have allergic rhinitis and atopic dermatitis. Materials & Methods : Eighty subjects without atopic dermatitis (control group) and 80 patients with atopic dermatitis (atopy group) were subjected to study from Nov. 1997 to Nov. 1999. The atopic group included pediatric patients who were diagnosed as having atopic dermatitis, but excluded patients who received medical treatment of steroid or antihistamine before the test for 1 month. In all the control and atopic groups, the nasal cavity volume was first estimated by acoustic rhinometry, followed by the allergic skin test (AST) and MAST. A nasal provocation test was taken with a positive allergen for patients who showed positive response to AST and MAST; for patients who showed negative response to AST and MAST, the test was taken with the House dust mites. RESULTS: In the atopic dermatitis group, the rate of positive responses to AST and MAST were 65% and 72.5%, respectively; in the control group, the rates were 25% and 35%, respectively. The most common positive allergen was the House dust mite in AST and MAST. In the nasal provocation test, the more positive rate was observed in the atopic group. CONCLUSION: The atopic group showed more positive response than the control group to AST, MAST and the nasal provocation test. Also, the nasal mucosa of 37.5% of the atopic dermatitis patients were sensitized to a certain allergen.
Asthma ; Child* ; Dermatitis, Atopic* ; Humans ; Nasal Cavity ; Nasal Mucosa ; Nasal Provocation Tests* ; Pyroglyphidae ; Rhinitis ; Rhinometry, Acoustic ; Skin Tests* ; Skin*

The allergen nasal provocation testing（NPT）, in which allergens are applied directly to the nasal mucosa under standard and controlled conditions to provoke the main symptoms of allergic rhinitis（AR）, reproduces the response of the upper respiratory tract to natural exposure to allergens under controlled conditions and is the only test currently available to confirm nasal reactivity to allergens. It is invaluable in studying the mechanisms of AR and in assessing the response to novel anti-allergic treatments. The test may play an increasingly important role in clinical practice, especially in the identification of local AR, the diagnosis of occupational AR, the clarification of the composition of allergens, the assessment of the efficacy of AR treatment and the selection of candidates undergoing allergen immunotherapy. This article reviewed the application of NPT in the diagnosis of allergic and non-allergic rhinitis, and also introduces the indications, contraindications, advantages and limitations of NPT in evaluating nasal response.
Humans ; Allergens ; Rhinitis/diagnosis* ; Nasal Provocation Tests ; Rhinitis, Allergic/diagnosis* ; Nasal Mucosa

A nasal provocation test is the most reliable diagnostic test to confirm allergen in allergic rhinitis. However, there are neither specific objective methods nor a standardized method and interpretation. In 20 normal subjects and 86 allergic rhinitis patients, we applied acoustic rhinometry as a new objective method to assess changes in nasal patency induced by nasal allergen challenge, a procedure which is used for confirming allergic rhinitis. The result shows that a minimal cross-sectional area (MCA) and volume from the nose tip on back to 7 cm (nasal cavity volume) after allergen challenge were significantly decreased in allergic rhinitis patients in comparison with the control subjects. We conclude that acoustic rhinometry can provide a sensitive index for evaluating the results of a nasal provocation test.
Acoustics* ; Diagnostic Tests, Routine ; Humans ; Nasal Provocation Tests* ; Nose ; Rhinitis ; Rhinometry, Acoustic*

OBJECTIVE: Allergic rhinitis is one of the most common diseases in the field of otorhinolaryngology. Correct diagnosis for allergic rhinitis is important for its optimal management. Many studies have been reported for the diagnosis with allergens. This study was performed to identify the relationship between MAST, the skin test, and the nasal provocation test. We attempted to find an appropriate diagnostic method for finding causative allergens. METHOD: We reviewed the medical records of patients with allergic rhinitis symptoms and physical findings from August 2001 through July 2002 at Inha University Hospital. We selected 197 patients who were examined with MAST, the skin prick test, and the nasal provocation test. The relationship between these tests was determined with SPSS (Ver10.0). RESULTS: There was a significant correlation between MAST and the skin prick test(P<.05). There were also significant correlations between MAST and the nasal provocation test, and between the skin prick test and the nasal provocation test(P<.05). CONCLUSION: MAST might be a useful diagnostic method for finding causative allergens, especially in children and patients with skin hypersensitivity and other skin disorders.
Allergens ; Child ; Diagnosis ; Humans ; Hypersensitivity ; Medical Records ; Nasal Provocation Tests* ; Otolaryngology ; Rhinitis* ; Skin Tests ; Skin*

Local allergic rhinitis (LAR) is a localized nasal allergic response in the absence of systemic atopy. The aim of this study was to evaluate the prevalence and clinical characteristics of LAR in Korean rhinitis patients compared to allergic rhinitis (AR) and non-allergic rhinitis (NAR). A total of 304 rhinitis patients were enrolled from November 2014 to March 2016. A skin prick test, serum total and specific immunoglobulin E, and a nasal provocation test (NPT) with house dust mite (HDM) were performed on all patients. Subjects also documented changes in rhinitis symptoms before and after NPT. Seventy-four patients with nasal hyper-reactivity and 80 patients with subclinical allergy were excluded. AR was diagnosed in 69 (46.0%) patients, NAR in 75 (50.0%) patients, and LAR to HDM in 6 (4.0%) patients. The average medication score and disease duration of each group were 14.5 points and 77.6 months in AR, 12.1 point and 51.1 months in NAR, and 17.7 point and 106.0 months in LAR, respectively. There were no significant differences in the baseline nasal symptom score of the three groups. However, after NPT with HDM, the score of rhinitis, itching, and obstructive were 4.83±1.47 vs. 1.95±2.53, 3.00±2.10 vs. 1.45±2.06, and 5.50±1.38 vs. 2.57±2.84 in LAR and NAR, respectively (p<0.05). LAR patients had longer duration of disease and tended to be older and have higher medication score than other rhinitis patients.
Dust* ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Nasal Provocation Tests ; Prevalence* ; Pruritus ; Pyroglyphidae* ; Rhinitis ; Rhinitis, Allergic* ; Skin

BACKGROUND AND OBJECTIVES: Nasal airflow is asymmetrical and is subjected to spontaneous reciprocal changes which are referred to as the nasal cycle. Limited information is available about how they are affected by allergens. The purpose of this study was to evaluate effects of allergen provocation on the nasal cycle. SUBJECTS AND METHOD: This study was performed in 11 patients with allergic rhinitis and 6 healthy controls. Acoustic rhinometry was used to test subjects before and after the allergen provocation. The subjects underwent acoustic rhinometry in 15 minutes interval for evaluation of nasal cycle and 3 minutes interval for immediate response. RESULTS: With the allergic subjects, 10 of the 11 subjects (90.9%) showed nasal cycle and they still had nasal cycle after the allergen provocation. In the study on the changes of the immediate responses, recovery time was on the average of 33.0 minutes and reduction rate of non-patent side was higher than that of patient side. And the period of nasal cycle was on the average of 173 minutes before the allergen provocation and the average 159 minutes after the allergen provocation; there were no statistical differences. The amplitude of each nasal cycle increased after allergen provocation and the difference had statistical meaning. CONCLUSION: Overall duration and reciprocity of nasal cycle were not changed after the allergen provocation and the amplitude of nasal cycle was increased significantly after the allergen provocation.
Allergens ; Humans ; Nasal Provocation Tests ; Rhinitis ; Rhinitis, Allergic, Perennial ; Rhinometry, Acoustic