Department of Pulmonary Disease, Istanbul University, Istanbul-Turkey.
Asian Pac J Allergy Immunol. 2010 Jun-Sep;28(2-3):115-21.
Although specific nasal provocation is an objective diagnostic test for allergic rhinitis, it can also increase the lower airway responsiveness in asthmatic patients. Our goal was to determine the value and safety of specific nasal provocation test for the diagnosis of allergic rhinitis in mild persistent asthmatic patients under low-dose inhaled steroid therapy. The study was performed on 32 mild persistent, stable, mite-sensitive allergic asthmatics (group 1), 9 mild persistent nonallergic asthmatics (group 2) and 9 healthy non-smokers (group 3). Nasal symptoms were noted, paranasal sinus computerized tomography (PNCT) and rhinoscopic evaluations were performed. Cases with pathologic-anatomic changes in PNCT and rhinoscopy were excluded. Symptom scoring, flow-volume, peak expiratory flow (PEF), serum and nasal lavage eosinophil cationic protein (ECP) and nasal lavage eosinophil counts were performed before mite specific nasal provocation test and at the 0th, 4th and 24th hours following the test. No adverse effects were observed in all diagnostic procedures. Total diagnostic value of nasal symptoms were found to be at 92%, while being 70% for rhinoscopy and 88% for specific nasal provocation test respectively in the diagnosis of allergic rhinitis in group 1. Statistically significant differences were found between basal nasal lavage eosinophil values (p < 0.001) and ECP levels (p < 0.05) when group 1 was compared with both group 2 and group 3. In the remaining measured values between three groups, no statistically significant differences were found. Specific nasal provocation test is a safe method for mild house dust mite allergic asthma cases under low-dose inhaled steroid therapy, but history of rhinitis might be sufficient for the diagnosis of allergic rhinitis.
虽然特定的鼻激发是过敏性鼻炎的客观诊断测试，但它也会增加哮喘患者的下呼吸道反应性。我们的目标是确定特定的鼻激发测试对低剂量吸入性类固醇治疗下轻度持续性哮喘患者过敏性鼻炎的诊断价值和安全性。该研究在 32 名轻度持续性、稳定、尘螨敏感的过敏性哮喘患者（第 1 组）、9 名轻度持续性非过敏性哮喘患者（第 2 组）和 9 名健康非吸烟者（第 3 组）中进行。记录了鼻症状，进行了副鼻窦计算机断层扫描（PNCT）和鼻内镜评估。排除了 PNCT 和鼻内镜检查有病理-解剖学改变的病例。在进行尘螨特异性鼻激发试验前以及试验后第 0、4 和 24 小时进行症状评分、流量-容积、呼气峰流速（PEF）、血清和鼻灌洗嗜酸性阳离子蛋白（ECP）以及鼻灌洗嗜酸性粒细胞计数。所有诊断程序均未观察到不良反应。鼻症状的总诊断价值为 92%，而在第 1 组中，鼻内镜检查为 70%，特异性鼻激发试验为 88%。第 1 组与第 2 组和第 3 组相比，基础鼻灌洗嗜酸性粒细胞值（p < 0.001）和 ECP 水平（p < 0.05）存在统计学差异。在三组之间的其余测量值中，未发现统计学差异。特定的鼻激发试验是轻度屋尘螨过敏哮喘患者在低剂量吸入性类固醇治疗下的安全方法，但鼻炎病史可能足以诊断过敏性鼻炎。
