University of Texas Medical School at Houston, Department of Otorhinolaryngology-Head and Neck Surgery, Texas Sinus Institute, Houston, Texas 77030, USA.
Otolaryngol Head Neck Surg. 2013 Mar;148(3):391-5. doi: 10.1177/0194599812474224. Epub 2013 Jan 16.
To evaluate optical rhinometry (ORM) using nasal provocation testing (NPT) as an objective tool to diagnose fungal allergic rhinitis (AR).
Prospective.
Tertiary academic center.
We prospectively enrolled healthy controls (HCs) and subjects with a clinical history of AR and positive skin prick test to Alternaria or Aspergillus antigens. Baseline measurements with an optical and acoustic rhinometer (AcR) were taken, and all subjects underwent NPT with increasing concentrations of Alternaria and then Aspergillus in each nasal cavity. Optical density (OD), nasal mean cross-sectional area (MCA), visual analog scale (VAS), and nasal allergen provocation scale (NAP) were measured after each provocation. A NAP score ≥ 3 was considered positive. Receiver operating characteristic (ROC) curve analysis was performed on measured parameters.
Eleven HCs and 11 AR subjects were enrolled. Of the 8 AR patients with an Alternaria-positive skin test, 50% had a positive NAP score (4/8) vs 0% in HCs (0/11, P = .01). Although VAS could differentiate Alternaria-sensitive patients from controls, change in OD and MCA could not. Of the 7 skin test-positive Aspergillus patients, 43% had a positive NAP score (3/7) vs 0% in HCs (0/11, P = .02). The VAS and change in OD and MCA did not differentiate Aspergillus-sensitive patients from controls.
In this study, fungal antigens caused irritation but did not elicit early phase changes in nasal patency or blood flow in fungal-sensitive AR patients. The poor correlation of skin testing and objective nasal response to fungi argues against a pure IgE-mediated immune response in the nasal cavity.
评估光学鼻测计（ORM）联合鼻激发试验（NPT）作为诊断真菌性变应性鼻炎（AR）的客观工具。
前瞻性研究。
三级学术中心。
我们前瞻性纳入健康对照者（HCs）和有 AR 临床病史且对Alternaria 或 Aspergillus 抗原皮肤点刺试验阳性的患者。采用光学和声学鼻测计（AcR）进行基线测量，所有患者均进行双侧鼻腔递增浓度的 Alternaria 和 Aspergillus 鼻激发试验。在每次激发后测量光学密度（OD）、鼻平均横截面积（MCA）、视觉模拟评分（VAS）和鼻变应原激发评分（NAP）。NAP 评分≥3 为阳性。对测量参数进行接收者操作特征（ROC）曲线分析。
纳入 11 例 HCs 和 11 例 AR 患者。8 例 Alternaria 皮肤试验阳性的 AR 患者中，50%（4/8）的患者 NAP 评分阳性，而 HCs 中无患者阳性（0/11，P=.01）。尽管 VAS 可区分 Alternaria 敏感患者和对照组，但 OD 和 MCA 的变化不能区分。7 例皮肤试验阳性的 Aspergillus 患者中，43%（3/7）的患者 NAP 评分阳性，而 HCs 中无患者阳性（0/11，P=.02）。VAS 和 OD 及 MCA 的变化均不能区分 Aspergillus 敏感患者和对照组。
在这项研究中，真菌抗原引起了鼻腔刺激，但未引起真菌敏感 AR 患者鼻气道通畅性或血流的早期变化。皮肤试验和鼻腔对真菌的客观反应之间相关性差，提示鼻腔内不存在纯 IgE 介导的免疫反应。
