Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, Republic of Korea.
Otolaryngol Head Neck Surg. 2014 Feb;150(2):194-200. doi: 10.1177/0194599813514512. Epub 2013 Dec 9.
Disagreement between results of skin prick test (SPT) and nasal provocation tests (NPT) causes difficulty in differential diagnosis of allergic rhinitis (AR) and nonallergic rhinitis (NAR). We hypothesized this discrepancy could be due to the nonspecific hyper-reactivity (NHR) and localized allergy of the nasal cavity.
Prospective pilot.
Academic tertiary rhinologic practice.
Sixty patients with AR and 62 with NAR were enrolled. We categorized patients according to results of SPT and NPT. We compared: (1) the clinical characteristics and severity of the disease, (2) change of minimal cross-sectional area (MCA) and total nasal volume (TNV) after normal saline (NS) challenge, and (3) change of nasal symptoms and acoustic parameters after intranasal house dust mite (HDM) challenge between groups.
Patients in groups A (SPT[+]/NPT[+]) and C (SPT[-]/NPT[+]) complained of more persistent discomfort than those in groups B (SPT[+]/NPT[-]) and D (SPT[-]/NPT[-]). The proportion of moderate to severe symptoms was significantly higher in groups A, B, and C compared to group D. After NS challenge, MCA/TNV showed a significantly greater decrease in groups A (MCA: 27.6% ± 21.3%, TNV: 24.6% ± 16.4%) and C (MCA: 31.2% ± 24.0%, TNV: 24.1% ± 23.4%) compared to groups B (MCA: 0.1% ± 13.2%, TNV: 3.9% ± 13.5%) and D (MCA: 2.1% ± 12.1%, TNV: 2.0% ± 17.2%) (P < .05). After HDM challenge, groups A/B showed a greater decrease in MCA (Group A: 62.4% ± 16.1%, Group B: 6.4% ± 11.3%) compared to groups C/D (Group C: 45.5% ± 14.4%, Group D: -3.0% ± 9.5%).
NHR and/or localized allergy should be considered in patients with rhinitis whose SPT and NPT results are not in agreement.
皮肤点刺试验（SPT）和鼻激发试验（NPT）结果不一致导致变应性鼻炎（AR）和非变应性鼻炎（NAR）的鉴别诊断困难。我们假设这种差异可能是由于鼻腔的非特异性高反应性（NHR）和局部过敏。
前瞻性试点研究。
学术三级鼻科实践。
纳入 60 例 AR 患者和 62 例 NAR 患者。我们根据 SPT 和 NPT 的结果对患者进行分类。我们比较了：（1）疾病的临床特征和严重程度，（2）生理盐水（NS）激发后最小横截面积（MCA）和总鼻容积（TNV）的变化，以及（3）鼻内屋尘螨（HDM）激发后鼻部症状和声学参数的变化。
SPT[+]/NPT[+]组（A 组）和 SPT[-]/NPT[+]组（C 组）患者比 SPT[+]/NPT[-]组（B 组）和 SPT[-]/NPT[-]组（D 组）患者报告的持续性不适更严重。与 D 组相比，A、B 和 C 组中中重度症状的比例明显更高。NS 激发后，A 组（MCA：27.6%±21.3%，TNV：24.6%±16.4%）和 C 组（MCA：31.2%±24.0%，TNV：24.1%±23.4%）MCA/TNV 显著下降，而 B 组（MCA：0.1%±13.2%，TNV：3.9%±13.5%）和 D 组（MCA：2.1%±12.1%，TNV：2.0%±17.2%）（P<0.05）。在 HDM 激发后，A/B 组 MCA 下降幅度更大（A 组：62.4%±16.1%，B 组：6.4%±11.3%），而 C/D 组 MCA 下降幅度较小（C 组：45.5%±14.4%，D 组：-3.0%±9.5%）。
对于 SPT 和 NPT 结果不一致的鼻炎患者，应考虑存在非特异性高反应性和/或局部过敏。
