Duman Handan, Bostanci Ilknur, Ozmen Serap, Dogru Mahmut
Department of Pediatric Immunology and Allergy, Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey.
Int Arch Allergy Immunol. 2016;170(2):115-21. doi: 10.1159/000447635. Epub 2016 Jul 30.
It is important to understand that allergic rhinitis, whether seasonal or perennial, may be difficult to distinguish clinically from the nonallergic forms of rhinitis.
This study aimed to investigate the presence of local allergic rhinitis (LAR) in children who have allergic rhinitis symptoms in the absence of skin test positivity and specific IgE by performing a nasal provocation test (NPT).
Our study followed a case-controlled, prospective design. Twenty-eight patients and 30 healthy children were included in the study in a pollen-free season. The NPTs with a grass mix, Dermatophagoides pteronyssinus (DP) and D. farinae (DF) allergens were performed with an interval of 1 week. The total symptom score and visual analog scale, nasal eosinophilia and pulmonary function tests were evaluated before and after each NPT. The change to nasal flow and resistance was recorded by anterior rhinomanometry.
The symptom frequencies before the NPTs were as follows: nasal congestion 100%; itching 82.1%; rhinorrhea 75% and sneezing 71.4%. The NPT was positive in 7 (25%) patients. In the NPT-positive group there was a statistically significant decrease in nasal flow at the concentrations of 10 and 100 IR/ml for DF (p = 0.026, p = 0.031, respectively). In the NPT-positive group total nasal resistance for DP was increased at the concentrations of 0.1 and 10 IR/ml, and for DF at 10 and 100 IR/ml (p = 0.049, p = 0.041, p = 0.022, p = 0.035, respectively).
We emphasize that the diagnosis of LAR should be taken into consideration by pediatricians and pediatric allergy specialists.
必须认识到，无论是季节性还是常年性变应性鼻炎，在临床上都可能难以与非变应性鼻炎形式相区分。
本研究旨在通过进行鼻激发试验（NPT），调查在无皮肤试验阳性和特异性IgE情况下有变应性鼻炎症状的儿童中局部变应性鼻炎（LAR）的存在情况。
我们的研究采用病例对照前瞻性设计。在无花粉季节，28例患者和30名健康儿童纳入研究。分别使用禾本科混合花粉、屋尘螨（DP）和粉尘螨（DF）变应原进行NPT，间隔1周。每次NPT前后评估总症状评分和视觉模拟量表、鼻嗜酸性粒细胞增多和肺功能测试。通过前鼻测压记录鼻气流和阻力的变化。
NPT前症状出现频率如下：鼻塞100%；瘙痒82.1%；流涕75%；打喷嚏71.4%。7例（25%）患者NPT呈阳性。在NPT阳性组中，DF浓度为10和100 IR/ml时鼻气流有统计学显著下降（分别为p = 0.026，p = 0.031）。在NPT阳性组中，DP浓度为0.1和10 IR/ml时总鼻阻力增加，DF浓度为10和100 IR/ml时总鼻阻力增加（分别为p = 0.049，p = 0.041，p = 0.022，p = 0.035）。
我们强调儿科医生和儿科过敏专科医生应考虑LAR的诊断。
