Pirilä T, Nuutinen J
Department of Otorhinolaryngology, University Hospital of Oulu, Finland.
Clin Exp Allergy. 1998 Apr;28(4):468-77. doi: 10.1046/j.1365-2222.1998.00247.x.
The reliable interpretation of the nasal provocation test in allergy diagnosis requires objective and measurable monitoring parameters for clinical practice. The clinical usefulness of the nasal provocation test has been limited by scanty knowledge of the specificity and sensitivity of the test and a lack of reference values.
To test and compare three objective monitoring parameters of a nasal provocation test in occupational allergic rhinitis. To evaluate the magnitude of the nasonasal effects in a unilateral allergen challenge.
The monitoring parameters of the nasal reaction were derived from the minimum cross-sectional area on acoustic rhinometry, the nasal resistance on active anterior rhinomanometry and the amount of nasal secretion measured at 15 min intervals for 60 min. Twenty-three bovine-allergic dairy and beef cattle farmers and 19 exposed, non-allergic control subjects were challenged first with a control solution and then with the cow allergen.
All the three monitoring parameters showed high specificity and sensitivity in finding allergic and non-allergic subjects. The secretion parameter was found to be slightly superior to the acoustic rhinometry and rhinomanometry parameters. The side difference in the nasal response between the allergen-challenged and the contralateral diluent-challenged cavity was significant for all the parameters among the allergic subjects. The contralateral secretion amount was 1/3 of the ipsilateral secretion, indicating the magnitude of the contralateral nasonasal reflex. A nasonasal reflex was also noted in the nasal patency monitoring. The coefficient of variation was significantly lower for the acoustic rhinometry than for the rhinomanometry (P=0.0001). The optimal threshold values for a positive test were a secretion amount of 100 mg, a 15% decrease in the minimum cross-sectional area and a 50% increase in the resistance for the observation period of 30 min and correspondingly 210 mg, 30% and 100% for 60 min.
The low-pressure aspiration of the nasal secretion from the anterior part of the nasal cavity was found to be a reliable and practical monitoring parameter to be used together with acoustic rhinometry or rhinomanometry in the nasal provocation test for clinical purposes. Although significant nasonasal effects took place in the unilateral allergen challenge, the response was more prominent in the allergen-challenged than in the contralateral diluent-challenged nasal cavity in most allergic subjects.
在过敏诊断中，鼻激发试验的可靠解读需要临床实践中客观且可测量的监测参数。鼻激发试验的临床实用性受到对该试验特异性和敏感性的了解不足以及缺乏参考值的限制。
检测并比较职业性变应性鼻炎鼻激发试验的三个客观监测参数。评估单侧变应原激发时鼻鼻效应的程度。
鼻反应的监测参数来自声反射鼻测量法的最小横截面积、主动前鼻测压法的鼻阻力以及每隔15分钟测量一次共测量60分钟的鼻分泌物量。23名对牛过敏的奶牛和肉牛养殖户以及19名暴露但无过敏反应的对照受试者先接受对照溶液激发，然后接受牛变应原激发。
所有这三个监测参数在鉴别变应性和非变应性受试者方面均显示出高特异性和高敏感性。发现分泌物参数略优于声反射鼻测量法和鼻测压法参数。在变应性受试者中，变应原激发侧与对侧稀释液激发侧鼻腔的鼻反应差异在所有参数中均具有显著性。对侧分泌物量为同侧分泌物量的1/3，表明对侧鼻鼻反射的程度。在鼻通畅性监测中也观察到鼻鼻反射。声反射鼻测量法的变异系数显著低于鼻测压法（P = 0.0001）。阳性试验的最佳阈值为：在30分钟观察期内，分泌物量为100毫克、最小横截面积减少15%、阻力增加50%；在60分钟时相应为210毫克、30%和100%。
发现从鼻腔前部低压力抽吸鼻分泌物是一种可靠且实用的监测参数，可在临床目的的鼻激发试验中与声反射鼻测量法或鼻测压法一起使用。虽然在单侧变应原激发中发生了显著的鼻鼻效应，但在大多数变应性受试者中，变应原激发侧的反应比对侧稀释液激发侧鼻腔的反应更明显。
