Method and safety of nasal allergen provocational test with house dust mite allergen in children with bronchial asthma and allergic rhinitis

O.V. Trusova, A.V. Kamaev, N.L. Lyashenko, I.V. Makarova

Pavlov University, Saint Petersburg, Russia

ALLERGOLOGY AND IMMUNOLOGY IN PEDIATRICS, Volume 62 • Number 3 • September 2020, pp. 15 – 22
DOI: 10.24411/2500-1175-2020-10008

Relevance. Nasal allergen provocation test (NAPT) is useful for revealing the causative allergen in patients with allergic rhinitis (AR). Currently, NAPT is not sufficiently standardized, there is also doubt about its high safety.
Aim of the study. Safety assessment of NAPT with house dust mite (HDM) allergens in children with AR and AR in combination with bronchial asthma (BA) in daily clinical practice.
Materials and methods. For the analysis, cases of positive NAPT in 128 patients were taken: 69 boys (age 5 to 15 years, average 9.2 ± 1.7) and 59 girls (age 5 to 17 years, average 11.6 ± 2.1) with AR or AR in combination with BA, with positive skin prick tests with HDM. Positive NAPT was recorded according to clinical signs and a decrease in peak inspiratory flow rate through the nose at least 20% from baseline. The protocol of the test included the introduction of a control fluid into one nostril, then dilutions of the allergen 10–4, then 10–3, 10–2, 10–1, and the undiluted allergen. Post-trial follow-up included monitoring of complaints, adverse events, registration of required therapy, and control spirometry.
Results. In 128 cases of positive NAPT with HDM, there were no serious adverse events, systemic reactions, bronchospasm, and cases of treatment requirements higher than the standard. In 1 case, a patient aged 13 years had a voice hoarseness 2 minutes after the introduction of an allergen at a dilution of 10-2. The reaction was stopped with cetirizine within 25 minutes after administration. In all patients, reactions to the allergen were completely resolved within 30 minutes of observation after the test.
Conclusion. NAPT with HDM allergens is safe can be performed on an outpatient basis.
It is safe to conduct NAPT according to a tested graduated method with a clinical and objective instrumental assessment of the reaction to an allergen and the observation of the patient after the test.

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Trusova OV, Kamaev AV, Lyashenko NL, Makarova IV. Method and safety of nasal allergen provocational test with house dust mite allergen in children with bronchial asthma and allergic rhinitis. Allergology and immunology in Pediatrics. 2020;62(3):15-22. (In Russ.) https://doi.org/10.24411/2500-1175-2020-10008

For correspondense

Olga V. Trusova MD, PhD, Associate professor, Department of Therapy with the course on Allergy and Immunology, Pavlov University
ORCID 0000-0002-0854-1536
Address: L’va Tolstogo str. 6-8, Saint Petersburg, Russian Federation
E-mail: o-tru@mail.ru

ALLERGOLOGY and IMMUNOLOGY in PEDIATRICS

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