title: Assessment of allergen-induced respiratory hyperresponsiveness before the prescription of a specific immunotherapy.
abstract: BACKGROUND
  Asymptomatic sensitization is a frequent condition that must be considered before the indication of allergic-specific immunotherapy.
  
  
  OBJECTIVE
  The aim of this study was to appreciate and correlate the local and spirometric changes elicited by the allergen-specific nasal provocation test (NPT) to define practical and feasible guidelines for the allergist/immunologist to demonstrate specific respiratory hyperresponsiveness before the indication of allergic-specific immunotherapy.
  
  
  METHODS
  A total of 172 subjects (children and adults) with a diagnosis of allergic rhinitis were submitted to flow-volume spirometry immediately before and after the NPT performed with Dermatophagoides antigens. The differences between the pre- and postspirometric estimated values of peak expiratory flow rate (PEFdif%), forced expiratory volume in 1 second (FEV1dif%), and forced vital capacity (FVCdif%) were correlated with the results of the nasal provocation test symptom score (NPT-SS).
  
  
  RESULTS
  There were 119 subjects (69%) with NPT-SS > 2. Among these patients who were reactive, the mean NPT-SS was 6.3. The Spearman's correlation between PEFdif% and NPT-SS was r = -0.44 (p = 0.01); the Spearman's correlation between FEV1dif% and NPT-SS was r = -0.22 (p = 0.01), and the Spearman's correlation between FVCdif% and NPT-SS was r = -0.21 (p = 0.04).
  
  
  CONCLUSIONS
  The combined utilization of the allergen-specific NPT-SS with the spirometry (or PEF meter) is a safe methodology to evaluate allergen-specific nasal and bronchial hyperresponsiveness (which sometimes acts as a bronchial provocation test) in patients with allergic rhinitis and asthma due to hypersensitivity who are candidates for allergen-specific immunotherapy.
authors: Instituto Alergoimuno de Americana, São Paulo, Brazil.
authors: Celso Eduardo
authors: CE
authors: Olivier
authors: Daiana Guedes Pinto
authors: DG
authors: Argentão
authors: Regiane Patussi
authors: RP
authors: Dos Santos Lima
authors: Mariana Dias
authors: MD
authors: da Silva
authors: Raquel Acácia Pereira Gonçalves
authors: RA
authors: Dos Santos
authors: Natalia
authors: N
authors: Fabbri