title: The response to nasal allergen provocation with grass pollen is reduced in patients with chronic rhinosinusitis with nasal polyposis and grass sensitization.
abstract: BACKGROUND
  The majority of grass pollen-sensitized rhinitis patients develops allergic symptoms when exposed to the causal allergen and shows a positive nasal allergen provocation test (NAPT). Chronic rhinosinusitis with nasal polyposis (CRSwNP) patients, also characterized by eosinophilic inflammation and local IgE production, can suffer from comorbid inhalant allergy, but may show a different response to allergens.
  
  
  OBJECTIVE
  We aimed to explore the allergic response to grass pollen allergens by NAPT in grass pollen-sensitized CRSwNP patients.
  
  
  METHODS
  Twelve grass pollen-sensitized CRSwNP patients underwent NAPT with grass pollen and were compared with 12 grass pollen allergic rhinitis patients, 12 control patients and 12 CRSwNP patients without grass pollen sensitization. A positive NAPT was based on change in nasal airflow and symptoms. Further, VAS scores of different symptoms were noted before and after NAPT. Biomarkers such as total IgE, grass pollen-specific IgE and tryptase were measured in serum and nasal secretions.
  
  
  RESULTS
  NAPT was positive in 6 of 12 of the grass pollen-sensitized CRSwNP patients, and another four patients developed allergic symptoms not fulfilling the criteria of positivity. In contrast, all patients with allergic rhinitis developed a positive provocation test, whereas in the control group one of the patients and in the non-sensitized CRSwNP group two of the patients developed a positive provocation test.
  
  
  CONCLUSIONS
  These results show that allergen exposure induces an attenuated clinical response in patients with CRSwNP and sensitization to grass pollen as compared with grass pollen allergic rhinitis patients.
authors.affiliation: Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Calus
authors.affiliation: Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Devuyst
authors.affiliation: Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Van Zele
authors.affiliation: Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: De Ruyck
authors.affiliation: Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Derycke
authors.affiliation: Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.|Division of ENT Diseases, Clintec, Karolinska Institutet, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Bachert
authors.affiliation: Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Gevaert
mesh_terms: D000328:Adult; D000485:Allergens / Q000276:immunology; D015415:Biomarkers; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007114:Immunization; D007073:Immunoglobulin E / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications*; D009299:Nasal Provocation Tests; D006109:Poaceae / Q000009:adverse effects*; D011058:Pollen / Q000009:adverse effects*; D012220:Rhinitis / Q000150:complications* / Q000175:diagnosis / Q000276:immunology*; D006255:Rhinitis, Allergic, Seasonal / Q000276:immunology*; D012307:Risk Factors; D012852:Sinusitis / Q000150:complications* / Q000175:diagnosis / Q000276:immunology*; D012882:Skin Tests
chemical_list: D000485:Allergens; D015415:Biomarkers; D007074:Immunoglobulin G; D007073:Immunoglobulin E
keywords: IgE; allergic rhinitis; chronic rhinosinusitis with nasal polyposis; nasal allergen provocation test; nasal polyp