title: Specific nasal provocation test withDermatophagoides pteronyssinus, monitored by acoustic rhinometry, in children with rhinitis.
abstract: BACKGROUND
  Currently, the diagnosis of allergic rhinitis (AR) is arrived at predominantly by a clinical history and by systemic sensitization tests, but specific nasal provocation tests (NPT) may establish a better direct correlation between etiologic surveyed allergens and nasal symptoms.
  
  
  OBJECTIVE
  To standardize the specific NPT with one of the most important house-dust mites, Dermatophagoides pteronyssinus, monitored by acoustic rhinometry, in children and adolescents, and propose a simplified specific NPT to improve its clinical applicability as a diagnostic tool.
  
  
  METHODS
  Sixteen controls (group 1) and 17 patients with an AR diagnosis sensitized to D. pteronyssinus (group 2) underwent a specific NPT with D. pteronyssinus. The acoustic rhinometry was performed after instillation of 0.15 mL of increasing concentrations of D. pteronyssinus (5000 BU/mL). The test was finalized after (1) instillation of the final concentration of D. pteronyssinus, or (2) after a 20% or more reduction in the volume of the first 5 cm of the nasal cavity (V5), or (3) a score of >3 in the symptoms questionnaire (a score from 0 to 7). A simplified specific NPT with two concentrations was proposed and implemented in a group of 10 patients with AR (group 3).
  
  
  RESULTS
  At the end of the specific NPT, the median (range) variation in V5 was -5.7% (-9 to 4%) in the control group and -22.8% (-24 to -20%) in group 2. None of the patients in the control group and 88% of group 2 (15/17) showed positive specific NPT results. The simplified specific NPT triggered a positive response in 80% of patients in group 3, with median (range) V5 variation of -30.4% (-36 to -20%).
  
  
  CONCLUSIONS
  This protocol has been proven safe and useful to differentiate between children and adolescents with AR and controls. Concentrations of 1:1000 and 1:100 D. pteronyssinus were the best for use in simplified specific NPT, which made it simpler and faster, and expanded its clinical applicability.
authors.affiliation: Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Fausto Yoshio
authors.initials: FY
authors.lastname: Matsumoto
authors.forename: Tessa Rachel Tranquillini
authors.initials: TR
authors.lastname: Gonçalves
authors.forename: Dirceu
authors.initials: D
authors.lastname: Solé
authors.forename: Gustavo Falbo
authors.initials: GF
authors.lastname: Wandalsen
mesh_terms: D000293:Adolescent; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000276:immunology; D002648:Child; D040002:Dermatophagoides pteronyssinus / Q000276:immunology; D005260:Female; D006801:Humans; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D009299:Nasal Provocation Tests / Q000379:methods*; D065631:Rhinitis, Allergic / Q000175:diagnosis* / Q000276:immunology; D023842:Rhinometry, Acoustic / Q000379:methods*; D012882:Skin Tests; D011795:Surveys and Questionnaires
chemical_list: D039741:Antigens, Dermatophagoides; D007073:Immunoglobulin E