Nasal allergen provocation tests in inner-city patients with perennial local allergic rhinitis

RATIONALE: Dermatophagoides pteronyssinus is the main sensitizing aeroallergen in European patients with local allergic rhinitis (LAR). LAR-causative allergens in the USA are unknown. We planned to evaluate for LAR in an inner-city population by performing nasal allergen provocation tests (NAPT) to dust mite, mouse and cockroach allergens.

METHODS: Patients with perennial rhinitis, negative skin testing and serum specific IgE to environmental allergens, and with confirmatory otolaryngologic examination underwent NAPT at separate visits. Positive NAPT was defined as ≥25% increase in the Symptom Visual Acuity Scale (VAS) score or 20% decrease in nasal inspiratory peak flow (NIPF) compared to baseline.

RESULTS: Seventeen patients underwent 30 NAPT. The majority were female (82%), of Hispanic or African-American ethnicity (71%), with a mean age of 46 years (±15.5) and no history of asthma or eczema. Overall, 8/17 (47%) patients had at least one positive NAPT. Out of 30 NAPT performed, 10 (33%) were positive: 7/17 (41%) to dust mites, 2/7 (29%) to mouse, 1/5 (20%) to cockroach. The mean increase in VAS score at 15 minutes after positive NAPT was 142% (±192) compared with baseline, while negative challenges had a decrease in VAS score by 35% (±31%, p<0.05). The mean drop in NPIF values at 15 minutes after a positive NAPT was -22.5% ( ±20) compared with baseline, while negative NAPT had a mean increase in NPIF by 7% (±17, p<0.05). Similar trends were found at one hour after the NAPT.

CONCLUSIONS: Dust mites, mouse, and cockroach allergens are responsible for symptoms in U.S. inner-city patients with LAR.