Nasal allergen provocation tests in inner-city patients with perennial local allergic rhinitis
Monday, March 5, 2018
South Hall A2 (Convention Center)
Denisa E. Ferastraoaru, MD, Nadeem Akbar, MD, Waleed M. Abuzeid, MD, Elina Jerschow, MD FAAAAI, David L. Rosenstreich, MD FAAAAI
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.