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Allergy. 2018 Aug;73(8):1597-1608. doi: 10.1111/all.13416. Epub 2018 Mar 27.

EAACI Position paper on the standardization of nasal allergen challenges.

Author information

1
Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne Medical Center, Cologne, Germany.
2
Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany.
3
Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
4
Transylvania University Brasov, Faculty of Medicine, Department of Allergy and Clinical Immunology, Brasov, Romania.
5
Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.
6
Allergy Unit, IBIMA-Regional University Hospital of Málaga, ARADyAL, Málaga, Spain.
7
Department of Otolaryngology, Center of Allergy and Environment (ZAUM), Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
8
ENT Department, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
9
Allergy and Clinical Immunology, Imperial College, NHLI, London, UK.
10
Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands.
11
Otorhinolaryngology, Ghent University, Ghent, Belgium.
12
Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Innsbruck, Medizinische Universitat Innsbruck, Innsbruck, Austria.
13
Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
14
Alergologie a klinická imunologie, Nemocnice na Homolce, Prague, Czech Republic.
15
Center for Rhinology and Allergology, Wiesbaden, Germany.
16
Department of ENT, Azienda Ausl di Imola, Imola, Italy.
17
Clinical and Experimental Immunoallergy, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
18
Department of ORL, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
19
Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
20
Department of Otorhinolaryngology, Medical Faculty, Kirikkale University, Kirikkale, Turkey.
21
Department of Pediatrics, Referral Centre for Food Allergy, Padua General University Hospital, Padua, Italy.
22
Fujita Health University, Otolaryngology, 1-98 Denngakugakubo, Kutukake-cho, Toyoake city, Aichi Prefecture, Japan.
23
London Allergy and Immunology Centre, London, UK.
24
Department of Prevention of Envinronmental Hazards and Allergology, Medical University of Warsaw, Poland.
25
Department of General Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria.
26
Faculty of Medicine, University of Latvia, Riga, Latvia.
27
Department of Otorhinolaryngology, Düsseldorf University Hospital (UKD), Düsseldorf, Germany.
28
Kharkiv National Medical University, Kharkiv, Ukraine.
29
Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.

Abstract

Nasal allergen challenge (NAC) is an important tool to diagnose allergic rhinitis. In daily clinical routine, experimentally, or when measuring therapeutic success clinically, nasal allergen challenge is fundamental. It is further one of the key diagnostic tools when initiating specific allergen immunotherapy. So far, national recommendations offered guidance on its execution; however, international divergence left many questions unanswered. These differences in the literature caused EAACI to initiate a task force to answer unmet needs and find a consensus in executing nasal allergen challenge. On the basis of a systematic review containing nasal allergen challenges of the past years, task force members reviewed evidence, discussed open issues, and studied variations of several subjective and objective assessment parameters to propose a standardized way of a nasal allergen challenge procedure in clinical practice. Besides an update on indications, contraindications, and preparations for the test procedure, main recommendations are a bilaterally challenge with standardized allergens, with a spray device offering 0.1 mL per nostril. A systematic catalogue for positivity criteria is given for the variety of established subjective and objective assessment methods as well as a schedule for the challenge procedure. The task force recommends a unified protocol for NAC for daily clinical practice, aiming at eliminating the previous difficulty of comparing NAC results due to unmet needs.

KEYWORDS:

allergic rhinitis; diagnostic tools; nasal allergen challenge; nasal provocation test

PMID:
29377177
DOI:
10.1111/all.13416

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