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Updated: May 15, 2026
Symptom Assessment of Patients with Allergic Rhinitis Using an Allergen Exposure Chamber
Published on: March 3, 2023
End-organ testing for allergic rhinitis with fungi is poorly correlated with fungal sensitivity
Garima Agarwal1, David Hernandez, Martin J Citardi
1University of Texas Medical School at Houston, Department of Otorhinolaryngology-Head and Neck Surgery, Texas Sinus Institute, Houston, Texas 77030, USA.
Objective:
To evaluate optical rhinometry (ORM) using nasal provocation testing (NPT) as an objective tool to diagnose fungal allergic rhinitis (AR).
Study Design:
Prospective.
Setting:
Tertiary academic center.
Methods:
We prospectively enrolled healthy controls (HCs) and subjects with a clinical history of AR and positive skin prick test to Alternaria or Aspergillus antigens. Baseline measurements with an optical and acoustic rhinometer (AcR) were taken, and all subjects underwent NPT with increasing concentrations of Alternaria and then Aspergillus in each nasal cavity. Optical density (OD), nasal mean cross-sectional area (MCA), visual analog scale (VAS), and nasal allergen provocation scale (NAP) were measured after each provocation. A NAP score ≥ 3 was considered positive. Receiver operating characteristic (ROC) curve analysis was performed on measured parameters.
Results:
Eleven HCs and 11 AR subjects were enrolled. Of the 8 AR patients with an Alternaria-positive skin test, 50% had a positive NAP score (4/8) vs 0% in HCs (0/11, P = .01). Although VAS could differentiate Alternaria-sensitive patients from controls, change in OD and MCA could not. Of the 7 skin test-positive Aspergillus patients, 43% had a positive NAP score (3/7) vs 0% in HCs (0/11, P = .02). The VAS and change in OD and MCA did not differentiate Aspergillus-sensitive patients from controls.
Conclusion:
In this study, fungal antigens caused irritation but did not elicit early phase changes in nasal patency or blood flow in fungal-sensitive AR patients. The poor correlation of skin testing and objective nasal response to fungi argues against a pure IgE-mediated immune response in the nasal cavity.
Insights
Optical rhinometry (ORM) did not objectively diagnose fungal allergic rhinitis (AR) in this study. Fungal antigens caused irritation, but not significant nasal changes, suggesting a non-IgE response.
Area of Science:
- Otolaryngology
- Allergy and Immunology
- Diagnostic Tools
Background:
- Allergic rhinitis (AR) is a common condition often triggered by fungal allergens.
- Accurate diagnosis of fungal AR is crucial for effective management.
- Objective diagnostic tools are needed to complement traditional methods like skin prick testing.
Purpose of the Study:
- To assess the utility of optical rhinometry (ORM) with nasal provocation testing (NPT) for diagnosing fungal allergic rhinitis.
- To investigate objective nasal responses to fungal antigens in patients with suspected fungal AR.
Main Methods:
- Prospective study at a tertiary academic center.
- Enrolled healthy controls and AR patients with positive skin tests to Alternaria or Aspergillus.
- Performed NPT with fungal antigens and measured optical density, nasal cross-sectional area, VAS, and NAP score.
Main Results:
- 50% of Alternaria-sensitive AR patients and 43% of Aspergillus-sensitive AR patients had a positive nasal provocation test (NAP score ≥ 3).
- Visual analog scale (VAS) differentiated Alternaria-sensitive patients, but optical density and cross-sectional area did not.
- No significant changes in nasal patency or blood flow were observed in response to fungal provocation.
Conclusions:
- Fungal antigens primarily caused irritation rather than early-phase nasal patency changes in sensitive AR patients.
- The weak correlation between skin testing and objective nasal response suggests a non-IgE-mediated mechanism in some cases of fungal AR.
- ORM with NPT may not be a reliable objective tool for diagnosing fungal allergic rhinitis based on these findings.
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