Clinical Feasibility and Safety of Nasal Allergen Provocation Testing in Pediatric Allergic Rhinitis

Nasal allergen provocation testing (NAPT) has been shown to be a safe and reproducible test in adults; however, pediatric data are limited. This study aims to investigate the clinical applications, feasibility, reproducibility and safety of NAPT in the pediatric population.

In this prospective study, 294 patients (4.16-14.25 years old, mean of 7.33 years), with symptoms and medical history of allergic rhinitis (AR) and IgE-mediated sensitization to Dermatophagoides pteronyssinus and Dermatophagoides farinae were recruited. Participants underwent NAPT with negative control and with increasing concentrations of crude Dermatophagoides farinae (50 µg/ml, 500 µg/ml, and 5000 µg/ml) at 15 min intervals. Pre- and post-test subjective symptom scores and objective active anterior rhinometry measurements were analyzed.

Among the 245 participants (83.3%) with a positive NAPT, the majority (n = 193, 78.8%) tested positive at 500 µg/ml or less. They (n = 226, 92.2%) were diagnosed based on an increase in total nasal symptoms score (TNSS) ≥ 5 points. The remaining 7.8% (n = 19) required objective measurements to fulfill the criteria for a positive result. Five participants were unable to fully comply with the instructions provided. There were no adverse events recorded during the study. The group which tested positive on NAPT recorded higher sIgE levels than that which tested negative. Furthermore, those with higher serum sIgE levels tested positive on NAPT at lower allergen concentrations. The baseline visual analog scale (VAS) was significantly higher in the group testing positive on NAPT at the lowest allergen concentration, compared with the other groups.

Our study demonstrates that NAPT is safe and feasible to be conducted on the pediatric population.