Exposure chamber for allergen challenge. A placebo-controlled, double-blind trial in house-dust-mite asthma

Exposure chambers have proven to be valuable tools in the study of reactions to aeroallergens, and in monitoring the efficacy of antiallergic therapy. In the present study, 15 house-dust-mite-allergic asthmatics and five nonallergic volunteers were challenged in a recently developed exposure chamber. The trial was performed double-blinded with house-dust-mite allergen or placebo. Patients with allergy to house-dust mite (Dermatophagoides pteronyssinus) (Der p) were included by positive skin prick test, allergen-specific IgE, and conventional bronchial allergen challenge, with nebulizer and mouthpiece. In the exposure chamber, a total allergen dose corresponding to 1200 ng Der p 1 was applied. All participants kept diaries, recording peak expiratory flow rates, symptoms, and medication in periods of at least 2 weeks before and after each challenge. Twelve of the 15 asthmatics reacted with asthmatic symptoms with a median change in FEV1 of -16.4% when exposed to the allergen, but not to placebo, in the exposure chamber. Three patients had only minor symptoms during both chamber exposures and experienced no impairment of pulmonary function. Late-phase reactions were less frequent (one vs three) after the exposure chamber challenges, as compared to the traditional challenges. None of the healthy subjects reacted to the challenges. In conclusion, our exposure chamber was able to elicit symptoms in allergic subjects, and this ability was obtained with only minor amounts of house-dust-mite allergen. The described method could prove to be a more physiologically relevant model to monitor individual responses to aeroallergens.