Nasal allergen provocation with Dermatophagoides pteronyssinus in patients with chronic rhinitis referred to a rhinologic surgical center.

BACKGROUND

Skin tests and specific immunoglobulin (Ig)E determinations identify the presence of some immune response to allergens, but frequently do not correlate to allergic disease in vivo.

OBJECTIVE

To compare clinical history, skin tests and specific IgE determinations with the results of nasal provocation tests (NPT) to confirm clinically relevant allergy to Dermatophagoides pteronyssinus (DP) in patients with chronic rhinitis referred to a rhinologic surgical center.

METHODS

Clinical data of 2,194 patients with chronic nasal disorders treated at two rhinologic referral centers between 1992 and 1998 were evaluated. Clinical allergy work-up was routinely performed corresponding to German and European guidelines providing consistent data in both centers.

RESULTS

Of chronic rhinitis patients, 752 of 2,194 (34%) had at least one positive skin reaction to a perennial allergen common in Central Europe. Three hundred seventy-three patients had a positive skin test to DP and were paradigmatically evaluated in detail. In 235 patients, a complete dataset including structured allergic history, skin test, specific IgE determinations, and NPT was available. Quality and severity of symptoms, clinical history, skin tests, and allergen-specific IgE-determinations were unreliable predictors of the outcome of NPT with DP.

CONCLUSION

In patients referred for surgical treatment of chronic rhinitis, diagnosis of perennial allergy is unreliable unless confirmed with NPT.