Nasal Secretion Der p-Specific IgE as a Potential Non-Invasive Diagnostic Biomarker for House Dust Mite-Related Allergic Rhinitis: A Single-Center Cross-Sectional Diagnostic-Accuracy Study.

BACKGROUND

Nasal secretion specific IgE (sIgE) may reflect local mucosal reactivity in allergic rhinitis (AR), but its diagnostic performance against nasal provocation remains uncertain.

OBJECTIVE

To evaluate nasal secretion Dermatophagoides pteronyssinus-specific IgE (Der p sIgE) for house dust mite (HDM)-related AR and its associations with nasal sensitivity and systemic sensitization.

METHODS

In this single-center cross-sectional diagnostic-accuracy study, 139 consecutive participants referred for suspected HDM-related AR underwent standardized HDM nasal provocation testing (NPT); after exclusion of 24 participants, 115 were included and classified as AR (positive NPT: Lebel score ≥ 5 with typical perennial rhinitis; n = 88) or non-AR controls (negative NPT, no typical history; n = 27). Nasal secretions were collected non-invasively with sterile cotton wool in one nostril for 15 min, and Der p sIgE was quantified in the eluate by chemiluminescent immunoassay (NOVEOS), with serum IgE on the same platform. Diagnostic accuracy was assessed by the area under the ROC curve (AUC).

RESULTS

Nasal Der p sIgE was higher in AR than controls (1.14 vs 0.03 kUA/L; P < 0.001); AUC was 0.84 (95% CI 0.76-0.91). At ≥ 0.1 kUA/L, sensitivity was 80.7% and specificity 66.7%; at ≥ 3.5 kUA/L, observed specificity was 100.0% (95% CI 87.5-100.0). Systemic HDM sensitization was present in 88/88 AR participants and 10/27 controls. Nasal Der p sIgE rose with nasal sensitivity (P < 0.001) and correlated with NPT score (ρ = 0.37), serum total IgE (ρ = 0.47), and serum Der p sIgE (ρ = 0.42; all q < 0.001).

CONCLUSION

Non-invasively collected nasal Der p sIgE distinguished HDM-related AR from non-AR controls and tracked the intensity of local nasal reactivity. It may serve as a potential non-invasive adjunct to NPT, pending prospective validation.