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The allergen nasal provocation testing（NPT）, in which allergens are applied directly to the nasal mucosa under standard and controlled conditions to provoke the main symptoms of allergic rhinitis（AR）, reproduces the response of the upper respiratory tract to natural exposure to allergens under controlled conditions and is the only test currently available to confirm nasal reactivity to allergens. It is invaluable in studying the mechanisms of AR and in assessing the response to novel anti-allergic treatments. The test may play an increasingly important role in clinical practice, especially in the identification of local AR, the diagnosis of occupational AR, the clarification of the composition of allergens, the assessment of the efficacy of AR treatment and the selection of candidates undergoing allergen immunotherapy. This article reviewed the application of NPT in the diagnosis of allergic and non-allergic rhinitis, and also introduces the indications, contraindications, advantages and limitations of NPT in evaluating nasal response., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To investigate the value of nasal provocation test（NPT） in evaluating the efficacy of allergen immunotherapy（AIT） in patients with dust mite induced allergic rhinitis（AR）. Methods: A total of 83 patients with dust mite induced AR with/without asthma were included. Symptom score（SS）, daily medication score（DMS）, combined symptom and medication score（CSMS）, rhinoconjunctivitis quality of life questionnaire（RQLQ）, NPT and skin prick test（SPT） were assessed before and after 1 year AIT. Results: There were statistical differences in SS（ P <0.000 1）, DMS（ P <0.000 1）, CSMS（ P <0.000 1）, and RQLQ（ P <0.000 1） after 1 year of AIT compared with pre-treatment. The effective rate of CSMS was 73.49%, and the effective rate of NPT was 42.17%. CSMS was consistent with NPT in efficacy assessment（Kappa=0.437, P <0.001）; while in 54 patients with pre-treatment NPT concentrations other than the original concentration, CMSM and NPT showed better consistence（Kappa=0.895, P <0.001）. Among the 48 patients with ineffective NPT assessment in the first year, 25 patients completed the second-year follow-up, and 12 patients（48.00%） showed effective in NPT. However, 10 out of 12 patients（83.33%） with NPT concentration other than original solution pre-treatment showed effective NPT at the second year. Conclusion: NPT can be used as one of the indicators for efficacy evaluation for dust mite induced AR patients, especially for patients with positive NPT induced at lower concentrations before treatment., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: This study aimed to compare the nasal response of cold dry air（CDA） provocation in patients with idiopathic rhinitis（IR） and healthy individuals, and further assess its ability in diagnosing IR. Method: CDA provocation was performed among 15 healthy volunteers and 17 IR patients from Beijing Tongren Hospital Outpatient Department. Nasal symptom scores, total nasal volume（TNV）, total nasal resistance（TNR） and minimal cross-sectional area（MCA） were checked before and after the provocation. Logistic regression analysis and Receiver Operating Characteristic（ROC） curves were used in data evaluation. Result: Subjects in the IR group showed significantly larger changes after CDA provocation in total nasal symptom score（TNSS）, total nasal resistance（TNR）, minimal cross-sectional area（MCA） and total nasal volume（TNV）, compared with healthy volunteers. We built a predictive model for IR, Y=0.394×ΔTNSS-0.061 ×ΔTNV（%）+0.014×ΔTNV（%） -2.318, whose area under curve was 0.919 based on multi-factor logistic regression and ROC curve. According to the Youden index, the cut-off criteria was set to be Y >0.49, when its sensitivity and specificity were 82.4% and 84.6%, respectively. Conclusion: Aggravated nasal symptoms and decreased nasal ventilation could be seen after CDA provocation in the IR population. The CDA provocation provides a possible method for assisting the diagnosis of IR, and we'll expand the sample size in future research to verify its clinical application value., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Nonspecific nasal hyperreactivity (NHR) has been widespread observed in patients with allergic rhinitis (AR) and nonallergic rhinitis (NAR). As a clinical hallmark, NHR is more common in patients with NAR. The cold dry air (CDA) can stimulate nasal symptoms such as rhinorrhea and nasal obstruction, and the CDA provocation test can be used as a reliable objective method to evaluate NHR. The mechanism of CDA-induced nasal symptoms is very complicated and thus it has not yet been fully illuminated. The innervation of the nasal nerves includes sensory nerve (trigeminal ganglion), sympathetic nerve (superior cervical ganglion) and parasympathetic nerve (sphenopalatine ganglion). CDA innervation may also be associated with these nerves and associated signal pathway. Recently, general attention has been focused on the transient receptor potential (TRP) channel, including TRP vanilloid-1 (TRPV1) and TRP ankyrin-1 (TRPA1). More relevant researches are needed to further clarify the mechanism., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To investigate the clinical symptoms and immunology inspection characteristics of nasal cavity local allergy. Method: Selected 60 patients as observation group, who had only nasal local allergy symptoms, allergen skin prick test and serum allergen specific IgE (SIgE) test were negative, 40 allergic rhinitis (AR) patients and 40 healthy volunteers as control groups. To detect Symptom scores and VAS scores, and eosinophilia counts in venous blood, allergen skin prick test (SPT), serum allergen SIgE test, nasal secretions allergen SIgE test, nasal mucous membrane excitation test in both observation group and AR group, eosinophilia counts in nasal secretion, taked the data for statistical analysis. Result: There was no difference ( P > 0.05) in the symptom scores and VAS scores of observation group and the AR group. The eosinophilia counts in venous blood in the AR group were higher than in the observation group ( P < 0.05). The eosinophilia counts in venous blood in the observation group were higher than in the healthy volunteers group ( P < 0.05). The positive rate of nasal secretions dust mites and pollen allergen was 90% (54/60) in observation group. There was no significant difference ( P > 0.05) in the eosinophilia percentages in nasal secretion in the observation group and the AR group. There was significant difference ( P < 0.05) in the eosinophilia percentages in nasal secretion in the observation group and the healthy volunteers group. There were 6 patients in observation group whose nasal secretions allergen SIgE test and nasal mucous membrane excitation test were both negative, could be diagnosised as non-allergic rhinitis (NAR). According to eosinophilia counts in venous blood and nasal secretions, 4 patients were diagnosised as vasomotor rhinitis and 2 patients were diagnosised as NAR with eosinophilia syndrome. There were 54 patients in observation group whose nasal secretions allergen SIgE test and (or) nasal mucous membrane excitation test were positive, could be diagnosised as local allergic rhinitis. After three years, all of the observation group patients were detected with SPT and serum allergen SIgE test. Five patients diagnosed as local allergic rhinitis before three years were positive. Six patients diagnosed as NAR before three years were negative. Conclusion: For patients with the typical medical history and symptoms of AR, but allergen SPT and serum allergen SIgE test were negative, there was local specific hypersensitivity in nasal mucosa, but the reaction was not accompanied by systemic sensitization. Combined with nasal secretions allergen SIgE test or allergen nasal mucosa proocation tests positive, could be diagnosed as local allergic rhinitis., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To evaluate the efficacy and safety of rush immunotherapy (RIT) for patients with persistent allergic rhinitis (AR)., Methods: In this study, a total number of thirty three (33) patients who suffered mite allergic rhinitis were included. These patients completed one year subcutaneous immunotherapy (SCIT). Using RIT, the patients underwent the incremental dose phase in a week instead of 15 weeks in a conventional treatment procedure. The symptom scores, visual analog scale (VAS), appropriate medication score, total blood serum IgE, dermatophagoides pteronyssinus specificity IgG4, mite allergy skin prick test (SPT), dermatophagoides farinae nasal provocation test (NPT) and the incidence of adverse reactions were used to evaluate the efficiency and safety of RIT., Results: After one year SCIT treatment, the symptom score and VAS scores were significantly decreased, the corresponding medication usage was significantly reduced (8.91 ± 1.84, 20.64 ± 6.99 vs. 4.97 ± 2.92, 11.94 ± 7.21, t value was 9.15, 7.11, both P < 0.001) and the cutaneous reactions to mite allergen were significantly decreased (P < 0.001) as well. However, dermatophagoides pteronyssinus-specific serum IgG4 increased significantly (Z = -4.517, P < 0.001). The concentration of dermatophagoides farinae nasal provocation test (NPT) was significantly increased. After the treatment, the number of patients who had positive reactions to high concentration nasal provocation test (NPT) increased (χ² = 1.93, P = 0.38). During the treatment, all the patients experienced local reactions, and specifically there were four patients got general reactions., Conclusion: RIT is safe and effective. It shortened the incremental dose phase remarkably. NPT is a good indicator for diagnosing allergic rhinitis and evaluating the efficacy of the treatment.

Objective: In order to explore the effect of plasma radiofrequency ablation on nasal mucosa provocative tests for allergic rhinitis., Method: Eighty patients with allergic rhinitis were enrolled in this study. The nasal mucosa provocative tests and nasal airway resistance and subjective nasal patency feeling were studied before and after plasma radiofrequency ablation treatment. The correlation of subjective and objective nasal patency was evaluated., Result: The preoperative nasal mucosa provocative test of all the patients allergic to mites were positive. The nasal mucosa provocative tests were negative within 72 patients, while remained positive in eight patients after 3 months of operation. The nasal airway resistance decreased from (0.772 +/- 0.224) kPa x s/L to (0.221 +/- 0.112) kPa x s/L after surgery (P < 0.01); Visual analog scale decreased from 7.0 +/- 2.0 to 2.5 +/- 1.5 after 3 months of operation (P < 0.01)., Conclusion: Due to its ability to reduce the sensitivity of the nasal mucosa, nasal airway resistance and improve subjective feeling of nasal patency, plasma radiofrequency ablation is effective for the treatment of patients with allergic rhinitis.

Objective: To study the distribution of allergens in our district and the correlation between skin prick test with antigen and nasal provoking test in patients with allergic rhinitis., Method: A total of 1400 cases with allergic symptoms and signs underwent skin prick test with standardized aero antigens provoking by Allergo Phamar Company. The patients allergic to Dermatophagoides with different scale of the skin prick test were taken nasal provoking test in order to evaluate the correlation between skin prick test and nasal provoking test., Result: One thousand and eighty-eight (78%) cases showed a positive result in skin prick test. The percent of patients with positive skin prick test were as follows: 462 cases of Dermatophagoides pteronyssinus, 428 cases of Dermatophagoides farinae. Positive perennial aero antigens were 52.2% (568), positive seasonal aero antigens were 35.7% (388). All the patients of the scale of skin prick test was +++ and ++++ were positive. There are 29 patients were positive with nasal provoking test which the scale of skin prick test was ++. There are 21 patients were positive with nasal provoking test, which the scale of skin prick test was +., Conclusion: The correlation between skin test with antigens and nasal provoking test in patients whose positive scale were +++ and ++++. There are false positive in the patients whose positive scale were + and ++. The specific immunotherapy should consider the scale of the skin prick test and eliminate the false positive before the therapy.

Objective: To investigate the effect of early allergen exposure on later development of allergic rhinitis in mouse., Methods: Twenty-four BALB/c neonates were randomly divided into 4 groups (low-dose group, high-dose group, negative control group and positive control group), each group had 6 mice. The mice were administered ovalbumin (OVA) by subcutaneous injection on day 1, 5, 12 after birth (10 μg OVA in 0.05 ml saline for low-dose group, 1000 μg OVA in 0.05 ml saline for high-dose group, only saline for negative and positive control group). Then the mice were sensitized and intranasally challenged with OVA (saline without OVA was used in negative control group) after 6 weeks. Symptoms, histopathological changes of nasal mucosa were observed, OVA-IgE in serum was examined, cytokines IL-4, IL-5 and IFN-gamma were detected in the supernatant of cultured splenic mononuclear cells., Results: Compared to the positive control group, symptoms and nasal mucosa histological changes of high-dose group was indistinctive. The level of OVA-IgE and cytokines IL-4, IL-5 (x(-) +/- s) in high-dose group [(265.11 +/- 26.29), (446.39 +/- 72.83) and (171.24 +/- 15.66) pg/ml, respectively] were significantly lower than those in positive control group [(665.85 +/- 43.15), (1113.45 +/- 30.47), (255.36 +/- 30.96) pg/ml, respectively, t value were 0.000, 0.000 and 0.009, respectively, all P < 0.05]. The level of IFN-γ in high-dose group [(319.74 +/- 56.30) pg/ml] was significantly higher than those in positive control group [(170.02 +/- 14.50) pg/ml, t = 0.000, P < 0.05]. There was no significant difference of the results between the low-dose group and positive control group., Conclusions: Neonatal immunization with high-dose OVA inhibited the future allergic rhinitis symptoms, nasal histological changes, serum OVA-IgE levels and Th1/Th2 cytokine imbalance, resulting in the protective effect.

Objective: To evaluate the correlation between upper and lower respiratory inflammation., Methods: Thirty rats were randomly divided into allergic rhinitis group (AR), asthma group (AS), and control group (Con). The pulmonary function was measured by pulmonary function instrument of animal model, the infiltration of eosinophils and mast cells was detected by hematotoxylin-eosin staining (HE staining) and toluidine blue staining respectively, the expression of VCAM-I and IL-13 was examined by immunohistochemistry. ELISA was used to measure the concentration of IL-5 in the peripheral serum., Results: The numbers of eosinophils and mast cells in nasal mucosa and lung tissue of AR were both significantly higher than those of Con, and similar results were observed between AS and Con. The forced expiratory volume in 0.3 second (FEV0.3)/forced vital capacity (FVC) of AR and AS was both significantly lower than that of Con. The numbers of VCAM-I and IL-13 positive vessels in lung tissue of AR were both significantly higher than those of Con, and similar results were observed between AS and Con. The concentration of IL-5 in the serum of AR and AS was both significantly higher than that of Con. The concentration of IL-5 in serum was positively correlated with the number of eosinophils in peripheral blood of AR and AS., Conclusion: The inflammation is similar between AR and AS, and repeatedly challenge upper respiratory tract can impact on lower respiratory response.

Objective: To explore efficient evaluation method for specific nasal provocation test(SNPT) and to observe the pathogenic process and patho-physiological changes of allergic rhinitis., Method: 30 patients with perennial allergic rhinitis(patients group) and 14 normal adults(controls group) were challenged unilaterally with the Coca's solution and/or the solution for allergen extracts. The nasal resistance variations in all subjects were monitored with active anterior rhinomanometry and the nasal symptoms were observed., Result: The symptoms of nasal stiffness, sneezing and rhinorrhea appeared in most patients between 0.5 and 3 minutes after provocation. The ratio of continual sneezes above 5 in patients group(83.3%) was significantly higher than in controls group (21.4%) (P < 0.01). The increased ratio of total nasal resistance and unilaterally-challenged nasal resistance were significantly higher in patients group than in controls group (P < 0.05) and no difference between coca's solution in patients group and controls group., Conclusion: Positive SNPT was indicated if obvious nasal symptoms appeared and the unilaterally-challenged nasal resistance increased 100% as well as the total nasal resistance increased 40% after SNPT.

Objective: To explore the relation between serum specificity immunoglobulin E (SIgE) and skin test (intracutaneous test) as well as nasal provocation in Perennial allergy rhinitis (PAR) by Mast Allergy Test System., Method: Serum allergen-specific IgE (SIgE) were examined by Mast Allergy Test System in 57 case of PAR patients., Result: The SIgE positive rate of fannae and pteronvssinus are highest (52.6%), the sensitive rate of intracutaneous test is 88.4% and nasal provocation is 88.9%. The SIgE positive rates of cludosporium, penicillum and altemana are 26.3%, 24.6% and 21.0%, respectively. The SIgE positive rates of fannae, cockroach, shrimp, crab, egg and milk is direct proportion with intracutaneous test (P < 0.01). Pteronvssiaus and pigweek mix have no relationship with intracutaneous test (P > 0.05). In addition, the positive rate of ragweed mix SIgE is 22.8%, but there is non of this plant in South China. It is worthy of paying attention in clinic., Conclusion: It indicate that Mast Allergy Test System is one of the better examination for PAR allergens.

The nasal mucosal microvascular of 37 patients with allergic rhinitis had been studied by nasal mucosal microcirculation microscope. It was found that the nasal mucosal microvascular diameter was wider after the nasal challenge test than before, but both after and before the nasal challenge test, the nasal mucosal microvascular diameter in patients with allergic rhinitis was narrower than in normal persons. The number of the microvascular in patients was also less than that in normal persons. The results indicate that the nasal mucosal microvascular with allergic rhinitis are characterized by dilated capacitance vessels and exchange vessels and constricted resistance vessels after nasal allergen challenge.