Skip to main content
SpringerLink
Log in

Stellenwert der nasalen Provokation bei Hausstaubmilbenallergie

Relevance of nasal provocation testing in house dust mite allergy

  • Leitthema
  • Published:
HNO Aims and scope Submit manuscript

Zusammenfassung

Hausstaubmilbenallergiker zeigen häufig deutlich unterschiedliche Symptome gegenüber Patienten mit Allergien auf andere Inhalationsallergene. Das Vorkommen eines allergischen Asthmas ist deutlich erhöht. Die Diagnostik kann daher eine Herausforderung sein. Vor allem ist es wichtig, eine klinisch „stumme“ Sensibilisierung von einer manifesten Allergie zu differenzieren. Die nasale Provokationstestung (NPT) ist eine geeignete Methode, Patienten zu selektieren, um sie einer kausalen Therapie (spezifische Immuntherapie) zuzuführen. Positionspapiere zur Methodik und Beurteilung der NPT sind verfügbar. Es zeigt sich zwar eine Korrelation der Provokationsergebnisse mit den gängigen Testverfahren (Pricktest, allergenspezifisches IgE), allerdings ist dies teilweise ungenau. Die Durchführung einer NPT bei Verdacht auf Vorliegen einer Hausstaubmilbenallergie ist bei Patienten mit fragwürdiger Anamnese bzw. unklaren Haut- und Bluttestergebnissen empfehlenswert, insbesondere vor Beginn einer Immuntherapie.

Abstract

Patients with house dust mite allergies frequently exhibit very different symptoms to those allergic to other inhalant allergens. The frequency of comorbid allergic asthma in these patients is increased. Therefore, diagnosing patients with suspected house dust mite allergies can be difficult. It is important to distinguish between sensitization to an allergen and a clinically relevant allergy. Nasal provocation testing (NPT) is a reliable method to identify patients suitable for a causal treatment (specific immunotherapy). Position papers on methodology and interpretation of NPT data are available. Skin prick and allergen-specific IgE tests reveal a reasonable correlation with NPT results, although this is inexact to some extent. Performance of NPT in patients with suspected house dust mite allergy is important in individuals with questionable symptoms and unclear skin and blood test results, particularly prior to initiation of allergen immunotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Anantasit N, Vilaiyuk S, Kamchaisatian W et al (2013) Comparison of conjunctival and nasal provocation tests in allergic rhinitis children with Dermatophagoides pteronyssinus sensitization. Asian Pac J Allergy Immunol 31:227–232

    Article  PubMed  Google Scholar 

  2. Arshad SH (2010) Does exposure to indoor allergens contribute to the development of asthma and allergy? Curr Allergy Asthma Rep 10:49–55

    Article  CAS  PubMed  Google Scholar 

  3. de Blay F, Doyen V, Lutz C et al (2015) A new, faster, and safe nasal provocation test method for diagnosing mite allergic rhinitis. Ann Allergy Asthma Immunol 115:385–390

    Article  PubMed  Google Scholar 

  4. Blomme K, Tomassen P, Lapeere H et al (2013) Prevalence of allergic sensitization versus allergic rhinitis symptoms in an unselected population. Int Arch Allergy Immunol 160:200–207

    Article  CAS  PubMed  Google Scholar 

  5. Bousquet PJ, Chinn S, Janson C et al (2007) Geographical variation in the prevalence of positive skin tests to environmental aeroallergens in the European Community Respiratory Health Survey I. Allergy 62:301–309

    Article  PubMed  Google Scholar 

  6. Calderon MA, Casale TB, Nelson HS et al (2013) An evidence-based analysis of house dust mite allergen immunotherapy: a call for more rigorous clinical studies. J Allergy Clin Immunol 132:1322–1336

    Article  CAS  PubMed  Google Scholar 

  7. Calderon MA, Linneberg A, Kleine-Tebbe J et al (2015) Respiratory allergy caused by house dust mites: What do we really know? J Allergy Clin Immunol 136:38–48

    Article  PubMed  Google Scholar 

  8. Chusakul S, Phannaso C, Sangsarsri S et al (2010) House-dust mite nasal provocation: a diagnostic tool in perennial rhinitis. Am J Rhinol Allergy 24:133–136

    PubMed  Google Scholar 

  9. Demoly P, Emminger W, Rehm D et al (2016) Effective treatment of house dust mite-induced allergic rhinitis with 2 doses of the SQ HDM SLIT-tablet: Results from a randomized, double-blind, placebo-controlled phase III trial. J Allergy Clin Immunol 137:444–451.e448

    Article  CAS  PubMed  Google Scholar 

  10. Dordal MT, Lluch-Bernal M, Sanchez MC et al (2011) Allergen-specific nasal provocation testing: review by the rhinoconjunctivitis committee of the Spanish Society of Allergy and Clinical Immunology. J Investig Allergol Clin Immunol 21:1–12 (quiz follow 12)

    CAS  Google Scholar 

  11. Forster U, Sperl A, Klimek L (2013) The NTP in allergy research : open questions regarding nasal provocation tests using allergens. HNO 61:818–825

    Article  CAS  PubMed  Google Scholar 

  12. Grutzenmacher S, Lang C, Mlynski R et al (2005) Long-term rhinoflowmetry: a new method for functional rhinologic diagnostics. Am J Rhinol 19:53–57

    PubMed  Google Scholar 

  13. Haxel BR, Huppertz T, Boessert P et al (2016) Correlation of skin test results and specific immunoglobulin E blood levels with nasal provocation testing for house-dust mite allergies. Am J Rhinol Allergy 30:60–64

    Article  PubMed  Google Scholar 

  14. King MJ, Tamulis T, Lockey RF (2008) Prick puncture skin tests and serum specific IgE as predictors of nasal challenge response to dermatophagoides pteronyssinus in older adults. Ann Allergy Asthma Immunol 101:12–17

    Article  PubMed  Google Scholar 

  15. Kirerleri E, Guler N, Tamay Z et al (2006) Evaluation of the nasal provocation test for its necessity in the diagnosis of nasal allergy to house dust mite. Asian Pac J Allergy Immunol 24:117–121

    CAS  PubMed  Google Scholar 

  16. Linneberg A, Nielsen HN, Frolund L et al (2002) The link between allergic rhinitis and allergic asthma: a prospective population-based study. The Copenhagen Allergy Study. Allergy 57:1048–1052

    Article  CAS  PubMed  Google Scholar 

  17. Loureiro G, Tavares B, Machado D et al (2012) Nasal Provocation Test in the Diagnosis of Allergic Rhinitis. In: Kowalski ML (Hrsg) Allergic Rhinitis. InTech, Rijeka

    Google Scholar 

  18. Lueer K, Biller H, Casper A et al (2016) Safety, efficacy and repeatability of a novel house dust mite allergen challenge technique in the Fraunhofer allergen challenge chamber. Allergy 71(12):1693–1700

    Article  CAS  PubMed  Google Scholar 

  19. Minami T, Fukutomi Y, Lidholm J et al (2015) IgE Abs to Der p 1 and Der p 2 as diagnostic markers of house dust mite allergy as defined by a bronchoprovocation test. Allergol Int 64:90–95

    Article  CAS  PubMed  Google Scholar 

  20. Mosbech H, Deckelmann R, de Blay F et al (2014) Standardized quality (SQ) house dust mite sublingual immunotherapy tablet (ALK) reduces inhaled corticosteroid use while maintaining asthma control: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol 134:568–575.e567

    Article  CAS  PubMed  Google Scholar 

  21. Pfaar O, Bachert C, Bufe A et al (2014) Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (OGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD). Allergo J Int 23:282–319

    Article  PubMed  PubMed Central  Google Scholar 

  22. Riechelmann H, Bachert C, Goldschmidt O et al (2002) Durchführung des nasalen Provokationstests bei Erkrankungen der oberen Atemwege. Positionspapier der Deutschen Gesellschaft für Allergologie und klinische Immunologie (Sektion HNO) gemeinsam mit der Arbeitsgemeinschaft Klinische Immunologie, Allergologie und Umweltmedizin der Deutschen Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie. Allergo J 11:29–36

    Google Scholar 

  23. Riechelmann H, Epple B, Gropper G (2003) Comparison of conjunctival and nasal provocation test in allergic rhinitis to house dust mite. Int Arch Allergy Immunol 130:51–59

    Article  PubMed  Google Scholar 

  24. Rondon C, Campo P, Galindo L et al (2012) Prevalence and clinical relevance of local allergic rhinitis. Allergy 67:1282–1288

    Article  CAS  PubMed  Google Scholar 

  25. Roux M, Devillier P, Yang WH et al (2016) Efficacy and safety of sublingual tablets of house dust mite allergen extracts: results of a dose-ranging study in an environmental exposure chamber. J Allergy Clin Immunol 138:451–458

    Article  CAS  PubMed  Google Scholar 

  26. Tovey ER, Willenborg CM, Crisafulli DA et al (2013) Most personal exposure to house dust mite aeroallergen occurs during the day. PLOS ONE 8:e69900

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Vuurman EF, Vuurman LL, Lutgens I et al (2014) Allergic rhinitis is a risk factor for traffic safety. Allergy 69:906–912

    Article  CAS  PubMed  Google Scholar 

  28. Weghofer M, Grote M, Resch Y et al (2013) Identification of Der p 23, a peritrophin-like protein, as a new major Dermatophagoides pteronyssinus allergen associated with the peritrophic matrix of mite fecal pellets. J Immunol 190:3059–3067

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Hals-, Nasen- und Ohrenheilkunde, AMEOS Klinikum Haldensleben, Kiefholzstr. 27, 39340, Haldensleben, Deutschland

    B. R. Haxel

  2. Universitätsklinik für Hals-Nasen-Ohren-Heilkunde und Kopf-Hals-Chirurgie, Universitätsmedizin Mainz, Mainz, Deutschland

    B. R. Haxel

Authors
  1. B. R. Haxel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. R. Haxel.

Ethics declarations

Interessenkonflikt

B. R. Haxel erhielt Vortragshonorare der Firmen ALK-Abelló Arzneimittel GmbH, HAL Allergie GmbH, Stallergenes GmbH, gehört einem Advisory Board von ALK-Abelló Arzneimittel GmbH und Stallergenes GmbH an und erhielt im Rahmen von Studien Zuwendungen der Fa. LETI Pharma GmbH.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Haxel, B.R. Stellenwert der nasalen Provokation bei Hausstaubmilbenallergie. HNO 65, 811–817 (2017). https://doi.org/10.1007/s00106-017-0342-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00106-017-0342-z

Schlüsselwörter

Keywords

Search

Navigation