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Praktische Allergologische Diagnostik pp 114–124Cite as

Bronchiale Provokation

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Zusammenfassung

Bei den bronchialen Provokationstests kann unterschieden werden zwischen „unspezifischen“ bronchialen Provokationstests, welche die Reaktivität des Bronchialsystems auf unspezifische Stimuli messen, und „spezifischen“ Provokationstests, meist mit Allergenen oder anderen, möglicherweise für die Erkrankung kausalen Substanzen. Die Grenzen zwischen beiden Testformen sind fließend, insbesondere bei niedermolekularen Substanzen ist es häufig nicht möglich, irritative und immunologische Effekte zu differenzieren. Für einen immunologischen (spezifischen) Mechanismus sprechen neben dem durch anderweitige Methoden erbrachten Sensibilisierungsnachweis insbesondere

  • ine Latenzzeit zwischen Expositionsbeginn und Auftreten von Symptomen

  • eringe Substanzkonzentrationen für die Symptomauslösung, die bei geeigneten Kontrollen nicht zu Symptomen führen

  • ine im Zeit-Wirkungsverlauf typische Sofortreaktion bzw. eine bronchiale verzögerte oder duale Reaktion

  • egleitende kutane oder systemische Reaktionen wie Urtikaria oder Quincke-Ödem

Die nachfolgenden Ausführungen beziehen sich auf bronchiale Provokationstests bei Erwachsenen. Die Tests werden überwiegend beim Asthmatiker durchgeführt, die Provokationstestung im Rahmen der Diagnostik der exogen-allergischen Alveolitis wird an anderer Stelle behandelt (Kapitel 11.10.).

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Literatur

  • American Thoracic Society (1995) Standardization of Spirometry. Am J Crit Care Med 152:1107–1136

    Article  Google Scholar 

  • Anderson SD (1984) Is there a unifying hypothesis for exercise-induced asthma?. J Allergy Clin Immunol 73:660–665

    Article  PubMed  CAS  Google Scholar 

  • Anderson SD, Smith CM, Rodwell LT, du Toit JI (1995) The use of nonisotonic aerosols for evaluating bronchial hyperresponsiveness. In: Spector SL (Hrsg) Provocation testing in clinical practise. Marcel Dekker, New York

    Google Scholar 

  • Aquilina AT (1983) Comparison of airway reactivity induced by histamine, methacholine, and isocapnic hyperventilation in normal and asthmatic subjects. Thorax 38:766–770

    Article  PubMed  CAS  Google Scholar 

  • Arbeitskreis „Bronchiale Provokationstests“ (1998) Leitlinien für die Durchführung bronchialer Provokationstests mit pharmakologischen Substanzen. Pneumologie 52:214–220

    Google Scholar 

  • Banks DE, Barkman HW, Butcher BT, Hammad YY, Rando RJ, Glindmeyer HW, Jones RN, Weill H (1986) Absence of hyperresponsiveness to methacholine in a worker with methylene diphenyl diisocyanate (MDI)-induced asthma. Chest 89:389–393

    Article  PubMed  CAS  Google Scholar 

  • Britton J, Chinn S, Burney P, Papacosta AO, Tattersfield A (1988) Seasonal variation in bronchial reactivity in a community population. J Allergy Clin Immunol 82:134–139

    Article  PubMed  CAS  Google Scholar 

  • Cartier A, Thompson NC, Frith PA, Roberts R, Hargreave FE (1982) Allergen-induced increase in bronchial responsiveness to histamine: Relationship to the late asthmatic response and change in airway caliber. J Allergy Clin Immunol 70:170–177

    Article  PubMed  CAS  Google Scholar 

  • Cartier A, Bernstein IL, Bürge PS, Cohn JR, Fabbri LM, Hargreave FE, Malo JI, McKay RT, Salvaggio JE (1989) Guidelines for bronchoprovocation for occupational asthma. Report of the subcommittee on bronchoprovocation for occupational asthma. J Allergy Clin Immunol 84:823–829

    Article  PubMed  CAS  Google Scholar 

  • Cartier A, Malo JL (1999) Occupational challenge tests. In: Asthma in the workplace. Bernstein et al (eds), 2nd edition. Marcel Dekker, New York

    Google Scholar 

  • Chai H, Farr RS, Froehlich LA, Mathison DA, McLean JA, Rosenthal RR, Sheffer AL, Spector SL, Townley RG (1975) Standardization of bronchial inhalation challenge procedures. J Allergy Clin Immunol 56:323–327

    Article  PubMed  CAS  Google Scholar 

  • Chandler-Deal E Jr, McFadden ER Jr, Ingram RH Jr, Breslin FJ, Jaegar JJ (1980) Airways responsiveness to cold air and hyperventilation in normal subjects and in those with hay fever and asthma. Am Rev Respir Dis 121:621–628

    Google Scholar 

  • Chen WY, Horton DJ (1977) Heat and water loss from the airways and exercise induced asthma. Respiration 34:305–313

    Article  PubMed  CAS  Google Scholar 

  • Cloutier Y, Lagier F, Lemieux R (1989) New methodology for specific inhalation challenges with occupational agents in powder form. Eur Respir J 2:769–777

    PubMed  CAS  Google Scholar 

  • Cockcroft DW, Killian DN, Mellon JJA, Hargreave FE (1977) Bronchial reactivity to inhaled histamine: A method and clinical survey. Clin Allergy 7:235–243

    Article  PubMed  CAS  Google Scholar 

  • Cockcroft DW, Berscheid BA (1982) Standardization of inhalation provocation tests: Dose vs concentration of histamine. Chest 82:672–675

    Google Scholar 

  • Cockcroft DW, Berscheid BA (1983) Slope of the doseresponse curve: Usefulness in assessing bronchial responses to inhaled histamine. Thorax 38:55–61

    Article  PubMed  CAS  Google Scholar 

  • Cockcroft DW, Murdock KY, Kirby J, Hargreave FE (1987) Prediction of airway responsiveness to allergen from skin sensitivity to allergen and airway responsiveness to histamine. Am Rev Respir Dis 135:264–267

    PubMed  CAS  Google Scholar 

  • Cockcroft DW, Murdock KY, Berscheid BA, Gore BP (1992) Sensitivity and specificity of histamine PC20 determination in a random selection of young college students. J Allergy Clin Immunol 89:23–30

    Article  PubMed  CAS  Google Scholar 

  • Crimi E, Balbo A, Voltolini S, Troise C, Brusasco V, Negrini AC (1993) Is the allergen-inhalation challenge predictive of the severity of seasonal asthmatic exacerbations?. Allergy 48:202–206

    Article  PubMed  CAS  Google Scholar 

  • De Luca S, Caire N, Cloutier Y, Cartier A, Ghezzo H, Malo JL (1988) Acute exposure to sawdust does not alter airway calibre and responsiveness to histamine in asthmatic subjects. Eur Respir J 1:540–546

    PubMed  Google Scholar 

  • Eggleston PA, Kagey-Sobotka A, Lichtenstein LM (1987) A comparison of the osmotic activation of basophils and human lung mast cells. Am Rev Respir Dis 135:1043–1048

    PubMed  CAS  Google Scholar 

  • Eliasson AH, Philipps YY, Rajagopal KR, Howard RS (1992) Sensitivity and specificity of bronchial provocation testing. An evaluation of four techniques in exercise-induced bronchospasm. Chest 102:347–355

    Article  PubMed  CAS  Google Scholar 

  • Empey DW, Laitinen LA, Jacobs L, Gold WM, Nadel JA (1976) Mechanism of bronchial hyperreactivity in normal subjects after upper respiratory tract infection. Am Rev Respir Dis 113:131–139

    PubMed  CAS  Google Scholar 

  • Frolund L, Madsen F, Scharling B, Heinig JH, Gerner Svendsen U (1992) Bronchial allergen challenge: Dose versus concentration. Clin Exp Allergy 22:219–225

    Article  PubMed  CAS  Google Scholar 

  • Gerritsen J, Koeter GH, Postma DS, Schouten JP, Knol K (1989) Prognosis of asthma from childhood to adulthood. Am Rev Respir Dis 140:1325–1330

    Article  PubMed  CAS  Google Scholar 

  • Giffon E, Orehek J, Vervloet D, Arnaud A, Charpin J (1987) Asthma without airway hyperresponsiveness to carbachol. Eur J Respir Dis 70:229–233

    PubMed  CAS  Google Scholar 

  • Gonsior E, Krüger M, Meier-Sydow J (1976) Die Durchführung inhalativer Antigen-Provokationsproben mit Hilfe der Ganzkörperplethysmographie. Acta Allerg 31:283–296

    Article  PubMed  CAS  Google Scholar 

  • Hargreave FE, Ryan G, Thomson NC, O’Byrne PM, Latimer K, Juniper EF, Dolovich J (1981) Bronchial responsiveness to histamine or methacholine in asthma: Measurement and clinical significance. J Allergy Clin Immunol 68:347–355

    Article  PubMed  CAS  Google Scholar 

  • Hargreave FE, Ramsdale EH, Pugsley SO (1984) Occupational asthma without bronchial hyperresponsiveness. Am Rev Respir Dis 130:513–515

    PubMed  CAS  Google Scholar 

  • Hauptverband der gewerblichen Berufsgenossenschaften, Ausschuss Arbeitsmedizin, ad-hoc Arbeitsgruppe „Lungenfunktion“ (1994) Leitfaden für die Lungenfunktionsprüfung bei arbeitsmedizinischen Vorsorgeuntersuchungen nach Berufsgenossenschaftlichen Grundsätzen. Arbeitsmed Sozialmed Umweltmed 29:75–80

    Google Scholar 

  • Heaton RW, Henderson AF, Costello JF (1984) Cold air as a bronchial provocation technique. Reproducibility and comparison with histamine and methacholine inhalation. Chest 86:810–814

    Article  PubMed  CAS  Google Scholar 

  • International consensus report on diagnosis and treatment of asthma (1992) Eur Respir J 5:601–641

    Google Scholar 

  • Jörres RA, Nowak D, Kirsten D, Grönke L, Magnussen H (1997) A short protocol for methacholine provocation testing adapted to the Rosenthal-Chai dosimeter technique. Chest 111:866–869

    Article  PubMed  Google Scholar 

  • Juniper EF, Syty-Golda M, Hargreave FE (1984) Histamine inhalation tests: Inhalation via a face mask versus a valve box with mouthpiece. Thorax 39:556–557

    Article  PubMed  CAS  Google Scholar 

  • Löwhagen O, Lindholm NB (1983) Short-term and longterm variation in bronchial response to histamine in asthmatic patients. Eur J Respir Dis 64:466–472

    PubMed  Google Scholar 

  • Melillo G, Aas K, Cartier A, Davies RJ, Debelic M, Dreborg S, Kerrebijn KF, Lassen A, Pinto Mendes J, Rizzo A, Rosenthal RR, Tateishi S, Corsico R (1991) Guidelines for the standardization of bronchial provocation tests with allergens. Allergy 46:321–329

    Article  PubMed  CAS  Google Scholar 

  • Melillo G (1989) Allergen inhalation challenge with a micronized, freeze-dried extract administered as a powder-inhaler. In: Melillo G, Norman PS, Marone G (eds) Clinical immunology, vol 2. Respiratory allergy. BC Decker, Toronto

    Google Scholar 

  • Merget R, Schultze-Werninghaus G, Bode F, Bergmann EM, Zachgo W, Meier-Sydow J (1991) Quantitative skin prick and bronchial provocation tests with platinum salt. Br J Indust Med 48:830–837

    CAS  Google Scholar 

  • Merget R, Heger M, Bergmann EM, Schultze-Werninghaus G (1996) Quantitative inhalative Provokationstests mit Weizenmehl — Inhalation von Extrakt oder nativem Mehl mittels Spinhaler?. Pneumologie 50:149

    Google Scholar 

  • Merget R, Dierkes A, Rueckmann A, Bergmann EM, Schultze-Werninghaus G (1996) Absence of relation between degree of nonspecific and specific bronchial responsiveness in occupational asthma due to platinum salts. Eur Respir J 9:211–216

    Article  PubMed  CAS  Google Scholar 

  • Muller BA, Leick CA, Suelzer M, Piyamahunt A, Richerson HB (1994) Prognostic value of methacholine challenge in patients with respiratory symptoms. J Allergy Clin Immunol 94:77–87

    Article  PubMed  CAS  Google Scholar 

  • O’Byrne PM, Ryan G, Morris M, McCormack D, Jones NL, Morse JLC, Hargreave FE (1982) Asthma induced by cold air and its relation to nonspecific bronchial responsiveness to methacholine. Am Rev Respir Dis 125:281–285

    PubMed  Google Scholar 

  • O’Connor G, Sparrow D, Taylor D, Segal M, Weiss S (1987) Analysis of dose response curves to methacholine. An approach suitable for population studies. Am Rev Respir Dis 136:1412–1417

    Article  PubMed  Google Scholar 

  • Postma DS, de Vries K, Koeter GH, Sluiter HJ (1986) Independent influence of reversibility of airflow obstruction and nonspecific hyperreactivity on the long term course of lung function in chronic airflow obstruction. Am Rev Respir Dis 134:276–280

    PubMed  CAS  Google Scholar 

  • Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC (1993) Lung volumes and forced ventilatory flows. Report Working Party Standardisation of Lung Function Tests. Eur Respir J 6(Suppl 16):5–40

    Google Scholar 

  • Redline S, Tager IB, Speizer FE, Rosner B, Weiss ST (1989) Longitudinal variability in airway responsiveness in a population-based sample of children and young adults. Am Rev Respir Dis 148:172–178

    Article  Google Scholar 

  • Rijcken B, Schouten JP, Weiss ST, Speizer FE, Van der Lende R (1988) The relationship between airway responsiveness to histamine and pulmonary function level in a random population sample. Am Rev Respir Dis 137:826–832

    Article  PubMed  CAS  Google Scholar 

  • Rijcken B, Schouten JP, Weiss ST, Rosner B, De Vries K, Van der Lende R (1993) Long-term variability of bronchial responsiveness to histamine in a random population sample of adults. Am Rev Respir Dis 148:944–949

    Article  PubMed  CAS  Google Scholar 

  • Ryan G, Dolovich MB, Roberts RS, Frith PA, Juniper EF, Hargreave FE, Newhouse MT (1981) Standardization of inhalation provocation tests: Two techniques of aerosol generation and inhalation compared. Am Rev Respir Dis 123:195–199

    PubMed  CAS  Google Scholar 

  • Schlegel J, Fischer B, Ferlinz R (1995) Untersuchungen zur Äquipotenz von Methacholin und Carbachol im unspezifischen inhalativen Provokationstest. Pneumologie 49:535–538

    PubMed  CAS  Google Scholar 

  • Schultze-Werninghaus G (1985) Inhalative Provokationsproben mit Pharmaka und Allergenen — Techniken und Nutzen. Atemw Lungenkrkh 11:550–558

    Google Scholar 

  • Sotomayor H, Badier M, Vervloet D, Orehek J (1984) Seasonal increase of carbachol airway responsiveness in patients allergic to grass pollen. Am Rev Respir Dis 130:56–58

    PubMed  CAS  Google Scholar 

  • Souharda JF, Souharda M (1995) Provocative challenge by exercise or hyperventilation. In: Spector SL (ed) Provocation testing in clinical practise. Marcel Dekker, New York

    Google Scholar 

  • Stanescu DC, Frans A (1982) Bronchial asthma without increased airway reactivity. Eur J Respir Dis 63:5–12

    PubMed  CAS  Google Scholar 

  • Sterck PJ, Fabbri LM, Quanjer PH, Cockcroft DW, O’Byrne PM, Anderson SD, Juniper EF, Malo JL (1993) Airway responsiveness. Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Report Working Party Standardization of Lung Function Tests. Eur Respir J 6 (Suppl):53–83

    Google Scholar 

  • Vandenplas O, Malo JL, Cartier A, Perreault G, Cloutier Y (1992) Closed-circuit methodology for inhalation challenge tests with isocyanates. Am Rev Respir Dis 154:582–587

    Article  Google Scholar 

  • Van Schayck CP, Dompeling E, Van Herwaarden CL, Wever AM, Van Weel C (1991) Interacting effects of atopy and bronchial hyperresponsiveness on the annual decline in lung function and the exacerbation rate in asthma. Am Rev Respir Dis 144:1297–1301

    Article  PubMed  Google Scholar 

  • Vogelmeier C, Baur X, Fruhmann G (1991) Isocyanateinduced asthma: Results of inhalation tests with TDI, MDI and methacholine. Int Arch Occup Environ Health 63:9–13

    Article  PubMed  CAS  Google Scholar 

  • Yan K, Salome C, Woolcock AJ (1983) Rapid method for measurement of bronchial responsiveness. Thorax 38:55–61

    Article  Google Scholar 

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Authors
  1. R. Merget
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  2. G. Schultze-Werninghaus
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Editor information

Editors and Affiliations

  1. Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, Frauenlobstr. 9-11, 80337, München, Deutschland

    Bernhard Przybilla

  2. Allergie- und Asthmaklinik, An der Martinusquelle 10, 33175, Bad Lippspringe, Deutschland

    Karl-Christian Bergmann

  3. Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein Technische Universität München, Biedersteiner Str. 29, 80802, München, Deutschland

    Johannes Ring

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© 2000 Springer-Verlag Berlin Heidelberg

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Merget, R., Schultze-Werninghaus, G. (2000). Bronchiale Provokation. In: Przybilla, B., Bergmann, KC., Ring, J. (eds) Praktische Allergologische Diagnostik. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57720-8_13

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  • DOI: https://doi.org/10.1007/978-3-642-57720-8_13

  • Publisher Name: Steinkopff, Heidelberg

  • Print ISBN: 978-3-642-63336-2

  • Online ISBN: 978-3-642-57720-8

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