Allergic skin tests and nasal provocation tests in asthmatic children

Grazyna Gornicka, Andrzej Emeryk, Jolanta Pietraszek-Mamcarz

University Children's Hospital in Lublin, Poland

Published in: R. Spiewak (Editor): "Pollens and Pollinosis: Current Problems". Institute of Agricultural Medicine, Lublin (Poland) 1995, pages 84-86.

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Po Polsku

Objective

Skin testing [3] and specific provocation tests are the basic methods in diagnosis of allergic diseases [1, 5, 6]. Recently nasal provocation test is more frequently applied, since it is more convenient and safer than allergen bronchial provocation test, especially in children [2, 6]. The aim of the study was evaluation of conformity and diagnostic usefulness of the skin "prick" test and the specific nasal provocation test with grasses pollen in children who suffer from atopic bronchial asthma.

Material and Methods

The study was carried out in a group of 95 children (28 girls and 67 boys) suffering from bronchial asthma (B.A.) who were treated in Pulmonological or Allergological Outpatient Ward of University Children's Hospital in Lublin. In all of children allergic skin tests (A.S.T.) and nasal provocation tests (N.P.T.) with allergens of grass pollen (Bencard or Allergopharma) have been performed. A.S.T. were performed with the "prick" technique [3] and N.P.T. was estimated by rhinospirometry [4]. Both of tests were made in standardized conditions. Children were aged from 4 to 19 years, 51 (53.7%) patients were below 10 yr and 44 (46.3%) above 10 yr of age.

The duration time of asthma ranged from 1 year to 12 years. 51 children (53.7%) were ill from 1-5 yrs and 44 patients (46,3%) were suffering longer than 5 yrs. 76 (80.0%) of children were affected from bronchial asthma and allergic rhinitis (A.R.) and 19 (20.0%) suffered from B. A. alone.

According to A.S.T. and N.P.T. results, children were divided into following groups:
Group A: negative A.S.T. - from (-) to (++)
Group B: - positive A.S.T. - from (+++) to (++++)
Group C: - negative N.P.T.
Group D: - positive N.P.T.

Results

The conformity of A.S.T. and N.P.T. was observed in 76 cases (80.0%). In this group positive A.S.T. and positive N.P.T. were observed in 53 children (69.7%), and 23 patients (30.3%) had negative both tests - Table 1.

Table 1. Frequency of positive and negative results of A.S.T. and N.P.T.

	N.P.T. (+) n (%)	N.P.T. (-) n (%)	Total
A.S.T. (+)	53 (55.8)	13 (13.7)	66 (69.5)
A.S.T. (-)	6 (6.3)	23 (24.2)	29 (30.5)
Total	59 (62.1)	36 (37.9)	95 (100)

In 20 cases no correlation was found. More frequently (in 13 children) N.P.T. was negative in spite of positive A.S.T. In 6 children positive N.P.T. with negative A.S.T. was found. Influence of children's age, duration of disease and presence of bronchial asthma and allergic rhinitis or bronchial asthma alone on conformity of both tests was investigated (Table 2).

Table 2. Frequency of conformity and noncorformity of the tests

	Children's age		Duration of disease		Type of disease
	< 10 yrs n (%)	> 10 yrs n (%)	< 5 yrs n (%)	> 5 yrs n (%)	B.A.+A.R. n (%)	B.A. n (%)
Conforming tests	42 (44.2)	34 (35.8)	35 (37.9)	41 (43.1)	64 (67.4)	12 (12.6)
Non-conforming tests	9 (9.5)	10 (10.5)	16 (16.8)	3 (3.2)	12 (12.6)	7 (7.4)
Total	51 (53.7)	44 (46.3)	51 (53.7)	44 (46.3)	76 (80)	19 (20)

Conclusions

1. The conformity between the A.S.T. and N.P.T. was found in 80% of cases. It was higher in children with both positive tests than in those with both negative tests.
2. Age of children did not influence a conformity of A.S.T. and N.P.T., but in children up to 10 years coexistence of both negative tests was observed more frequently than in older children.
3. Duration of disease did not influence conformity of both tests.
4. Higher conformity of both tests was observed in group of children with coexistence of bronchial asthma and allergic rhinitis comparing to children with bronchial asthma alone.

References

1. Berg T.L.O., Johansson S.G.O. Allergy diagnosis with the radioallergosorbent test. A comparison with the results of skin and provocation tests in an unselected group of children with asthma and hay fever. J Allergy Clin Immunol 1974, 54, 209.
2. Emeryk A. Rhinospirography as a new method estimation of the nasal provocation test in asthmatic children. The Congress of Allergology and Clinical Immunology of the Socialist Countries. Warsaw-Jachranka, 1988. Abstracts.
3. Jedrys-Klucjasz U. Testy skorne w diagnostyce chorob alergicznych u dzieci. Nowa Klinika 1995, 4, 13.
4. Lebel B. et al. J Allergy Clin Immunol 1988, 82, 869.
5. Mazurek H. Testy swoistej prowokacji oskrzelowej w diagnostyce astmy. Nowa Klinika 1995, 4, 19.
6. Vidart J.N., Ghaem A., Herman D., Roger A.M. Etude comparative des tests de provocation nasale et bronchique. Rev Franc Allergol 1980, 20, 93.

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