Do Skin Prick Tests Predict Nasal Provocation Test Outcomes in Perennial Allergic Rhinitis Patients?

Introduction: Upon assessing and diagnosing allergic rhinitis (AR) patients, currently the most commonly performed modalities are skin prick tests (SPT) and serum-specific immunoglobulin E (IgE) assays. Nevertheless, these tests are often inaccurate and may not reflect nasal symptoms upon allergen exposure. On the other hand, a nasal provocation test (NPT) may more accurately assess the presence and severity of AR. However, NPT may not be equipped and performed in the real world, compared with skin prick tests or serum assays. Thus, we aimed to investigate whether the results of SPT may correlate with NPT and further predict NPT results with SPT results in diagnosing AR.

Methods: From March 2022 to Dec 2023, a retrospective review of patients who underwent a simultaneous SPT and NPT was conducted. NPT was done using the 1,000 AU/mL Dermatophagoides pteronyssinus (Dp) allergen solution of 100 μL into both nostrils, in accordance with EAACI guidelines. The degree of NPT was represented as changes in the visual analog scale (VAS) of the total nasal symptom score (TNSS) at 15 minutes following the nasal challenge. For SPT, the mean of the long and short-axis diameter of the wheal of Dp allergen divided by the histamine was measured. A Pearson correlation analysis and linear regression analysis were adopted to assess the significant correlation and prediction model.

Results: A total of 110 adult patients with a mean age of 35.1 ± 12.5 and 73 (66.4%) male patients were analyzed. The VAS changes at 15 minutes following nasal Dp allergen challenge significantly correlated positively with the wheal/histamine ratio of Dp in the SPT (Pearson r = 0.53, p < 0.001). Subsequently, a linear regression model showed very significant linearity (p < 0.001) between the amplitudes of NPT and SPT, validating a regression model for predicting NPT outcomes with SPT results.

Conclusions: Our findings reveal a significant linear correlation between SPT and NPT results, underscoring the predictive value of SPT for nasal symptoms following allergen exposure in PAR patients.