Clinical applicability of rhinomanometry in the monitoring of specific immunotherapy in patients with seasonal allergic rhinitis

Radoslaw Spiewak¹, Krzysztof Buczylko²

1. Department of Aerobiology and Allergology, Institute of Agricultural Medicine, Lublin, Poland
2. Allergologic Laboratory, Department of Maxillo-Facial Surgery, Military Medical Academy, Lodz, Poland

Published in: R. Spiewak (Editor): "Pollens and Pollinosis: Current Problems". Institute of Agricultural Medicine, Lublin (Poland) 1995, pages 100-102. (The book's table of contents.)

Objective

The aim of the present work was to evaluate whether systemic application of specific allergen during the immunotherapy causes rhinomanometrically detectable functional changes in the nasal cavity. If such effect exists, rhinomanometry might be useful in the monitoring of the so-called subclinical side effects of the specific immunotherapy (SIT), which is very important for performing the effective but at the same time safe SIT. Because of relevant interindividual differences of sensitivity in patients, in every case the physician should choose the antigen dosis individually, basing on as broad as possible spectrum of clinical data [6]. The objective of this study was therefore to examine whether the rhinomanometry is an appropriate tool to detect the effects of subcutaneows antigen application on nasal patency in pollinotic patients with seasonal allergic rhinitis (SAR).

Material

16 SAR patients, 7 females and 9 males, aged 7 to 43 years (see Table 1).

Methods

The Homoth rhinomanometer was used. This rhinomanometer is a part of a multi-functional diagnostic device "HNO Diagnostik Center" produced by Homoth, Germany. The study was performed outside the pollen season. After a 30-min acclimatisation to the examination room, in each patient five measurements in ten-minutes intervals were carried out. The nasal resistance during inspiration and expiration was measured at the differential pressure of 150 Pa. Immediately after the second measurement, the patients who were before qualified to the SIT, received an initial dose of pollen vaccine "Catalet - T" (Biomed, Krakow) in amount of 0.1 ml 25 PNU solution, i. e. 2.5 biological units. After 10, 20, and 30 minutes the patients underwent subsequent rhinomanometric measurements. Because of the small size of the group tested, the data obtained were tested statistically with the use of the small sample paired signs test [3].

Results

The results of systemic antigen administration in the group tested are shown Table 1. In the tested group the only statistically significant (p=0.05) difference was observed between the nasal inspiratory flow values at the start of the experiment (Median=779 cm³ x s^-1) and after 30 minutes since the antigen administration (Median = 740.5 cm³ x s^-1). Analysis of the graph (Fig. 1) suggests that because of a considerable variability of the parameters measured the conclusions should be drawn with caution. In none of the patients any side effects after receiving the immunotherapy were observed. None had complained of feeling any nasal blockage either.

Table 1. The influence of systemic antigen application on the nasal patency

					Measurement (minute of observation)
					1 (0. min)		2 (10. min)		3 (20. min)		4 (30. min)		5 (40. min)
No	Sex			Age	Ins	Exp	Ins	Exp	Ins	Exp	Ins	Exp	Ins	Exp
1	M			30	616	570	637	670	490	357	409	496	444	464
2	F			43	615	638	553	723	417	789	333	763	630	858
3	F			18	797	799	776	806	793	843	804	855	762	832
4	M			18	805	742	648	788	658	812	701	682	746	485
5	F			16	786	726	722	694	772	747	785	747	735	711
6	M			33	934	908	884	897	762	718	585	548	859	805
7	M			8	532	578	640	638	604	536	524	518	466	504
8	M			7	772	728	812	756	835	800	768	721	643	590
9	M			14	693	695	715	669	777	811	789	819	691	710
10	M			26	791	834	805	897	786	763	604	700	771	842
11	F			6	375	372	488	428	329	392	400	354	377	398
12	M			12	656	659	668	589	692	735	764	850	758	753
13	F			35	822	770	800	881	821	830	771	758	800	809
14	F			17	843	871	785	919	828	871	784	823	748	815
15	F			31	844	803	818	785	817	807	809	779	782	788
16	M			25	595	606	594	501	524	575	644	537	593	513
Median					779	727	718.5	739.5	767	776	732.5	734	740.5	732
Minimum					375	372	488	428	329	357	333	354	377	398
Maximum					934	908	884	919	835	871	809	855	859	858
1, 2, 3, 4, 5 - results of subsequent measurements in 10-minutes intervals; Ins- total nasal flow during inspiration at differential pressure of 150 Pa, the value was computed by adding the right- and left-side nasal flow measured during the inspiration; Exp - total nasal flow during expiration at differential pressure of 150 Pa, the value was computed by adding the right- and left-side nasal flow measured during the expiration

Figure 1. Median changes of the total inspiratory and expiratory flow values at the differential pressure of 150 Pa in patients receiving the SIT using "Catalet - T" desensitising vaccine

Discussion

The presented study was performed in patients at the beginning of their immunotherapy. Therefore, it can be assumed that the patients reactions were typical for the "natural" hypersensitivity. Ghaem et al. [2] observed correlation between specific IgE concentration and the nasal resistance increase during the allergen exposure. As shown in Table 1, 30 minutes after systemic application of the allergen a slight decrease of nasal patency was noted in the observed group. These data suggest that after the allergen application the nasal patency changes are very small and should not cause a relevant - from the patient's point of view - decrease of nasal comfort. Topically the airborne allergens cause an allergic reaction in the nasal mucosa which results in a nasal patency decrease [5]. In the presented study the allergen is carried by blood to the target organ. In the literature, the possibility of causing the allergic rhinitis by food allergens in the same way is discussed [4]. In both cases antigens pass to the nasal mucosa through blood.

The described observations are based on examination of the small group. If, however, they were confirmed in a larger population, it would mean that even a minimal allergen dose (2-3 biological units) having no effects on what a patient feels (no skin reaction in the application site, no systemic reactions), causes a detectable reaction in the shock organ. Without further research it would be difficult to foresee, whether expected diminishing of this phenomenon during the immunotherapy could be a sign of successful desensitization [1] or rather a sign suggesting that a too small dose had been administered [6]. Besides the nasal patency measurement, also other monitoring methods should be used parallelly e.g. specific IgG4 level determination [6] or, far less expensive and easy to perform, skin tests.

Conclusion

Rhinomanometry may be helpful as a monitoring method during the specific immunotherapy.

References

1. Clarke PS. Titration of immunotherapy by periodical nasal allergic challenges in the treatment of allergic rhinitis. Med J Aust 1992, 157, 11-13.
2. Ghaem A., Dessanges J.P., Lockhart A., Martineaud J.P. Exploration par rhinomanometrie des malades atteints d'allergie respiratoire. Bull Eur Physiopathol Respir 1986, 22, 443-449.
3. Miller T., Orzeszyna S. (Ed.) Elementy Statystyki Medycznej. PZWL, Warszawa 1982.
4. Pelikan Z. Nasal response to food ingestion challenge. Arch Otolaryngol Head Neck Surg 1988, 114, 525-530.
5. Skoner D.P., Lee L., Doyle W.J., Boehm S., Fireman P. Nasal physiology and inflammatory mediators during natural pollen exposure. Ann Allergy 1990, 65, 206-210.
6. Willoughby J.W. New concepts in immunotherapy. Otolaryngol Clin North Am 1992, 25, 71-100.

For personal use only. © Radoslaw Spiewak.
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