Main Article Content
Bermuda grass, dessert environment, nasal challenge test, skin prick test.
Background and aim: Skin prick test (SPT) with a wheal diameter of >3 mm, generally accepted as a positive, is most commonly use diagnostic tool for Allergic rhinitis. Aim was to validate wheal size of Skin Prick Test for the Bermuda grass, in desert environment, with positive Bermuda grass Nasal challenge in same environment.
Methods: In 53 adults, mean age 33.43 ± 9.36 years, both gender (females: 33.96%), SPT positive on Bermuda grass, on cut off wheal longest diameter of 3 mm, Bermuda grass nasal challenge test (bgNCT) was carried out. Response was assessed subjectively (scored) and objectively (PNIF). Safety profile was assessed by PEF measurement.
Results: Mean weal size of SPT (mm) was bigger in bgNCT positive patients (n=47; 88.68%) 8 [4, 15] vs 5 [3, 6] (p<0.0001). ROC analysis showed Bermuda Grass SPT at the threshold of >6.5 enabled identification of Bermuda challenge with sensitivity of 82.98% and specificity of 100.0% (area under the curve 0.9326, standard error 0.03528; 95% confidence interval (CI): 0.8635 to 1.002; p=0.0006203).
Conclusions: A SPT wheal size ≥6.5 might be considered as an appropriate wheal size for confirming Bermuda grass allergy in adults with SAR, avoiding the demanding, time consuming and often unavailable bgNCT, especially in patients eligible for allergen immunotherapy. In these patients, bgNCT is recommended if SPT wheal size is <6.5 mm.
2. Behbehani N, Arifhodzic N, Al-Mousawi M, Marafie S, Ashkanani L, Moussa M, et al. The seasonal variation in allergic rhinitis and its correlation with outdoor allergens in Kuwait. Int Arch Allergy Immunol. 2004; 133(2): 164-7.
3. D'Amato G, Cecchi L, Bonini S, Nunes C, Annesi-Maesano I, Behrend H, et al. Allergenic pollen and pollen allergy in Europe. Allergy. 2007. 62(9): 976-90.
4. Al-Dowaisan A, Fakim N, Khan MR, Arifhodzic N, Panicker R, Hanoon A, et al. Salsola pollen as a predominant cause of respiratory allergies in Kuwait. Ann Allergy Asthma Immunol. 2004; 92(2): 262-7.
5. Dowaisan A, Al-Ali S, Khan M, Hijazi Z, Thomson MS, Ezeamuzie CI. Sensitization to aeroallergens among patients with allergic rhinitis in a desert environment. Ann Allergy Asthma Immunol. 2000; 84(4): 433-8.
6. Almogren A. Airway allergy and skin reactivity to aeroallergens in Riyadh. Saudi Med J. 2009; 30(3): 392-6.
7. Aalberse RC. Clinically significant cross-reactivities among allergens. Int Arch Allergy Immuno. 1992; 99: 261-4.
8. Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, et al. The skin prick test - European standards. Clin Transl Allergy. 2013; 3(1): 3.
9. Hong SD, Ryu G, Seo MY, Jeong JI, Kim HY, Chung SK, et al. Optimal cutoff values of allergen-specific immunoglobulin E to house dust mites and animal dander based on skin-prick test results: Analysis in 16,209 patients with allergic rhinitis. Am J Rhinol Allergy. 2018; 32(1): 23-6.
10. Bernstein IL, Li JT, BernsteinDI, Hamilton R, Spector SL, Tan R, et al. American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology. Allergy Diagnostic Testing: An Updated Practice Parameter. Ann Allergy Asthma Immunol. 2008; 100(3 Suppl 3): S1-148.
11. Bousquet PJ, Chatzi L, Jarvis D, Burney P. Assessing skin prick tests reliability in ECRHS-I. Allergy. 2008. 63(3): 341-6.
12. Gungor A, Houser SM, Aquino BF, Akbar I, Moinuddin R, Mamikoglu B, et al. A comparison of skin endpoint titration and skin-prick testing in the diagnosis of allergic rhinitis. Ear Nose Throat J. 2004; 83(1): 54-60.
13. Nevis IF, Binkley K, Kabali C. Diagnostic accuracy of skin-prick testing for allergic rhinitis: a systematic review and meta-analysis. Allergy Asthma Clin Immunol. 2016; 12: 20.
14. Sin AZ, Ersoy R, Gulbahar O, Ardeniz O, Gokmen NM, Kokuludag A. Prevalence of Cypress Pollen Sensitization and Its Clinical Importance in Izmir, Turkey, With Cypress Allergy Assessed by Nasal Provocation. J Investig Allergol Clin Immunol 2008; 18(1): 46-51.
15. Zarei M, Remer CF, Kaplan MS, Staveren AM, Lin CK, Razo E, et al. Optimal skin prick wheal size for diagnosis of cat allergy. Ann Allergy Asthma Immunol. 2004; 92(6): 604-10.
16. Carr WW, Martin B, Howard RS, Cox L, Borish L. Immunotherapy Committee of the American Academy of Allergy, Asthma and Immunology. Comparison of test devices for skin prick testing. J Allergy Clin Immunol 2005; 116(2): 341-6.
17. Choi IS, Kim SJ, Won JM, Park MS. Usefulness of House Dust Mite Nasal Provocation Test in Asthma. Allergy Asthma Immunol Res. 2017; 9(2): 152-7.
18. Rondon C, Canto G, Blanca M. Local allergic rhinitis: a new entity, characterization and further studies. Curr Opin Allergy Clin Immunol 2010; 10: 1-7.
19. Scadding GW, Eifan A, Penagos M, Dumitru A, Switzer A, McMahon O, et al. Local and systemic effects of cat allergen nasal provocation. Clin Exp Allergy. 2015; 45(3): 613-23.
20. Augé J, Vent J, Agache I, Airaksinen L, Campo Mozo P, Chaker A, et al. EAACI Position paper on the standardization of nasal allergen challenges. Allergy. 2018; 73(8): 1597-608.
21. Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Im-munol. 2017; 140(4): 950-8.
22. Tiwari R, Bhalla PL, Singh MB. Mapping of IgE-binding regions on recombinant Cyn d 1, a major allergen from Bermuda Grass Pollen (BGP). Clin Mol Allergy. 2009; 7:3.
23. Al-Nesf MA, Gharbi D, Mobayed HM, Dason BR, Ali RM, Taha S et al. The association between airborne pollen monitoring and sensitization in the hot desert climate. Clin Transl Allergy.2020; 10:35.
24. Martin BG, Mansfield LE, Nelson HS. Cross-allergenicity among the grasses. Ann Allergy. 1985; 54(2): 99-104.
25. Boelke G, Berger U, Bergmann KC, Bindslev-Jensen C, Bousquet J, Gildemeister J, et al. Peak nasal inspiratory flow as outcome for provocation studies in allergen exposure chambers: a GA2LEN study. Clin Transl Allergy. 2017; 7: 33.
26. Tehrani M, Sankian M, Assarehzadegan MA, Falak R, Jabbari F, Varasteh A. Immunochemical characterization of Amaranthus retroflexus pollen extract: extensive cross- reactive allergenic components among the four species of Amaranthaceae/Chenopodiaceae. Iran J Allergy Asthma Immunol. 2010; 9(29): 87-95.
27. Til-Pérez G, Carnevale C, Sarría-Echegaray PL, Arancibia-Tagle D, Chugo-Gordillo S, Tomás-Barberán MD. Sensitization profile in patients with respiratory allergic diseases: differences between conventional and molecular diagnosis (a cross-sectional study). Clin Mol Allergy. 2019; 17: 8.
28.Wang X, Du K, She W, Ouyang Y, Sima Y, Liu C, et al. Recent advances in the diagnosis of allergic rhinitis. Expert Rev Clin Immunol. 2018; 14(11): 957-64.
29.Demoly P, Bousquet J, Romano A. In vivo methods for the study of allergy. In: Adkinson NF Jr, Bochner BS, Busse WW, Holgate ST, Lemanske RF Jr, doi: 10.1186/s12948-019-0112-4. eCollection 2019.
30. Zhang H, Karmaus W, Gan J, Bao W, Zhao YD, Rahardja D, et al. Adjusting wheal size measures to correct atopy misclassification. Int J Gen Med. 2011; 4: 597-606.
31. Konstantinou GN, Bousquet PJ, Zuberbier T, Papadopoulos NG. The Longest Wheal Diameter Is the Optimal Measurement for the Evaluation of Skin Prick Tests. Int Arch Allergy Immunol. 2010; 151(4): 343-5.
32. Haxel BR, Huppertz T, Boessert P, Bast F, Fruth K. Correlation of skin test results and specific immunoglobulin E blood levels with nasalprovocation testing for house-dust mite allergies. Am J Rhinol Allergy. 2016; 30(1): 60-4.
33. Haxel BR, Huppertz T, Boessert P, Bast F, Fruth K. Correlation of skin test results and specific immunoglobulin E blood levels with nasalprovocation testing for house-dust mite allergies. Am J Rhinol Allergy. 2016; 30(1): 60-4.
34. Chusakul S, Phannaso C, Sangsarsri S, Aeumjaturapat S, Snidvongs K. House-dust mite nasal provocation: a diagnostic tool in perennial rhinitis. Am J Rhinol Allergy. 2010; 24(2): 133-6.
35. Karakaya G, Ozturk ab, Kalyoncu AF. Prediction of atopy by skin prick tests in patients with asthma and/or persistent rhinitis. Allergol Immunopathol (Madr). Allergol Immunopathol (Madr). 2012; 40(1): 37-40.
36. Al-Ahmad M, Jusufovic E, Arifhodzic N, Nurkic J, Hanoun AL. Sensitization to Cat: When Is Nasal Challenge Needed? Int Arch Allergy Immunol. 2019; 179(2): 108-13.
37. de Blay F, Doyen V, Lutz C, Godet J, Barnig C, Qi S, Braun JJ. A new, faster, and safe nasal provocation test method for diagnosing mite allergic rhinitis. Ann Allergy Asthma Immunol. 2015 Nov;115(5):385-390.e1.
38. Tantilipikorn P, Vichyanond P, Lacroix JS. Nasal provocation test: how to maximize its clinical use? Asian Pac J Allergy Immunol. 2010 Dec;28(4):225-31.