To examine the accuracy of nasal allergic disease, we examined the results of skin tests, measurement of serum specific IgE (RAST), and the nasal response to nasal challenge in 886 patients clinically suspected of having allergic respiratory disease. Nasal responses were assessed by measuring nasal airway resistance by both active anterior and posterior rhinomanometry. Nasal airway resistance was determined 25 min. after intranasal nebulization of saline solution and after administration of increasing doses of allergen (maximum dose = 280 micrograms). The dose of allergen causing a 100% increase over the value obtained after saline (Ri) at a flow rate of 0.15 l.s-1 was taken as the threshold dose (Dl). Our findings were that active anterior and posterior rhinomanometry yield comparable results; in subjects with a positive response to antigen challenge, the increase in nasal airway resistance correlated well with the dose of allergen administered and a significant inverse relationship was found between Ri and Dl; 3) a high level of serum specific IgE accurately predicted nasal responsiveness to a particular allergen, whereas skin tests were often positive to allergens that had no detectable effect on the nasal resistance. We conclude that nasal allergen provocation tests with rhinomanometric measurement of nasal resistance is a useful procedure for diagnosis of nasal allergic disease.
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