Specific nasal challenge in the diagnosis of alternaria-induced asthma

Background: Allergic sensitization to Alternaria has been identified as a risk factor for the development and persistence of asthma and is associated with severe and life-threatening episodes. The interaction between upper and lower airways has not been investigated for Alternaria. Aims and objectives: To investigate whether specific nasal challenge with Alternaria allergen can be used as a diagnostic tool for Alternaria-induced asthma. Patients and methods: The study included 15 adults patients with mild, allergic asthma sensitive to Alternaria and two control groups: 1) 8 patients with mild, allergic asthma non-attributed to Alternaria and 2) 7 healthy controls. Diagnosis of asthma was already established by positive both reversibility and methacholine test. Two nasal provocation tests were performed, one with normal saline (placebo) and another with Alternaria antigen (specific nasal challenge, SNC) performed at two different days. FEV 1 was measured during a 12-hour period, at 18 time points (10, 20, 30, 40, 50, 60, 90, 120, 180, 240, 300, 360, 420, 480, 540, 600, 660, 720 minutes) after nasal provocation. Results: A significant FEV 1 decline >20% from baseline (26.02±2.38%) was recorded after SNC (p Conclusions: Specific nasal challenge could be a reliable and specific tool for the diagnosis of Alternaria-induced asthma, alternatively to bronchial challenge, in case confirmation of mould implication is necessary.