Am. J. Respir. Crit. Care Med.,
Volume 157, Number 6, June 1998, 1748-1755
Intranasal Cold Dry Air Is Superior to Histamine
Challenge in Determining the Presence and Degree of
Nasal Hyperreactivity in Nonallergic Noninfectious
Perennial Rhinitis
JOSEPH P. M.
BRAAT,
PAUL G.
MULDER,
WYTSKE J.
FOKKENS,
ROY GERTH
van WIJK,
and
EVERT
RIJNTJES
Departments of Ear, Nose and Throat Surgery, Biostatistics, and Allergology, Erasmus University Rotterdam and University Hospital
`Dijkzigt,' Rotterdam; and Department of Ear, Nose and Throat Surgery, Leyenburg Hospital, The Hague, The Netherlands
The objective of the study was to compare cold dry air (CDA) and histamine in differentiating patients with nonallergic noninfectious perennial rhinitis (NANIPER) from control subjects. Nasal reactivity (nasal patency, mucus production, and sneezing) in 16 symptomatic nonsmoking patients with
NANIPER and seven nonsmoking control subjects was measured with standardized CDA and histamine provocation series in a randomized crossover study. Intranasal CDA resulted in increased mucus
production and nasal blockage in a dose-dependent manner in patients with NANIPER but not in
control subjects. Sneezing did not occur. The reproducibility of CDA for patency and mucus production was good. Sensitivity for CDA was 87% compared with 100% for histamine. However, specificity
was 71% for CDA and 0% for histamine. It is concluded that the new standardized intranasal CDA
provocation method uses a recognizable natural nonspecific stimulus and seems to be more suitable
than histamine for characterizing and assessing the presence and degree of nasal reactivity in NANIPER.
