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Nasal Hyperreactivity: Nonspecific Nasal Provocation Tests. Review by the Rhinoconjunctivitis Committee of the Spanish Society of Allergy and Clinical Immunology


M Lluch-Bernal1,2, Dordal MT3,4, Antón E5, Campo P6, Colás C7, Dávila I8, Del Cuvillo Bernal A9, Fernández-Parra B10, González R11, González ML12, Matheu V11, Montoro J13, Panizo C14, Rondón C6,15, Sánchez MC16, Valero A17, Vega F18, Velázquez E19, Navarro A20 (SEAIC 2010 Rhinoconjunctivitis Committee)

1Department of Allergology, Hospital La Paz, Madrid, Spain
2Department of Allergology, Hospital Virgen Del Valle, Toledo, Spain
3Department of Allergology, Hospital Municipal Badalona, Spain
4Department of Allergology, Sant Pere Claver Fundació Sanitària, Barcelona, Spain
5Department of Allergology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
6UGC Allergy IBIMA-Hospital Regional, UMA, Malaga, Spain
7Department of Allergology, Hospital Clínico Universitario Zaragoza, Zaragoza, Spain
8Department of Allergology, Hospital Universitario IBSAL, Salamanca, Spain
9Asthma and Rhinitis Unit Department of Otorhinolaryngology, Hospital de Jerez, Cadiz, Spain
10Department of Allergology, Hospital El Bierzo, Ponferrada, León, Spain
11Department of Allergology Hospital del Tórax/Ofra, HUNS La Candelaria, Tenerife, Spain
12Department of Allergology, Hospital Clínico San Carlos, Madrid, Spain
13Allergy Unit, Hospital Universitario Arnau de Vilanova Facultad de Medicina, Universidad Católica de Valencia "San Vicente Martir," Valencia, Spain
14Department of Allergology, Hospital Nuestra Señora del Prado, Toledo, Spain
15Department of Allergology, Hospital Carlos Haya Málaga, Spain
16Departmentof Allergology, CE Virgen de la Cinta Huelva, Spain
17Allergy Unit, Department of Pneumology and Allergy, Hospital Clínic i Universitari Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES Barcelona, Spain
18Department of Allergology, Hospital de la Princesa, Instituto de Investigación Sanitaria Princesa (IP) Madrid, Spain
19Quiron Sagrado Corazón, Sevilla, Spain
20UGC-IC Alergología Sevilla, Hospital el Tomillar, Sevilla, Spain

J Investig Allergol Clin Immunol 2015; Vol. 25(6): 396-407



Nasal hyperreactivity is the abnormal reaction of nasal tissue to a stimulus that is innocuous to most people. This response is caused by dysregulation of the autonomic nervous system at various levels of the nasal autonomic reflex arc. Various stimuli (methacholine, histamine, adenosine 5´-monophosphate, cold air, mannitol, capsaicin, phentolamine, and distilled water) have been used in an attempt to find the test that most reliably differentiates between healthy individuals and patients and also between different types of rhinitis. Despite the small number of publications available, in the present review, we provide an update on current nonspecific nasal provocation techniques.
The studies published to date are not comparable: the stimuli applied act through different mechanisms and are used to assess different pathways, and the methodologies differ in terms of selection of participants, concentrations used, and assessment of response (criteria for positivity). Given the limited use of nonspecific nasal provocation tests in routine clinical practice, we believe that more studies are warranted to address the research issues we present at the end of the present review, for example, the need to standardize the methodology for each test or even the clinical benefits of knowing whether or not a patient has nasal hyperreactivity.

Key words: Nasal provocation. Nasal hyperreactivity. Rhinitis. Methacholine. AMP. Histamine. Mannitol. Cold air.