Page 64 - Portuguese Journal - SPORL - Vol 61. Nº1

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Table 2 also be used in other clinical situations (Table
Clinical manifestations of local allergic rhinitis 3). There are absolute contraindications for
performing the NAPT, including acute viral
Local Allergic Rhinitis – Clinical manifestations
or bacterial rhinosinusitis, acute exacerbation
Anterior rhinorrhea
of the allergic disease, previous anaphylactic
Sneezing reaction to an allergen, systemic diseases with
Nasal itching reduced lung capacity, and pregnancy. Relative
Nasal congestion contraindications that warrant the delay of
NAPT are as follows: episodes of AR exacerbation
4. Diagnosis: (wait 2-4 weeks), nasal surgery (wait 6-8 weeks),
Some manifestations of NAR mimic symptoms and treatment with: antihistaminic drugs (wait 3
of AR but it is very important to distinguish days), topical nasal corticosteroids (wait 1 week),
them because the treatment approach of oral corticosteroids at a dose higher than 10
these two conditions may differ. mg (1-2 weeks), nonsteroidal anti-inflammatory
Rondón et al. proposed a new diagnostic drugs (1 week), centrally acting antihypertensives
11
approach in patients with symptoms of AR
who have a negative SPT and sIgE (Figure 1). Table 3
The diagnosis of LAR can be confirmed through Indications for performing the NAPT
the detection of IgE in nasal secretions and/or Indications for performing the nasal
through a positive response to NAPT. However, allergen provocation test (NAPT) 19
NAPT is the gold standard method for the Diagnosis:
diagnosis of LAR due to its high specificity, Persistent allergic rhinitis
sensitivity, and reproducibility 3-6,8 .
Intermittent allergic rhinitis

4.1 NAPT: Local allergic rhinitis
The NAPT is a safe and well tolerated Occupational allergic rhinitis
technique, both through nasal administration Correlation with extra-nasal symptoms
and using a micropipette . This technique Differential diagnosis of ocular symptoms
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has high diagnostic precision, because of Increasing the evidence for the diagnosis
the standardized and validated method for of food allergies
the cut-off parameters . In addition to being Clinical monitoring of the efficacy

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used for the diagnosis of LAR, the NAPT can of immunotherapy

Figure 1
Diagnostic approach to local allergic rhinitis

Abbreviations: SPT, skin prick tests; sIgE, serum levels of Immunoglobulin E specific for inhaled allergens;
NAPT, nasal allergen provocation test; “-“if negative; “+”if positive

64 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery