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c) Allergens Paper by Augé et al. , which was based on
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The allergens are available in the form of the Total Nasal Symptom Score as well as the
standard solutions. The solutions used in the Linder and Lebel scores, and considers five
NAPT should be isotonic and at neutral pH 15,19-20 . symptoms: sneezing, nasal itching, rhinorrhea,
nasal congestion, and ocular symptoms (Table
d) Allergen administration technique 4). The reported symptoms are classified
The most reproducible and easiest form of according to the severity described by the
allergen administration is the nasal spray, patient (0 – none; 1 – mild; 2 – moderate; 3 –
because it allows the delivery of a similar severe). The scores given to each symptom
standard amount of the allergen to patients, are added to obtain the total score, which is
with a precise dose of 50 µL per spray being compared before and after the NAPT.
administered. Allergen administration is Table 4
performed with two sprayings in each nostril, NAPT: Subjective criteria
one at the level of the inferior meatus and
the other toward the middle meatus 19-20 . Subjective criteria
Inclination toward the nasal septum should Nasal congestion
be avoided. The following measures should Rhinorrhea
be taken during spray application to prevent Sneezing
allergens from reaching the lower airway:
1. Deep inhalation, 2. Stop breathing during Nasal itching
spray application, 3. Deep exhalation after Ocular symptoms
spray application 15,19 .
Nasal permeability is evaluated using the
e) Evaluation of the results following objective methods: peak nasal
All patients undergo an evaluation through inspiratory flow (PNIF), active anterior
a questionnaire on symptoms, rhinoscopy, rhinomanometry, acoustic rhinometry, or
anterior rhinomanometry, and/or acoustic four-phase rhinomanometry 19 (Table 5). In
rhinometry to establish the patient’s baseline this protocol, the authors used active anterior
status. After the period of adjustment in the rhinomanometry due to its sensitivity and
test room, a test is performed with saline high specificity and because it is the standard
solution (two sprayings in each nostril) to internationally accepted method for the
exclude hyperreactivity of the nasal mucosa. objective assessment of nasal permeability .
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The parameters of the baseline evaluation are The evaluation of nasal permeability through
retested 10-15 minutes after this initial test. active anterior rhinomanometry is performed
If no changes occur, the NAPT can then be before NAPT and is repeated 10 minutes after
performed. The parameters are reevaluated it. Then, the variation in nasal permeability
10-15 minutes after allergen provocation. between the two tests is determined.
When the test is finished, the patients remain The NAPT is considered positive (Table 6) when
under observation for 30 minutes to check for one of the following criteria is met :
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any allergic reaction. - Significant change in the subjective
parameters (≥5);
f) Criteria of positivity in the NAPT - Significant change in the objective
For evaluating the response to the NPT, both parameters (≥40%);
subjective (symptoms) and objective (nasal - Moderate changes in the subjective (≥3) and
permeability) parameters after allergen objective (≥20%) parameters.
provocation are considered.
The ideal assessment of the subjective
parameters is that proposed in the Position
66 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
