Review of Symptoms Assessment During Nasal Allergen Provocation in Patients with Allergic Rhinitis

Akli Zetchi, Marie-Claire Rousseau, Annie LeBlanc, Marie-Eve Boulay, Louis-Philippe Boulet*
Institut universitaire de cardiologie et de pneumologie de Quebec, 2725, Chemin Ste-Foy, Quebec, Canada, G1V 4G5, Canada.

© 2010 Zetchi et al;

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Institut universitaire de cardiologie et de pneumologie de Quebec, 2725, Chemin Ste-Foy, Quebec, Canada, G1V 4G5, Canada; Tel: 418-656-4747 Fax: 418-656-4762; E-mail:


Background: Allergic rhinitis is the most prevalent allergic disease. Nasal provocation tests (NPTs) may be useful for its clinical diagnostic and therapy monitoring although they are mostly used in clinical research. However, the lack of standardisation in the symptoms assessed and the variety of instruments used make effective comparison between studies difficult. Objective: To review the published literature searching for instruments assessing nasal symptoms during NPTs for allergic rhinitis. Methods: Pubmed and Embase electronic databases were reviewed, looking for all methods including an instrument assessing symptoms during or following NPTs. Studies on animal models, pediatric subjects, and patients without allergic rhinitis were excluded. Studies were also excluded if they did not assess nasal symptoms during or following the NPT. Only NPT studies performed with allergen extracts or histamine were included. Results: A total of 520 studies were retrieved, from which 81 different instruments from 81 studies were included in the present analysis. There was no instrument reporting a validation process for the assessment of symptoms during NPTs. From the remaining instruments, the most common symptoms assessed were rhinorrhea (67), sneezing (70), congestion (67), and nasal pruritus (50). The most frequently used type of scales among those instruments was the four-point Likert scale (39), although different methods were used. Conclusions: This review illustrates the large variety of symptoms and methods used to assess the aforementioned NPTs. The lack of validation studies suggests the need to develop and validate a standardized instrument assessing symptoms following NPTs.

Keywords: Rhinitis, symptoms, symptom score, allergen challenge, nasal provocation test.