Abstract / Summary
Fei Ye,1– 3,* Mei Ni,4,* Qiuyan Shen,5,* Zhihui Xu,2,3 Jiance Rong,2 Ji Wang,6 Hui Gan7,81Department of Otolaryngology, Huangpu People’s Hospital of Zhongshan, Zhongshan, Guangdong, People’s Republic of China; 2Department of Allergy and Department of Otolaryngology Head and Neck Surgery, Zhongshan People’s Hospital, Zhongshan, Guangdong, People’s Republic of China; 3Faculty of Chinese Medicine, Macau University of Science and Technology, Macao, People’s Republic of China; 4Department of Ophthalmology, Zhongshan Shiqi Suhuazan Hospital, Zhongshan, Guangdong, People’s Republic of China; 5Medical School, Shenzhen University, Shenzhen, Guangdong, People’s Republic of China; 6National Institute of TCM Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 7Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China; 8Institute of Allergy, Wuhan University, Wuhan, Hubei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hui Gan, Department of Dermatology, Zhongnan Hospital of Wuhan University, No. 195, Donghu Road, Wuchang District, Wuhan, 430000, People’s Republic of China, Tel +86013207161660, Email hustgh@hotmail.comBackground: Nasal secretion specific IgE (sIgE) may reflect local mucosal reactivity in allergic rhinitis (AR), but its diagnostic performance against nasal provocation remains uncertain.Objective: To evaluate nasal secretion Dermatophagoides pteronyssinus–specific IgE (Der p sIgE) for house dust mite (HDM)-related AR and its associations with nasal sensitivity and systemic sensitization.Methods: In this single-center cross-sectional diagnostic-accuracy study, 139 consecutive participants referred for suspected HDM-related AR underwent standardized HDM nasal provocation testing (NPT); after exclusion of 24 participants, 115 were included and classified as AR (positive NPT: Lebel score ≥ 5 with typical perennial rhinitis; n = 88) or non-AR controls (negative NPT, no typical history; n = 27). Nasal secretions were collected non-invasively with sterile cotton wool in one nostril for 15 min, and Der p sIgE was quantified in the eluate by chemiluminescent immunoassay (NOVEOS), with serum IgE on the same platform. Diagnostic accuracy was assessed by the area under the ROC curve (AUC).Results: Nasal Der p sIgE was higher in AR than controls (1.14 vs 0.03 kUA/L; P < 0.001); AUC was 0.84 (95% CI 0.76– 0.91). At ≥ 0.1 kUA/L, sensitivity was 80.7% and specificity 66.7%; at ≥ 3.5 kUA/L, observed specificity was 100.0% (95% CI 87.5– 100.0). Systemic HDM sensitization was present in 88/88 AR participants and 10/27 controls. Nasal Der p sIgE rose with nasal sensitivity (P < 0.001) and correlated with NPT score (ρ = 0.37), serum total IgE (ρ = 0.47), and serum Der p sIgE (ρ = 0.42; all q < 0.001).Conclusion: Non-invasively collected nasal Der p sIgE distinguished HDM-related AR from non-AR controls and tracked the intensity of local nasal reactivity. It may serve as a potential non-invasive adjunct to NPT, pending prospective validation.Keywords: allergic rhinitis, nasal provocation test, local IgE, nasal secretion, house dust mite, non-invasive diagnosis