Clinical practice guideline for nasal allergen provocation test in children (2025)

In recent years, the incidence of pediatric allergic rhinitis (AR) has continued to increase, severely affecting children's sleep quality, cognitive development, learning, and daily life, while also imposing a growing burden on health care from families and the healthcare system. The nasal allergen provocation test (NAPT), as an important tool for assessing nasal mucosal reactivity to allergens, plays a critical role in the diagnosis of AR and local allergic rhinitis (LAR), and it is significantly valuable in guiding individualized treatment strategies. However, the clinical application of NAPT in the pediatric population in China currently lacks unified standards, limiting its widespread adoption and standardized implementation in clinical practice. To promote the standardized application of NAPT in the diagnosis and management of pediatric AR in China, this guideline was jointly initiated by multiple national authoritative organizations, including experts in otorhinolaryngology, allergy, pediatrics, and methodology, who collaborated using a multidisciplinary nominal group approach to develop this guideline. This guideline systematically addresses the clinical indications and contraindications of NAPT, provocation agents, administration methods, operational procedures, assessment approaches, result interpretation, and safety management, aiming to provide clinicians with a scientific, practical, and highly applicable guideline, improve the accuracy of pediatric AR diagnosis, and offer strong support for the implementation of individualized and standardized management of pediatric AR.

近年来，儿童变应性鼻炎（allergic rhinitis，AR）的发病率持续上升，严重影响患儿的睡眠质量、认知发育、学习与生活，同时亦加重家庭与社会医疗负担。鼻腔变应原激发试验（nasal allergen provocation test，NAPT）作为评估鼻腔黏膜对变应原反应性的重要检查手段，在确诊AR、局部变应性鼻炎（local allergic rhinitis，LAR）以及指导个体化治疗等方面具有重要价值。然而，目前我国儿童群体中NAPT的应用尚缺乏统一规范，限制了其临床规范化开展。为推进NAPT在我国儿童AR诊疗中的标准化应用，由国内多家权威单位联合发起，组织耳鼻咽喉科、变态反应科、儿科及方法学专家，采用多学科名义群体法共同制定本指南。指南围绕NAPT的临床价值、适应证、禁忌证、激发试剂选择、给药方式、操作流程、评估方法、结果判读及安全管理等方面进行了系统阐述，旨在为相关专业临床医师提供科学、实用且可操作性强的实践指南，提升儿童AR的精准诊断水平，为实现儿童AR个体化、规范化管理提供有力支撑。.