Volume 97, Issue 1, Pages 30-36 (January 2003)

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ABSTRACT

ABSTRACT + REFS

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Discriminant analysis in allergic rhinitis and asthma: methacholine dose–response slope allows a good differentiation between mild asthma and rhinitis

Received 5 November 2001; accepted 1 July 2002.

Abstract

Asthma and rhinitis frequently coexist in allergic patients, but nasal symptoms may predominate, leading to asthma underdiagnosis and undertreatment. Discriminant analysis obtains the best differentiation between groups using one or one set of variables. Our aim was to identify the laboratory test [allergen exposure, total and specific serum IgE, lung function, blood eosinophils and, bronchial response and sensitivity to methacholine (Mth) and allergen] or combination of them that allowed the best differentiation between mild asthma and allergic rhinitis. A cross-sectional analysis was performed in 86Dermatophagoides pteronyssinus allergic rhinitis patients, who were classified according to clinical data as rhinitis plus mild asthma (n =62) or “pure” rhinitis (n =24). Bronchial symptoms had been exhaustively evaluated during a 2-years pre-inclusion period. Patients underwent skin tests and bronchial challenge with Mth and allergen. The exposure toD. pteronyssinus allergen (Der p1) was quantified in dust samples. Dose–response curves with Mth [until the FEV1 fell by 40% or the maximal dose (200mg/ml) was inhaled] were attained. We developed multiple models of discriminant analysis in order to evaluate the capacity of the above variables to differentiate groups. Asthma patients had higher total and specific IgE levels and a greater sensitivity (PD20 values) and response [dose–response slope (DRS)] to both Mth and allergen. The model entering these variables was the one that correctly classified more patients (79.2%). The discriminative power of the model that only included Mth-DRS values was similar to the above (78.8%). Bronchial response to Mth is quantitatively different in allergic rhinitis patients who display mild asthma symptoms when compared to those that only report rhinitis, suggesting a distinct bronchial intrinsic behavior. The utilization of complete dose–response curves with Mth allows a good separation between mild asthma and “pure” rhinitis patients and might be useful in the diagnosis of mild asthma. Whether the early detection and treatment of these patients prevents the development of symptomatic asthma needs further evaluation.

Keywords: allergen, bronchial challenge, discriminant analysis, dose–response slope, methacholine, mild asthma, rhinitis.

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References

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Department of Allergy, Hospital Virgen del Camino, Pamplona, Spain

f1 Correspondence should be addressed to: Dr M. J. Alvarez Puebla, Servicio de Alergologı́a, CS Conde Oliveto, Plaza de la Paz SN, 31002 Pamplona, Spain. Fax: +34 948 429271; E-mail: jmolaguibel@telefonica.net

PII: S0954-6111(02)91420-4

doi:10.1053/rmed.2002.1420

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