Nasal Versus Conjunctival Allergen Provocation Tests: Diagnostic Performance and Clinical Utility in Respiratory Allergy.
Nasal allergen challenge test showed good discrimination for olive pollen allergy diagnosis
Nasal Versus Conjunctival Allergen Provocation Tests: Diagnostic Performance and Clinical Utility in Respiratory Allergy.
Respiratory allergic diseases are highly prevalent and often underdiagnosed, requiring diagnostic approaches that reflect clinically relevant allergic responses.
Eighty participants (50 patients with respiratory allergy and 30 controls) underwent skin prick tests, sIgE, component-resolved diagnostics, nasal allergen provocation testing (nasal allergen provocation testing), and conjunctival allergen provocation testing (conjunctival allergen provocation testing).
Conjunctival allergen provocation testing demonstrated higher sensitivity than nasal allergen provocation testing across all reference standards (91.3-94.9% vs 75.0-86.1%).
In contrast, nasal allergen provocation testing showed superior discriminative performance, diagnostic accuracy, and model calibration.
Polysensitization and asthma were the strongest predictors of positive nasal allergen provocation testing responses.
Decision curve analysis indicated greater net clinical benefit for the nasal allergen provocation testing-based model across relevant threshold probabilities.
Conjunctival allergen provocation testing demonstrates high sensitivity, whereas nasal allergen provocation testing provides greater clinical discrimination and decision-making value, particularly in complex allergic phenotypes.
nasal allergen provocation testing may offer clinically actionable information in patients with discordant or polysensitized profiles, supporting allergen selection and optimization of immunotherapy strategies.