Effect of levocetirizine on nasal provocation testing with adenosine monophosphate compared with allergen challenge in allergic rhinitis

S. Vaidyanathan; A. Nair; M. L. Barnes; K. Meldrum; B. J. Lipworth

doi:10.1111/j.1365-2222.2008.03166.x

Effect of levocetirizine on nasal provocation testing with adenosine monophosphate compared with allergen challenge in allergic rhinitis

S. Vaidyanathan, A. Nair, M. L. Barnes, K. Meldrum, B. J. Lipworth

Research output: Contribution to journal › Article › peer-review

7 Citations (Scopus)

Abstract

End-organ hyperreactivity is an important feature of the allergic airway. There are no data directly comparing the responsiveness to treatment of different nasal provocation tests (NPT).

We compared the effect of levocetirizine on nasal adenosine 5'-monophosphate (AMP) with specific allergen challenge in patients with intermittent and persistent allergic rhinitis (AR).

Patients with AR were randomized in double-blind cross-over fashion to receive single doses of levocetirizine 5 mg or identical placebo, with nasal challenge performed 12 h after dosing. Sixteen participants completed per protocol. Nasal AMP or allergen challenge was conducted on separate days with 1- and 2-week washout periods in between, respectively. Measurements of peak nasal inspiratory flow (PNIF) were made over 60 min after each challenge. The primary end-point was the provocative concentration of AMP or allergen causing a 20% drop in the PNIF (PC20).

The time-profile for PNIF recovery [area under the 60 min time-response curve as % PNIF change (min)] were significantly attenuated for AMP challenge, as mean difference [95% confidence interval (CI)]: 11.57 (3.87, 19.25), P=0.005 and for allergen challenge: 17.82 (0.11, 35.53), P=0.04. A highly significant correlation was shown between methods for the area under the curve: (R=0.86, P < 0.001). A statistically significant correlation was also seen for the PC20: (R=0.94, P < 0.001). PC20 improvement amounted to a 1.26 (95% CI 0.16, 2.35) and 0.16 (95% CI -0.41, 0.73) doubling-dilution shifts for allergen and AMP challenges, respectively. Bland-Altman plots confirmed good agreement between methods.

A high correlation and statistical agreement has been demonstrated between AMP and allergen challenge for all outcome measures. In particular, the recovery profile after NPT is a sensitive and discriminatory measure of anti-allergic treatment.

Cite this as: S. Vaidyanathan, A. Nair, M. L. Barnes, K. Meldrum and B. J. Lipworth, Clinical and Experimental Allergy, 2009 (39) 409-416.

Original language	English
Pages (from-to)	409-416
Number of pages	8
Journal	Clinical and Experimental Allergy
Volume	39
Issue number	3
DOIs	https://doi.org/10.1111/j.1365-2222.2008.03166.x
Publication status	Published - Mar 2009

Keywords

Adenosine monophosphate
Allergic rhinitis
Levocetirizine
Nasal allergen challenge
Nasal provocation testing
Peak nasal inspiratory flow rate
Calculating correlation-coefficients
Corticosteroid response
Acoustic rhinometry
Statistics notes
Air-flow
Asthma
Histidine phosphorylation
Desloratadine
Fexofenadine
Rhinomanometry

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10.1111/j.1365-2222.2008.03166.x

Cite this

@article{23ddd6a4afec4acb9cf832678140e1e7,

title = "Effect of levocetirizine on nasal provocation testing with adenosine monophosphate compared with allergen challenge in allergic rhinitis",

abstract = "End-organ hyperreactivity is an important feature of the allergic airway. There are no data directly comparing the responsiveness to treatment of different nasal provocation tests (NPT).We compared the effect of levocetirizine on nasal adenosine 5'-monophosphate (AMP) with specific allergen challenge in patients with intermittent and persistent allergic rhinitis (AR).Patients with AR were randomized in double-blind cross-over fashion to receive single doses of levocetirizine 5 mg or identical placebo, with nasal challenge performed 12 h after dosing. Sixteen participants completed per protocol. Nasal AMP or allergen challenge was conducted on separate days with 1- and 2-week washout periods in between, respectively. Measurements of peak nasal inspiratory flow (PNIF) were made over 60 min after each challenge. The primary end-point was the provocative concentration of AMP or allergen causing a 20% drop in the PNIF (PC20).The time-profile for PNIF recovery [area under the 60 min time-response curve as % PNIF change (min)] were significantly attenuated for AMP challenge, as mean difference [95% confidence interval (CI)]: 11.57 (3.87, 19.25), P=0.005 and for allergen challenge: 17.82 (0.11, 35.53), P=0.04. A highly significant correlation was shown between methods for the area under the curve: (R=0.86, P < 0.001). A statistically significant correlation was also seen for the PC20: (R=0.94, P < 0.001). PC20 improvement amounted to a 1.26 (95% CI 0.16, 2.35) and 0.16 (95% CI -0.41, 0.73) doubling-dilution shifts for allergen and AMP challenges, respectively. Bland-Altman plots confirmed good agreement between methods.A high correlation and statistical agreement has been demonstrated between AMP and allergen challenge for all outcome measures. In particular, the recovery profile after NPT is a sensitive and discriminatory measure of anti-allergic treatment.Cite this as: S. Vaidyanathan, A. Nair, M. L. Barnes, K. Meldrum and B. J. Lipworth, Clinical and Experimental Allergy, 2009 (39) 409-416.",

keywords = "Adenosine monophosphate, Allergic rhinitis, Levocetirizine, Nasal allergen challenge, Nasal provocation testing, Peak nasal inspiratory flow rate, Calculating correlation-coefficients, Corticosteroid response, Acoustic rhinometry, Statistics notes, Air-flow, Asthma, Histidine phosphorylation, Desloratadine, Fexofenadine, Rhinomanometry",

author = "S. Vaidyanathan and A. Nair and Barnes, {M. L.} and K. Meldrum and Lipworth, {B. J.}",

year = "2009",

month = mar,

doi = "10.1111/j.1365-2222.2008.03166.x",

language = "English",

volume = "39",

pages = "409--416",

journal = "Clinical and Experimental Allergy",

issn = "0954-7894",

publisher = "Wiley",

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TY - JOUR

T1 - Effect of levocetirizine on nasal provocation testing with adenosine monophosphate compared with allergen challenge in allergic rhinitis

AU - Vaidyanathan, S.

AU - Nair, A.

AU - Barnes, M. L.

AU - Meldrum, K.

AU - Lipworth, B. J.

PY - 2009/3

Y1 - 2009/3

N2 - End-organ hyperreactivity is an important feature of the allergic airway. There are no data directly comparing the responsiveness to treatment of different nasal provocation tests (NPT).We compared the effect of levocetirizine on nasal adenosine 5'-monophosphate (AMP) with specific allergen challenge in patients with intermittent and persistent allergic rhinitis (AR).Patients with AR were randomized in double-blind cross-over fashion to receive single doses of levocetirizine 5 mg or identical placebo, with nasal challenge performed 12 h after dosing. Sixteen participants completed per protocol. Nasal AMP or allergen challenge was conducted on separate days with 1- and 2-week washout periods in between, respectively. Measurements of peak nasal inspiratory flow (PNIF) were made over 60 min after each challenge. The primary end-point was the provocative concentration of AMP or allergen causing a 20% drop in the PNIF (PC20).The time-profile for PNIF recovery [area under the 60 min time-response curve as % PNIF change (min)] were significantly attenuated for AMP challenge, as mean difference [95% confidence interval (CI)]: 11.57 (3.87, 19.25), P=0.005 and for allergen challenge: 17.82 (0.11, 35.53), P=0.04. A highly significant correlation was shown between methods for the area under the curve: (R=0.86, P < 0.001). A statistically significant correlation was also seen for the PC20: (R=0.94, P < 0.001). PC20 improvement amounted to a 1.26 (95% CI 0.16, 2.35) and 0.16 (95% CI -0.41, 0.73) doubling-dilution shifts for allergen and AMP challenges, respectively. Bland-Altman plots confirmed good agreement between methods.A high correlation and statistical agreement has been demonstrated between AMP and allergen challenge for all outcome measures. In particular, the recovery profile after NPT is a sensitive and discriminatory measure of anti-allergic treatment.Cite this as: S. Vaidyanathan, A. Nair, M. L. Barnes, K. Meldrum and B. J. Lipworth, Clinical and Experimental Allergy, 2009 (39) 409-416.

AB - End-organ hyperreactivity is an important feature of the allergic airway. There are no data directly comparing the responsiveness to treatment of different nasal provocation tests (NPT).We compared the effect of levocetirizine on nasal adenosine 5'-monophosphate (AMP) with specific allergen challenge in patients with intermittent and persistent allergic rhinitis (AR).Patients with AR were randomized in double-blind cross-over fashion to receive single doses of levocetirizine 5 mg or identical placebo, with nasal challenge performed 12 h after dosing. Sixteen participants completed per protocol. Nasal AMP or allergen challenge was conducted on separate days with 1- and 2-week washout periods in between, respectively. Measurements of peak nasal inspiratory flow (PNIF) were made over 60 min after each challenge. The primary end-point was the provocative concentration of AMP or allergen causing a 20% drop in the PNIF (PC20).The time-profile for PNIF recovery [area under the 60 min time-response curve as % PNIF change (min)] were significantly attenuated for AMP challenge, as mean difference [95% confidence interval (CI)]: 11.57 (3.87, 19.25), P=0.005 and for allergen challenge: 17.82 (0.11, 35.53), P=0.04. A highly significant correlation was shown between methods for the area under the curve: (R=0.86, P < 0.001). A statistically significant correlation was also seen for the PC20: (R=0.94, P < 0.001). PC20 improvement amounted to a 1.26 (95% CI 0.16, 2.35) and 0.16 (95% CI -0.41, 0.73) doubling-dilution shifts for allergen and AMP challenges, respectively. Bland-Altman plots confirmed good agreement between methods.A high correlation and statistical agreement has been demonstrated between AMP and allergen challenge for all outcome measures. In particular, the recovery profile after NPT is a sensitive and discriminatory measure of anti-allergic treatment.Cite this as: S. Vaidyanathan, A. Nair, M. L. Barnes, K. Meldrum and B. J. Lipworth, Clinical and Experimental Allergy, 2009 (39) 409-416.

KW - Adenosine monophosphate

KW - Allergic rhinitis

KW - Levocetirizine

KW - Nasal allergen challenge

KW - Nasal provocation testing

KW - Peak nasal inspiratory flow rate

KW - Calculating correlation-coefficients

KW - Corticosteroid response

KW - Acoustic rhinometry

KW - Statistics notes

KW - Air-flow

KW - Asthma

KW - Histidine phosphorylation

KW - Desloratadine

KW - Fexofenadine

KW - Rhinomanometry

U2 - 10.1111/j.1365-2222.2008.03166.x

DO - 10.1111/j.1365-2222.2008.03166.x

M3 - Article

C2 - 19187327

SN - 0954-7894

VL - 39

SP - 409

EP - 416

JO - Clinical and Experimental Allergy

JF - Clinical and Experimental Allergy

IS - 3

ER -

Effect of levocetirizine on nasal provocation testing with adenosine monophosphate compared with allergen challenge in allergic rhinitis

Abstract

Keywords

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