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Table 4 Practical aspects of ASNC

From: Diagnostic tools in Rhinology EAACI position paper

PURPOSES CONTRAINDICATIONS
Demonstration of the causal role of an allergen
Identification of the most relevant allergen(s)
Evaluation of the effect of a treatment
Investigating the inflammatory phenomena (research)
Occupational rhinitis
Acute bacterial or viral rhinosinusitis.
Acute exacerbation of allergic disease.
History of previous anaphylactic reaction
Severe general diseases
Pregnancy
Polyps
Recent ENT surgery (6-8 wks)
CAUSES OF FALSE POSITIVE CAUSES OF FALSE NEGATIVE
Nasal cycle
Recent exposure to irritants
Rhinosinusitis
Priming effect
Weak extract
Drugs
nasal antihistamine (1 day withdrawal)
oral antihistamine (3 day withdrawal)
nasal steroid (7 day withdrawal)
  1. GENERAL PROCEDURE
  2. Let the patient be adapted to room temperature
  3. Inspect nasal cavity
  4. Spray or apply saline as negative control
  5. Perform measurement(s)
  6. Instruct to avoid nasal breathing
  7. Apply the allergen into one nostril and re-evaluate after 10-15 minutes
  8. Proceed on with increasing concentration in the other nostril
  9. Use both active and plasebo tests for diagnosis for occupational rhinitis