Do Skin Prick Tests Predict Nasal Provocation Test Outcomes in Allergic Rhinitis Patients?

Background: In diagnosing allergic rhinitis (AR), conventional skin prick tests (SPTs) often fail to reflect allergen-induced nasal symptoms. Conversely, nasal provocation tests (NPTs) provide more definitive assessments but are less accessible. Therefore, we aimed to evaluate the correlation between SPT and NPT outcomes to assess SPT's predictive reliability for NPT results.

Methods: A retrospective review was performed on 106 patients who underwent simultaneous SPT and NPT for suspected perennial AR. The SPT was assessed by measuring the mean wheal diameter of Dermatophagoides pteronyssinus (Dp). The NPT was performed by administering 100 µL of a 1000 AU/mL Dp solution into both nostrils, with responses assessed by changes in the five AR-related symptoms (total nasal symptom score, TNSS) at 15 min. Correlation and linear regression analyses were conducted to evaluate the relationship between SPT and NPT outcomes.

Results: TNSS changes at 15 min following intranasal Dp challenge showed a significant, moderately positive correlation with SPT Dp wheal diameter for all 106 subjects (ρ = 0.640, p < 0.001). In patients positive for both SPT and NPT (n = 24, ρ = 0.510, p = 0.011) and those with monosensitization (n = 30, ρ = 0.644, p < 0.001), a stronger and significant correlation was observed compared to the polysensitized group (n = 35, ρ = 0.372, p = 0.028), while no significant correlation was noted in patients negative for either test. Linear regression confirmed a significant linear relationship (R² = 0.423, Y = 2.65X - 0.59, p < 0.001) between SPT wheal size and 15-min TNSS changes in NPT among all the subjects.

Conclusion: Significant correlations and linear associations between SPT and NPT outcomes support SPT's predictive capability for NPT responses.