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Changes in Exhaled Nitric Oxide Levels After Bronchial Allergen Challenge

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Abstract

Background

Fractional exhaled nitric oxide (FeNO) is a marker of inflammation of the airways accompanying changes in the clinical condition of asthma. Allergen exposure has been associated with a delayed elevation of FeNO. The aim of this study was to assess airway inflammation with FeNO measurements during bronchial allergen challenge (BAC), and to determine the diagnostic performance of FeNO changes.

Methods

Thirty-four patients with asthma and sensitization to inhalant allergens were studied. BAC with common or high-molecular-weight occupational aeroallergens was performed. FeNO was measured before and 24 h after BAC. Receiver operating characteristics curve was built to assess the sensitivity and specificity of increase in FeNO levels associated with BAC outcome.

Results

In 21 patients (61.76%) a positive asthmatic reaction (responders) was observed. A significant increase in postchallenge FeNO was observed in this group of patients compared to the group of nonresponders. A median increase (FeNO postchallenge–FeNO prechallenge) of 14.0 ppb was observed in the group of responders, whereas a −1.0 ppb change was attained in the nonresponder group (P < 0.001). The cutoff point providing maximal sensitivity and specificity for %ΔFeNO after BAC was 12%. This change in FeNO levels has a sensitivity of 0.81 and a specificity of 0.92 for predicting a positive outcome in the BAC.

Conclusion

FeNO measurements can be used as a surrogate of airway inflammation accompanying the asthmatic reaction induced by BAC. FeNO measurements may be a useful and reliable tool in the monitoring and interpreting specific bronchial challenge test with allergens.

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Authors and Affiliations

  1. Department of Allergy, Hospital La Paz Health Research Institute (IdiPAZ), Madrid, Spain

    María Pedrosa, Pilar Barranco, Valentín López-Carrasco & Santiago Quirce

  2. Department of Allergy, University Hospital La Paz, P. Castellana, 261, 28046, Madrid, Spain

    María Pedrosa

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  1. María Pedrosa
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  2. Pilar Barranco
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  3. Valentín López-Carrasco
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  4. Santiago Quirce
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Correspondence to María Pedrosa.

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Pedrosa, M., Barranco, P., López-Carrasco, V. et al. Changes in Exhaled Nitric Oxide Levels After Bronchial Allergen Challenge. Lung 190, 209–214 (2012). https://doi.org/10.1007/s00408-011-9358-4

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  • DOI: https://doi.org/10.1007/s00408-011-9358-4

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