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Allergic Rhinitis :
an Objective Diagnostic Significance and its Correlation with Laboratory Tests.


Key-Hun Kim, M.D., MS.D., Ph.D. & Janet K. Oh, M.D.
Department of Oto-Rhino-Laryngology,
Dr. Kim Ear, Nose & Throat Clinic, Seoul, Korea


Allergic rhinitis is one form of IgE-mediated atopic diseases.
The development of PRIST (Paper Radioimmunosorbent Test) and RAST (Radioallergosorbent Test) sensitive for immunoglobulin detection 1) have improved the significance of diagnosing the allergic rhinitis.
In the present study, we reviewed various objective tests, both in vivo and in vitro, and they are as follows: skin prick test, nasal challenge, nasal smear and peripheral blood eosinophil counts, PRIST, RAST, and MAST (Multiple Antigen Simultaneous Test) chemiluminescent assay.
800 odd patients exhibiting positive skin test were examined at the department of Oto-Rhino-Laryngology of Dr. Kim Ear, Nose & Throat clinic The aim of this study is to find the significance of each test and its correlation to one another.


In the skin test, we used 54 allergen extracts prepared by Bencard (U.K.).
Of these patients with positive skin test, nasal provocation test (Bencard allergen extracts) was performed. During the nasal challenge, symptoms were observed for 15-20 minutes and objectively evaluated by the rhinomanometry (Rhinotest MP500, Germany).
For the PRIST and RAST, we used Pharmacia IgE RIA (Pharmacia Diagnostics AB, Uppsala, Sweden). The reactivity to 35 specific allergen extracts and total IgE were reevaluated by using MAST chemiluminescent assay system (MAST Immunosystems, Ca., U.S.A.).
Then, each set of data was evaluated for its positive rate as compared to the RAST.
A particular interest was focused on the diagnostic significance of MAST and its relationship with PRIST and RAST. Their sensitivity and specificity were reported.


1. The Skin Prick test provided the following data: Nasal Smear (eosinophils alone,87% / eosinophils and mast cells,58%), Stool (0%), Nasal Challenge (by symptoms, 48%/ by rhinomanometry, 36%), PRIST (74%), MAST total IgE (98.7%).
2. The positive rate of Nasal Smear's eosinophil count when compared to RAST was 68% and for that of eosinophils and mast cells concurrently was 42%.
3. The positive rate of Peripheral Blood test for eosinophils when compared to RAST was 55%.
4. The positive rate of Nasal Challenge when compared to RAST showed 76% when evaluated by symptoms and 44% when reevaluated by rhinomanometry.
5. The positive rate of PRIST when compared to RAST was 68% at most. The MAST panel, however, regarding to the presence of total IgE shows as high as 98.7% and 85.4% for class 1 and 2, respectively.
6. The sensitivity of MAST for specific allergens when compared to the RAST was, on the other hand, as low as 38.4% for D.P.. When specific allergens detected from both tests were compared, the sensitivity of detecting capability was relatively lower in the MAST test than in the RAST. The accuracy of MAST was also treated in this study.


Our primary goal for this study was to provide a framework against which we would be able to measure diagnostic significances of various allergy tests currently available.
This is an important step towards our long-term goal of developing a project in which types of rhinitis, either allergic or non-allergic, with or without polyps, with or without aspirin intolerance, can be determined. Nonetheless, the results obtained are important in its own right and provide a number of useful information about the diagnostic significance by correlating with one another.
Allergic rhinitis tends to increase in recent years 2). Further, uses of both in vivo and in vitro tests, development of rhinomanometry, and a continuous progress in diagnostic technology let the identification of patients with allergic rhinitis more accurate, especially on the basis of responsible allergens. The rates of correlation of the RAST with skin test, the presence of eosinophils, nasal provocation (or challenge) tests, and measurement of total IgE have been investigated for various allergic diseases 3)4). The studies report over 80% between the skin test and RAST, 40-50% between the nasal smear and RAST, 70-90% rate of agreement among the nasal challenge, PRIST, and RAST.
MAST is a new test with advantages of using chemiluminescent material and measuring reactivity of multiple allergens simultaneously. The rates of agreement of the test with RAST and skin prick test are fully described in numbers of studies 4)5). However, according to the results at our clinic show some discrepancy in that MAST for total IgE was observed to be too sensitive while the one for specific IgE was not when compared to the RAST. Hence, we indicate that the concentration of allergens on the MAST panel needs to be re-assessed for a better correlation with the RAST.


1. The Skin Prick test provided the following data: Nasal Smear (eosinophils alone,87% / eosinophils and mast cells,58%), Stool (0%), Nasal Challenge (by symptoms, 48% / by rhinomanometry, 36%), PRIST (74%), MAST total IgE (98.7%, class 1, and 85.4%, class 2).
2. The MAST panel, however, regarding to the presence of total IgE shows its positive rate as high as 98.7% although its sensitivity when compared to PRIST was as low as 42%.
3. The positive rate of MAST for specific allergens, on the other hand, was as low as 38% for DP whereas RAST showed as high as 68%. When allergens detected from both tests were compared, the sensitivity of detecting capability was similarly lower in the MAST test than in the RAST.
4. The distribution of allergens, pollens only, pollens + house dust mites, or house dust mites only, showed a similar pattern both in the MAST and RAST.
5. When positive scores of MAST and RAST were compared, they shifted toward RAST, meaning that the score from MAST was lower than that of RAST in the same patient.
6. The author proposes that more correlative and highly accurate objective test is necessary for Korean panel of MAST. Further, we need more specific and detailed objective test for allergic rhinitis.


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