Use of a vibrating mesh nebulizer for allergen challenge
Allergy, Asthma & Clinical Immunology(2019)
Abstract
Background Allergen inhalation tests are a valuable research tool. The allergen dose producing an early asthmatic response (EAR) can be predicted from methacholine responsiveness and allergen skin test endpoint (STE). The Wright ® jet nebulizer, which is both inefficient and increasingly difficult to obtain, has been used historically. We assessed the Solo ® vibrating mesh nebulizer as an alternative for allergen and methacholine challenges. Methods Eighteen mild atopic asthmatics completed the study. Doubling concentration allergen prick skin tests were performed to determine the STE in allergen units/mL. The Wright ® protocol was used to measure the methacholine provocation dose causing a 20% forced expired volume in one second (FEV 1 ) fall (PD 20 ) (μg) and the allergen PD 20 (units). The Solo ® protocol (0.5 mL nebulized to completion, tidal breathing inhalation) was used to determine both methacholine PD 20 and allergen PD 20 . The nebulizer order was randomized and separated by ≥ 2 weeks. Results All data were log transformed. The allergen PD 20 , predicted from the methacholine PD 20 and the STE, was within 2 doubling doses of the PD 20 measured with the Wright ® and 2.64 doubling doses of that measured with Solo ® . The Wright ® allergen PD 20 correlated with the Wright ® methacholine PD 20 (r = 0.74) and the STE (r = 0.78) and more strongly with the product of the two (Wright ® methacholine PD 20 × STE, r = 0.91, p < 0.00001). The Solo ® allergen PD 20 showed similar relationships with the Solo ® methacholine PD 20 (r = 0.61), the STE (r = 0.75) and the product of the two (Solo ® methacholine PD 20 × STE, r = 0.83, p < 0.00002). The Wright ® and the Solo ® methacholine geometric mean PD 20 s were not significantly different (49.3 and 54.5 μg respectively, p = 0.62). The Wright ® allergen PD 20 was slightly but significantly lower than the Solo ® allergen PD 20 (geometric means 6.7 and 10.5 units respectively, p = 0.003). Conclusion The Solo ® allergen PD 20 showed the same relationship with methacholine responsiveness and STE as did the Wright ® . The Solo ® allergen PD 20 was slightly but significantly higher than the Wright ® allergen PD 20 . The Solo ® vibrating mesh nebulizer was well tolerated and is an acceptable alternative for allergen challenge. Trial registration clinicaltrials.gov: NCT03491358
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Key words
Allergen inhalation test, Methacholine inhalation test, Skin test endpoint, Jet nebulizer (Wright®), Vibrating mesh nebulizer (Solo®)
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