Leitlinie für die Durchführung bronchialer Provokationstests mit Allergenen

E. Gonsior; M. Henzgen; R. A. Jörres; R. F. Kroidl; R. Merget; F.-W. Riffelmann; G. Wallenstein

doi:10.1055/s-2002-20553

Pneumologie, Table of Contents

Pneumologie 2002; 56(3): 187-198
DOI: 10.1055/s-2002-20553

Leitlinie

Georg Thieme Verlag Stuttgart · New York

Leitlinie für die Durchführung bronchialer Provokationstests mit Allergenen

Deutsche Gesellschaft für Allergologie und klinische Immunologie und Deutsche Gesellschaft für PneumologieGuidelines for Conducting Provocation Tests with AllergensE. Gonsior¹ , M. Henzgen² , R. A. Jörres³ , R. F. Kroidl⁴ , R. Merget⁵ , F.-W. Riffelmann⁶ , G. Wallenstein⁷

¹Klinik Kurhessen, Abt. f. Innere Medizin, Bad Sooden-Allendorf (Priv.-Doz. Dr. med. E. Gonsior)
²Pneumologie und Allergologie/Immunologie der Klinik für Innere Medizin IV, FSU, Jena (Prof. Dr. med. C. Kroegel)
³Krankenhaus Großhansdorf, Großhansdorf (Prof. Dr. med. H. Magnussen)
⁴Pneumologische Praxis, Stade
⁵Berufsgenossenschaftliches Forschungsinstitut für Arbeitsmedizin, Bochum (Prof. Dr. med. X. Baur)
⁶Fachkrankenhaus Kloster Grafschaft, Abt. Allergologie, Schmallenberg (Dr. med. Lauter)
⁷Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Berlin (Prof. Dr. med. W. D. Schneider)

Diese Leitlinie wurde erarbeitet vom gemeinsamen Arbeitskreis „Bronchiale Provokationstests” der Deutschen Gesellschaft für Allergologie und klinische Immunologie und der Sektion Allergologie und Immunologie der Deutschen Gesellschaft für Pneumologie.Durch Kommentare und Vorschläge haben zu dieser Richtlinie beigetragen: X. Baur, Bochum, jetzt Hamburg, K.-Ch. Bergmann, Bad Lippspringe, P. Ganshorn, Münnerstadt, R. Köbrich, Höchberg, G. Kröll, Frankfurt, G. Müller, Wedel, A. Paap, Reinbek

Abstract

Zusammenfassung

In Überarbeitung der 1984 erstmals veröffentlichten Leitlinien für die Durchführung von bronchialen Provokationen [28] und nachdem kürzlich Leitlinien für Provokationstests mit pharmakologischen Substanzen erstellt wurden [4], werden im Folgenden aktualisierte Leitlinien für die Durchführung bronchialer Provokationstests mit Allergenen vorgestellt. Diese wurden durch Auswertung der verfügbaren Literatur in mehreren Expertentreffen formuliert. Neben präzisen Aussagen zu Indikationen, Kontraindikationen und Sicherheitsmaßnahmen werden drei Untersuchungsprotokolle, deren Existenz als gesichert angesehen wird, detailliert beschrieben.

Abstract

Guidelines for bronchial allergen provocation tests, first published in 1984 [28], are updated by this paper. This version has been compiled in repeated meetings of a panel of experts after evaluation of the publications available. Precise statements regarding indications, contraindications, after safety measures are given. Three evidence-based protocols are submitted in detail.

Full Text

References

Literatur

1 Aalbers R, Kauffman H F, Koëter G H, Postma D S, de Vries K, de Monchy G JR. Dissimilarity in methacholine and adenosine 5′-monophosphate responsiveness 3 and 24 hours after allergen challenge. Am Rev Respir Dis. 1991; 144 352-357
2 Aas K. The bronchial provocation test. Springfield: Thomas 1975
3 American Thoracic Society . Guidelines for methacholine and exercise challenge testing - 1999. Am J Respir Crit Care Med. 2000; 161 309-329
4 Arbeitskreis Bronchiale Provokationstests . Leitlinien für die Durchführung bronchialer Provokationstests mit pharmakologischen Substanzen. Pneumologie. 1998; 52 214-220
5 Baur X, Huber H, Degens P O, Allmers H, Ammon J. Relation between occupational asthma case history, bronchial methacholine challenge and specific challenge test in patients with suspected occupational asthma. Am J Ind Med. 1998; 33 114-122
6 Bruce C A, Rosenthal R R, Lichtensstein L M, Norman P S. Diagnostic tests in ragweed-allergic asthma. A comparison of direct skin tests, leukocyte histamine release, and quantitative bronchial challenge. J Allergy Clin Immunol. 1974; 53 (4) 230-239
7 Bryant D H, Burns M W, Lazarus L. The correlation between skin tests, bronchial provocation tests and the serum level of IgE specific for common allergens in patients with asthma. Clin Allergy. 1975; 5 145-157
8 Bryant D H, Burns M W. Bronchial histamine reactivity: its relationship to the reactivity of the bronchi to allergens. Clin Allergy. 1976; 6 523-532
9 Chai H, Farr R S, Froehlich L A, Mathison D A, McLean J A, Rosenthal R R, Sheffer A L, Spector S L, Townley R G. Standardization of bronchial inhalation challenge procedures. J Allergy Clin Immunol. 1987; 56 323-327
10 Chinn S. Repeatability and method comparison. Thorax. 1991; 46 454-456
11 Cockcroft D W, Hurst T S, Gore B P. Importance of evaporative water losses during standardized nebulized inhalation provocation tests. Chest. 1989; 96 505-508
12 Cockcroft D W, Killian D N, Mellon J JA, Hargreave F E. Bronchial reactivity to inhaled histamine: a method and clinical survey. Clin Allergy. 1977; 7 235-243
13 Cockcroft D W, Ruffin R E, Dolovich J, Hargreave F E. Allergen-induced increase in nonallergic bronchial reactivity. Clin Allergy. 1977; 7 503-513
14 Cockcroft D W. Modulation of airway responsiveness. Ann Allergy. 1988; 60 465-471
15 Cockroft D W, Murdock K Y, Kirby J, Hargreave F E. Prediction of airway responsiveness to allergen from skin sensitivity to allergen and airway responsiveness to histamine. Am Rev Respir Dis. 1987; 135 264-267
16 Cockroft D W. Airway hyperresponsiveness: therapeutic implications. Ann Allergy. 1987; 59 405-414
17 Cockroft D W. Bronchial inhalation test II. Ann Allergy. 1987; 59 89-99
18 Cropp G JA, Bernstein I L, Boushey H A, Hyde R W, Rosenthal R R, Spector S L, Townley R G. Guidelines for bronchial inhalation challenges with pharmacologic and antigenic agents. ATS News 1980: 11-19
19 Dierkes-Globisch A, Merget R, Bergmann E-M, Schultze-Werninghaus G. Fehlende Assoziation von Hautsensibilisierung, spezifischer und unspezifischer bronchialer Reaktivität beim Hausstaubmilbenasthma. Allergo J. 1997; 6 127-132
20 Djukanovic R, Roche W R, Wilson J W, Beasley C RW, Twentyman O P, Horwarth P H, Holgate S T. Mucosal inflammation in asthma. Am Rev Respir Dis. 1990; 142 434-457
21 Durham S R, Craddock C F, Cookson W O, Benson M K. Increases in airway responsiveness to histamine preceede allergen-induced responses. J Allergy Clin Immunol. 1988; 82 764-770
22 Eiser N M, Kerrebijn K F, Quanjer Ph H. Guidelines for standardization of bronchial challenges with (nonspecific) bronchoconstricting agents. Bull Eur Physiopathol Respir. 1983; 19 495-514
23 Eiser N M. Bronchial provocation tests. In: Nadel JA, Pauwels R, Snashdall PD (Hrsg). Bronchial Hyperresponsiveness. Oxford, London, Edinburgh, Boston, Palo Alto, Melbourne: Blackwell 1987: 173-254
24 Frølund L, Madsen F, Scharling B, Heinig J H, Svendsen U G. Bronchial allergen challenge: dose versus concentration. Clin exp Allergy. 1992; 22 219-225
25 Fuchs E, Gronemeyer W. Die Beziehung von Provokationstesten zu Anamnese und Hautreaktion beim Asthma bronchiale. Verh Dtsch Ges Inn Med. 1959; 65 848-851
26 Gayrard P, Orehek J, Grimaud C, Charpin J. Bronchoconstrictor effects of a deep inspiration in patients with asthma. Am Rev Respir Dis. 1975; 111 433-439
27 Gimeno F, Berg W Chr, Sluiter H J, Tammeling G J. Spirometry-induced bronchial obstruction. Am Rev Respir Dis. 1972; 105 68-74
28 Gonsior H. (Hrsg) . Richtlinien für die Durchführung von bronchialen Provokationen mit Allergenen und pharmakodynamischen Substanzen bei obstruktiven Atemwegserkrankungen. Allergologie. 1984; 7 238-242
29 Gonsior E, Krüger M, Meier-Sydow J. Influence of physiological method and criterion of evaluation on results of bronchial antigen provocation tests. In: Herzog H (Hrsg). Asthma Volume 14. Prog Respir Res 1980: 104-108
30 Gonsior E, Meier-Sydow J, Thiel Cl. Routine application of bodyplethysmography in bronchial antigen challenge. Bull Physiopath Respir. 1972; 8 519-520
31 Gonsior E. Bronchialtest. In: Fuchs E, Schulz K-H (Hrsg). Manuale allergologicum. Deisenhofen: Dustri Verlag Dr. Karl Feistle 1995: IV.8.1-IV.8.13
32 Gronemeyer W, Fuchs E. Der inhalative Antigen-Pneumometrie-Test als Standard-Methode in der Diagnose allergischer Krankheiten. Int Arch Allergy. 1959; 14 (3-4) 217-240
33 Hansen K. Die spezielle Diagnostik bei allergischen Krankheiten. In: Berger W, Hansen K (Hrsg). Allergie, Kap. 10. Leipzig: Thieme 1940: 256-257
34 Hansen K. Die spezielle Diagnostik bei allergischen Krankheiten. In: Berger W, Hansen K (Hrsg). Allergie, Kap. 10. Leipzig: Thieme 1940: 265-266
35 Hargreave K F, Fink J N, Cockcroft D W, Fish J E, Holgate E H, Ramsdale S T, Roberts R S, Shapiro D, Sheppard D. The role of bronchoprovocation. J Allergy Clin Immunol. 1986; 78 517-524
36 Harris L H. Experimental reproduction of mold allergy. J Allergy. 1941; 12 279-289
37 Inman M D, Watson R, Cockcroft D W, Wong B J, Hargreave F E, O'Byrne P M. Reproducibility of allergen-induced early and late asthmatic responses. J Allergy Clin Immunol. 1995; 95 1191-1195
38 Jeffrey P K. Morphology of the airway wall in asthma and in chronic pulmonary disease. Am Rev Respir Dis. 1991; 143 1152-1158
39 Jörres R, Nowak D, Magnussen H, Speckin P, Koschyk S. The effect of ozone exposure on allergen responsiveness in subjects with asthma or rhinitis. Am J Respir Crit Care Med. 1996; 153 56-64
40 Juniper E F, Frith P A, Dunnett C, Cockcroft D W. Reproducibility and comparison of response to inhaled histamine and methacholine. Thorax. 1978; 33 705-710
41 Kappos A, Gonsior E, Schultze-Werninghaus G, Giese D. Zur Interpretation der Unterschiede bei plethysmographischer oder oszillatorischer Bestimmung des Atemwiderstandes. Prax Pneumol. 1981; 35 772-775
42 Knox A J, Wisniewski A, Cooper S, Tattersfield A E. A comparison of the yan and a dosimeter method for methacholine challenge in experienced and unexperienced subjects. Eur Respir J. 1991; 4 497-502
43 Kongerud J, Soyseth V, Johannsen B. Room temperature influences output from the wright nebulizer. Eur Respir J. 1989; 2 681-684
44 Kopferschmitt-Kubler M C, Bigot H, Pauli G. Allergen bronchial challenge tests: variability and reproducibility of the early response. J Allergy. 1987; 80 730-740
45 Lœwenstein H. Report on behalf of the international union of immunological societies (IUIS) allergen standardization subcommittee. Arb Paul Ehrlich Inst. 1983; 63 (suppl 4) 542-545
46 McFadden jr E R. Exertional dyspnea and cough as preludes to acute attacks of bronchial asthma. N Engl J Med. 1975; 292 555-559
47 Melillo G, Aas K, Cartier A, Davies R J, Debeliè M, Dreborg S, Kerrebijn K F, Lassen A, Pinto Mendes J, Rizzo A, Rosenthal R R, Tateishi S, Cooscio R. Guidelines for the standardization of bronchial provocation tests with allergens. An update by an international committee. Allergy. 1991; 46 321-329
48 Mellilo G, Bonini S, Cocco G, Davies R J, de Monchy J GR, Frølund L, Pelikan Z. Provocation tests with allergens (report). Allergy. 1997; 52 (Suppl 35) 5-36
49 Merget R, Dierkes A, Rueckmann A, Bergmann E-M, Schultze-Werninghaus G. Absence of relationship between degree of non-specific and specific bronchial responsiveness in occupational asthma due to platinum salts. Eur Respir J. 1996; 9 211-216
50 Newball H H. The unreliability of the maximal midexpiratory flow as an index of acute airway changes. Chest. 1975; 67 311-314
51 O'Byrne P M. Allergen-induced airway hyperresponsiveness. J Allergy Clin Immunol. 1988; 81 119-127
52 Olive J T, Hyatt R E. Maximal expiratory flow and total respiratory resistance during induced bronchoconstriction in asthmatic subjects. Am Rev Respir Dis. 1972; 106 366-376
53 Österreichische Gesellschaft für Lungenerkrankungen und Tuberkulose. Arbeitsgemeinschaft für klinische Atemphysiologie . Empfehlungen zur Standardisierung der inhalativen Provokation zur Messung der unspezifischen bronchialen Reagibilität. Prax Klin Pneumol. 1986; 40 356-364
54 Pastorello E A, Incorvaia C, Ortolani C, Bonini S, Canonica G W, Romagnani S, Tursi A, Zanussi C. Studies on the relationship between the level of specific IgE antibodies and the clinical expression of allergy: I. Definition of levels distinguishing patients with symptomatic from patients with asymptomatic allergy to common aeroallergens. J Allergy Clin Immunol. 1996; 96 580-587
55 Pliss L B, Ingenito E P, Ingram R H. Responsiveness, inflammation, and effects of deep breaths on obstruction in mild asthma. J Appl Physiol. 1989; 66 2298-2304
56 Popa V, Teculescu D, Stnescu D, Gavrilescu N. The value of inhalation tests in perennial bronchial asthma. J Allergy. 1968; 42 (3) 130-139
57 Quanjer Ph H, Tammeling G J, Cotes J E, Pedersen O F, Peslin R. Lung volumes and forced ventilatory flows. Eur Respir J. 1993; 6 (Suppl. 16) 4-39
58 Rosenthal R R, Bruce C A, Lichtenstein L L, Norman P S. The role of inhalation challenge. Int Archs Allergy Appl Immunol. 1975; 49 89-94
59 Ryan G, Dolovich M B, Obminski G, Cockcroft D W, Juniper E F, Hargreave F E, Newhouse M T. Standardization of inhalation provocation tests: influence of nebulizer output, particle size and method of inhalation. J Allergy Clin Immunol. 1981; 67 156-161
60 Scott G R, Küng M. How many spirograms for a histamine challenge?. Am Rev Respir Dis. 1985; 132 268-271
61 Spector S L, Farr R. Bronchial inhalation challenge with antigens. J Allergy Clin Immunol. 1979; 64 580-586
62 Sterk P J, Fabbri L M, Quanjer Ph H, Cockcroft D W, O'Byrne P M, Anderson S D, Juniper E F, Malo J-L. Airway responsiveness: Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Eur Respir J. 1993; 6 Suppl. 16 53-83
63 Sterk P J, Plomp A, Van de Vate J F, Quanjer Ph H. Physical properties of aerosols produced by several jet and ultrasonic nebulizers. Bull Eur Physiopathol Respir. 1984; 20 65-72
64 Stevens F A. A comparison of pulmonary and dermal sensitivity to inhaled substances. J Allergy. 1934; 5 285-287
65 Summers Q A. Inhaled drugs and the lung. Clin Exp Allergy. 1991; 21 259-268
66 WHO Expert committee on biological standardization . Guidelines for the preparation and establishment of reference materials and reference reagents for biological substances. WHO, technical report 1978

Prof. Bergmann

Allergie- u. Asthma-Klinik W. Gronemeyer

An der Martinusquelle 10

33175 Bad Lippspringe