Nasal washings challenge test with food allergen sIgE, is it possible?

The main aim of this study will be an attempt to evaluate sIgE in the nasal lavage in the nasal passages
provocation test with egg allergens in the investigated group - adults (18-45 years old). The research
is a breakthrough in the area of ​​understanding the mechanisms of the IgE-dependent reaction (within the
nasal mucosa) in food allergy. Assessment options at various levels of reaction including
cellular levels: the determination of sIgE in nasal lavage is evidence of the innovative nature of the
project and, consequently, will constitute (the results of obtained during the implementation of this project will be used in a future project) a continuation under the project of the National Science Center - OPUS carried out on the population
children 6-14 years old. The intranasal allergen challenge test is a method that mimics
the body's response to the action of the allergenic factor. Used in the assessment of membrane reactivity
mucosa to common environmental allergens, it is characterized by high specificity, sensitivity and
test safety [1]. As of today, the literature on the subject shows that there is a need to work on
this issue due to the promising research results and the expansion of new opportunities of assessment. Three currently promising works including: a mouse model [2] and the use of egg allergens
chicken [3] and peanuts [4] prove the need for further research in this area. It must be noted that the assessment of the degree of response to a provoked allergen was based on the technique that
goes beyond the traditional scheme of nasal challenge assessment - vision thermograph, but
significant differences were observed in relation to the assessed values ​​- head and nasal cavity temperature
(Mann-Whitney test: 18.2 ° Cmin (range 4.7-80.8) vs control group 4.8 ° C min (0-24.7); p =
0.0006) [4]. Importantly, EAACI Position paper on the standardization of nasal allergen challenges
points to a new premise for indications for nasal attempts with a clear accent of
the need for further research in this area [1]. The applicant is the first in the world to intend
implementation of a qualified assessment as an objective assessment in the form of an sIgE assay in the nasal washings
directed against egg proteins after intranasal application of the allergen. The research hypothesis
assumes that as a result of local allergen provocation, there will be observed
a significant increase in the level of sIgE in the nasal lavage, which will translate into a typical picture of
early phase of an allergic reaction, i.e. nasal blockage, sneezing, discharge of watery secretions.
Material and method. 50 patients will be qualified for the study, including: 25 people allergic to
chicken egg allergens (positive clinical history, skin tests, serum sIgE) and 25 people aged 18-45 years as a control group. Patients will be diagnosed at the University Clinical Center of the Medical University of Warsaw. The method we will use in the study will be intranasal provocation test with egg allergen. The 10 μg (extract) allergen suspended in 100
μg of saline will be administered as per standard [1] through an atomizer to both nostrils.
The dose used in the provocation test following the research pattern is 50% of the extract used in
oral nutritional tests [4]. The examination will be carried out in two stages: after local
acclimatization to the conditions in the research laboratory, the first test will be performed (after
topical application with a saline atomizer in which allergen will be suspended),
in which patients will undergo nasal lavage for the determination of sIgE in the lavage, and then this
procedure will be repeated in the first 30 minutes of the early phase of the allergic reaction. Material
for testing purposes obtained after prior centrifugation of the nasal washes at a speed of 1,000 rpm, for
a period of 15 minutes was stored at -70 ° C and then subjected to treatment
enzyme-linked immunosorbent biochemical test (UniCAP, Pharmacia, Sweden) at the recommended
sensitivity threshold of 1.0μg / l. At the same time, we will make a subjective evaluation of the nasal washings with
visual and analog scale of the reported complaints in the field of: nasal cavity blockage,
itching, discharge of watery secretions.