Nasal allergen challenge (NAC) is an important tool to diagnose allergic rhinitis. In daily clinical routine, experimentally, or when measuring therapeutic success clinically, nasal allergen challenge is fundamental. It is further one of the key diagnostic tools when initiating specific allergen immunotherapy. So far, national recommendations offered guidance on its execution; however, international divergence left many questions unanswered. These differences in the literature caused EAACI to initiate a task force to answer unmet needs and find a consensus in executing nasal allergen challenge. On the basis of a systematic review containing nasal allergen challenges of the past years, task force members reviewed evidence, discussed open issues, and studied variations of several subjective and objective assessment parameters to propose a standardized way of a nasal allergen challenge procedure in clinical practice. Besides an update on indications, contraindications, and preparations for the test procedure, main recommendations are a bilaterally challenge with standardized allergens, with a spray device offering 0.1 mL per nostril. A systematic catalogue for positivity criteria is given for the variety of established subjective and objective assessment methods as well as a schedule for the challenge procedure. The task force recommends a unified protocol for NAC for daily clinical practice, aiming at eliminating the previous difficulty of comparing NAC results due to unmet needs.

Alergologie a klinická imunologie Nemocnice na Homolce Prague Czech Republic

Allergy and Clinical Immunology Imperial College NHLI London UK

Allergy Unit IBIMA Regional University Hospital of Málaga ARADyAL Málaga Spain

Center for Rhinology and Allergology Wiesbaden Germany

Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias Barcelona Spain

Clinical and Experimental Immunoallergy Institut d'Investigacions Biomediques August Pi i Sunyer Barcelona Spain

Department of ENT Azienda Ausl di Imola Imola Italy

Department of General Otorhinolaryngology Head and Neck Surgery Medical University of Graz Graz Austria

Department of ORL Hospital Clínic de Barcelona Universitat de Barcelona Barcelona Spain

Department of Otolaryngology Center of Allergy and Environment Klinikum rechts der Isar Technical University Munich Munich Germany

Department of Otolaryngology Head and Neck Surgery Beijing TongRen Hospital Capital Medical University Beijing China

Department of Otorhinolaryngology Cliniques Universitaires Saint Luc Brussels Belgium

Department of Otorhinolaryngology Düsseldorf University Hospital Düsseldorf Germany

Department of Otorhinolaryngology Head and Neck Surgery Medical University of Innsbruck Medizinische Universitat Innsbruck Innsbruck Austria

Department of Otorhinolaryngology Head and Neck Surgery Universitätsmedizin Mannheim Medical Faculty Mannheim Heidelberg University Mannheim Germany

Department of Otorhinolaryngology Head and Neck Surgery University of Cologne Medical Center Cologne Germany

Department of Otorhinolaryngology Medical Faculty Kirikkale University Kirikkale Turkey

Department of Pediatrics Referral Centre for Food Allergy Padua General University Hospital Padua Italy

Department of Prevention of Envinronmental Hazards and Allergology Medical University of Warsaw Poland

ENT Department Faculty of Medicine Eskisehir Osmangazi University Eskisehir Turkey

Faculty of Medicine University of Latvia Riga Latvia

Fujita Health University Otolaryngology 1 98 Denngakugakubo Kutukake cho Toyoake city Aichi Prefecture Japan

Health and Work Ability Finnish Institute of Occupational Health Helsinki Finland

Institute of Medical Statistics and Computational Biology Faculty of Medicine University of Cologne Cologne Germany

Kharkiv National Medical University Kharkiv Ukraine

London Allergy and Immunology Centre London UK

Otorhinolaryngology Academic Medical Centre Amsterdam The Netherlands

Otorhinolaryngology Ghent University Ghent Belgium

Transylvania University Brasov Faculty of Medicine Department of Allergy and Clinical Immunology Brasov Romania

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