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Intranasal Schirmer Test: A Useful Diagnostic Tool in Nasal Allergen Provocation Testing
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  • Paula von der Lage,
  • David Bächinger,
  • Silvan Marti,
  • Peter Schmid-Grendelmeier,
  • Claudia Lang,
  • Christof Röösli,
  • Michael B. Soyka
Paula von der Lage
Universitatsspital Zurich Klinik fur Ohren Nasen Hals und Gesichtschirurgie
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David Bächinger
Universitatsspital Zurich Klinik fur Ohren Nasen Hals und Gesichtschirurgie
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Silvan Marti
Universitatsspital Zurich Klinik fur Ohren Nasen Hals und Gesichtschirurgie
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Peter Schmid-Grendelmeier
UniversitatsSpital Zurich Dermatologische Klinik
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Claudia Lang
UniversitatsSpital Zurich Dermatologische Klinik
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Christof Röösli
Universitatsspital Zurich Klinik fur Ohren Nasen Hals und Gesichtschirurgie
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Michael B. Soyka
Universitatsspital Zurich Klinik fur Ohren Nasen Hals und Gesichtschirurgie

Corresponding Author:micheal.soyka@usz.ch

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Abstract

Goals: The intranasal Schirmer test (INS) is a quick method to objectify nasal secretion. This study aims to use the INS to assess nasal secretion change through direct nasal allergen provocation (NPT). Material and Methods: This prospective single-center study included patients who received allergy diagnostics using NPT and anterior rhinomanometry (aRMM). The Schirmer filter paper was attached to the nasal septum bilaterally pre- and post-allergen provocation. Additionally, all participants completed the sinonasal outcome test 22 (SNOT-22). The difference in wetting length before and after allergen provocation was investigated. Moreover, a cut-off value for allergic rhinitis were calculated. Results: A total of n = 25 patients and n = 25 in the control group were included. Patients with a positive result in NPT showed a significantly higher secretion in the provoked nasal cavity (mean difference = 13.95 mm; p = 0.01). The increased moisture level through provocation resulted in an area under the curve (AUC) of 0.814. A cut-off value of 2.75 mm wetting length increase (Youden index = 0.532) was calculated (sensitivity = 81.8% and specificity = 71.4%). Allergy diagnostic patients scored significantly higher in the SNOT-22 than the control group (25.04 score difference; p < 0.001). Conclusion: The INS represents a straightforward and cost-effective test to assess intranasal secretion changes in allergy diagnostics. The incorporation of the INS in the NPT protocol could particularly enhance treatment efficacy for patients with inconclusive NPT results or it could serve as a substitute for other objective measurements like aRMM or acoustic rhinometry.