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. 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 (FEV1) fall (PD20) (μg) and the allergen PD20 (units). The Solo® protocol (0.5 mL nebulized to completion, tidal breathing inhalation) was used to determine both methacholine PD20 and allergen PD20. The nebulizer order was randomized and separated by ≥ 2 weeks. All data were log transformed. The allergen PD20, predicted from the methacholine PD20 and the STE, was within 2 doubling doses of the PD20 measured with the Wright® and 2.64 doubling doses of that measured with Solo®. The Wright® allergen PD20 correlated with the Wright® methacholine PD20 (r = 0.74) and the STE (r = 0.78) and more strongly with the product of the two (Wright® methacholine PD20 × STE, r = 0.91, p < 0.00001). The Solo® allergen PD20 showed similar relationships with the Solo® methacholine PD20 (r = 0.61), the STE (r = 0.75) and the product of the two (Solo® methacholine PD20 × STE, r = 0.83, p < 0.00002). The Wright® and the Solo® methacholine geometric mean PD20s were not significantly different (49.3 and 54.5 μg respectively, p = 0.62). The Wright® allergen PD20 was slightly but significantly lower than the Solo® allergen PD20 (geometric means 6.7 and 10.5 units respectively, p = 0.003). The Solo® allergen PD20 showed the same relationship with methacholine responsiveness and STE as did the Wright®. The Solo® allergen PD20 was slightly but significantly higher than the Wright® allergen PD20. The Solo® vibrating mesh nebulizer was well tolerated and is an acceptable alternative for allergen challenge. Trial registration clinicaltrials.gov: NCT03491358

中文翻译：

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使用振动网状雾化器应对过敏原挑战

过敏原吸入测试是一种有价值的研究工具。可以从乙酰甲胆碱反应性和过敏原皮肤试验终点 (STE) 预测产生早期哮喘反应 (EAR) 的过敏原剂量。Wright® 喷射雾化器效率低下且越来越难以获得，历史上一直在使用。我们评估了 Solo® 振动网状雾化器作为过敏原和乙酰甲胆碱挑战的替代品。十八名轻度特应性哮喘患者完成了研究。进行加倍浓度过敏原点刺皮肤试验以确定过敏原单位/mL 的 STE。Wright® 方案用于测量引起 20% 在一秒内用力呼气量 (FEV1) 下降 (PD20) (μg) 和过敏原 PD20 (单位) 的乙酰甲胆碱激发剂量。Solo® 方案（0.5 mL 雾化至完成，潮式呼吸吸入）用于测定乙酰甲胆碱 PD20 和过敏原 PD20。雾化器顺序是随机的，间隔 ≥ 2 周。所有数据都经过对数转换。根据乙酰甲胆碱 PD20 和 STE 预测的过敏原 PD20 在 Wright® 测量的 PD20 的 2 倍剂量和 Solo® 测量的 2.64 倍剂量范围内。Wright® 过敏原 PD20 与 Wright® 乙酰甲胆碱 PD20 (r = 0.74) 和 STE (r = 0.78) 相关，并且与两者的乘积更密切相关 (Wright® 乙酰甲胆碱 PD20 × STE, r = 0.91, p < 0.00001) . Solo® 过敏原 PD20 与 Solo® 乙酰甲胆碱 PD20 (r = 0.61)、STE (r = 0.75) 和两者的乘积 (Solo® 乙酰甲胆碱 PD20 × STE, r = 0.83, p < 0.00002) 具有相似的关系。Wright® 和 Solo® 乙酰甲胆碱几何平均 PD20 没有显着差异（分别为 49.3 和 54.5 μg，p = 0.62）。Wright® 过敏原 PD20 略低于 Solo® 过敏原 PD20（几何平均值分别为 6.7 和 10.5 个单位，p = 0.003）。Solo® 过敏原 PD20 与乙酰甲胆碱反应性和 STE 的关系与 Wright® 相同。Solo® 过敏原 PD20 略高于 Wright® 过敏原 PD20。Solo® 振动网状雾化器具有良好的耐受性，是过敏原挑战的可接受替代品。试验注册临床试验.gov：NCT03491358 分别为 5 个单位，p = 0.003）。Solo® 过敏原 PD20 与乙酰甲胆碱反应性和 STE 的关系与 Wright® 相同。Solo® 过敏原 PD20 略高于 Wright® 过敏原 PD20。Solo® 振动网状雾化器具有良好的耐受性，是过敏原挑战的可接受替代品。试验注册临床试验.gov：NCT03491358 分别为 5 个单位，p = 0.003）。Solo® 过敏原 PD20 与乙酰甲胆碱反应性和 STE 的关系与 Wright® 相同。Solo® 过敏原 PD20 略高于 Wright® 过敏原 PD20。Solo® 振动网状雾化器具有良好的耐受性，是过敏原挑战的可接受替代品。试验注册临床试验.gov：NCT03491358