ABSTRACT
Charles Harrison Blackley [1] was almost certainly the first person to perform bronchial provocation tests with allergens. His study, which included nasal and conjunctival tests, convinced him of the importance of grass pollen in the etiology of these diseases. This use of inhalation challenge techniques in diagnosis was continued into the twentieth century, but in 1934 Stevens [2] suggested the routine diagnostic use of such tests should be abandoned because attacks of asthma lasting several days were occasionally provoked. In 1947, Lowell and Schiller [3] showed that inhalation of aerosols of pollen extract provoked a fall in the vital capacity of the lungs in asthmatic patients. Since that time, bronchial challenge techniques, in which the reaction has been monitored with lung function tests, have been extensively used in the investigation of patients with asthma and hypersensitivity pneumonitis due to an identifiable extrinsic agent. Bronchial challenge testing using soluble antigens which also elicit an immediate skin test reaction is recognized to be a safe procedure provided appropriate precautions are taken. In over 9000 bronchial provocation 144tests with a wide variety of allergens in 1035 children no anaphylactic or other severe reactions were noted [4].
