The study was approved by the Institutional Review Board and an informed consent was obtained from each patient.

Forty-eight hay fever patients were prospectively and consecutively evaluated (all males, age 22.8 ± 5.4 years). All of them were Navy soldiers who were referred to the Navy Hospital for periodic fitness visit. Subjects were visited during the spring 2003.All of them were evaluated with rhinomanometry, spirometry and methacholine bronchial challenge during the pollen(which pollen season, is there only one?) (in our region the most important allergenic pollens are grasses, Parietaria and Betulaceae that have the peak during the spring) season, i.e. in the spring. Successively, all of them were re-evaluated outside the pollen season, i.e. in the winter, a season without pollens in our geographic area (₃,₇).

A detailed clinical history and a complete physical examination, including allergy evaluation, were performed. The patients were included in the study on the basis of a clinical history of seasonal(?Spring yes) allergic rhinitis and positive skin prick test only for pollens (including: Parietaria judaica, grasses(which Holcus lanatus, Cynodon dactylon and Lolium perenneolive tree, birch, and hazel(please provide scientific names for the trees/bushes) Betula alba Olea europaea, Corylus avellana) as described elsewhere (₃,₇). None of the patients was a previous or a current smoker.

Skin prick test: Sensitization was assessed by performing skin prick test. It was performed as stated by the European Society of Allergy and Clinical Immunology (₈). The allergen panel consisted of the following: house dust mites (Dermatophagoides farinae and pteronyssinus), cat, dog, grasses mix, Compositae mix, Parietaria judaica, birch, hazel tree, olive tree, Alternaria tenuis, Cladosporium, and Aspergilli mix; the concentration of allergen extracts was 100 I.R./mL (Stallergenes, Milan, Italy).

Nasal symptoms: The following symptoms were assessed by the patient, answering the questions made by the investigator, before and after treatment: nasal obstruction, sneezing, rhinorrhea, and itchy nose. Each symptom was evaluated on the following scale: 0= absent, 1= mild (symptom was present but was not annoying or troublesome), 2= moderate (symptom was frequently troublesome but did not interfere with either normal daily activity or sleep), and 3= severe (symptom was sufficiently troublesome to have interfered with normal daily activity or sleep). Total symptom score (TSS) being the sum of each individual symptom was also considered.

Rhinomanometry: Nasal airflow was measured by active anterior rhinomanometry. Patients wore a tight-fitting facemask, and with the mouth closed, breathed through one nostril. A sensor, placed in the contralateral nostril, recorded data on pre- and post-nasal pressures via airflow and pressure transducers. The instrument (ZAN 100 Rhino Flow Handy II, ZAN, Messgeraete Gmbh, Germany) was connected to a personal computer. The signals of transnasal airflow and pressure were amplified, digitized, and saved for statistical analysis.

Nasal airflow was reported as the sum of recorded airflow through right and left nostrils in milliliter per second at a pressure difference of 150 Pa across the nasal passage. Four or more airflow measurements were performed for each patient and the mean was recorded when reproducible values were achieved.

Spirometry: spirometry was performed with a computer-assisted spirometer (Pulmolab 435-spiro 235, Morgan, England) and according to the European Respiratory Society guidelines using the European Community for Steel and Coal reference equations (₉).

Methacholine challenge: methacholine was administered using a dosimetric computerized apparatus (MEFAR MB3, Marcos, Italy), activated by the inhalator effort. Subjects inhaled progressively increasing doses of methacholine, starting from 30 µg until 1,200/ml µg in 11 steps. The procedure was stopped if and when the FEV1 fell by more than 20% from baseline. A computerized algorithm provided the provocation dose (PD₂₀) value. If no response was obtained with the maximal cumulative dose of 1,200 µg/ml, the test was considered negative.

Statistical analysis: This was performed with Stata 8, using Mann Whithey U test to compare the absolute value? Or percent predicted? If percent predicted used, please provide reference values/equation(see ref 9) used percent predicted values of FEF 25^th-75^th between positive and negative BHR patients and a general linear model to assess the association of log-transformed MCH and FEF 25-75, TSS or nasal air flow. Pearson R was computed.