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LETTERS TO THE EDITOR 1071 aeroallergens. HDM exposure is common, associated with perennial allergy, and a significant risk factor for AR and asthma. Here we compared the symptom dynamics in the natural setting versus the ACC in HDM-sensitive (M+) and nonsensitive (MJ) participants meeting the inclusion/exclusion criteria shown in Table E1 in this article’s Online Repository at www. jacionline. org. MJ subjects lacked both a history of AR and skin prick test (SPT) wheal reactivity (> _5 mm) to 17 allergens, including HDM (see Table E2 in this article’s Online Repository at www. jacionline. org).

The study comprised 4 study phases: a 4-day run-in phase followed by 2 ACC exposure phases (ACC-I and ACC-II) with an intervening 38-day observation phase (Fig 1, A). This design allowed for evaluation of the reproducibility of symptom responses and factors that could potentially confound clinical trials in the …