Abstract
Some patients with chronic rhinitis have a positive nasal allergen provocation test (NAPT) without systemic IgE sensitization by skin prick tests or serum allergen-specific IgE (sIgE). This novel concept is called local allergic rhinitis (LAR) and affects children and adults worldwide, but is underdiagnosed. LAR is not just the initial state of allergic rhinitis (AR), it is a unique form of chronic rhinitis that is neither classical AR nor non-AR. Many of the features of AR and LAR are similar, such as a positive NAPT, positive type 2 inflammatory markers, including the nasal discharge of sIgE, and a high incidence of asthma. A differential diagnosis of LAR needs to be considered in patients with symptoms suggestive of AR in the absence of systemic atopy, regardless of age. The diagnostic method for LAR relies on positive responses to single or multiple allergens in NAPT, the sensitivity, specificity, and reproducibility of which are high. The basophil activation test and measurement of IgE in nasal secretions also contribute to the diagnosis of LAR. Treatment for LAR is similar to that for AR and is supported by the efficacy and safety of allergen exposure avoidance, drug therapy, and allergen immunotherapy. This review discusses current knowledge on LAR.
Highlights
Chronic rhinitis may be divided into two groups: allergic rhinitis (AR) and non-allergic non-infectious rhinitis, often simplified as non-AR (NAR) [1,2]
The simple classification of chronic rhinitis into AR and NAR appears to be limited because it does not consider the form of rhinitis in which allergen-specific IgE produced locally in the nasal mucosa contributes to pathogenesis
A previous study demonstrated the diagnostic accuracy of nasal specific IgE (sIgE) for local allergic rhinitis (LAR) in 212 children with chronic rhinitis; 14 had nasal sIgE > 0.35 kU/L and 12 were diagnosed with LAR based on significantly higher nasal sIgE than controls and a positive nasal allergen provocation test (NAPT) [42]
Summary
Chronic rhinitis may be divided into two groups: allergic rhinitis (AR) and non-allergic non-infectious rhinitis, often simplified as non-AR (NAR) [1,2]. Patients with allergies are identified by skin prick testing or the presence of allergen-specific IgE in serum [4,5]. The simple classification of chronic rhinitis into AR and NAR appears to be limited because it does not consider the form of rhinitis in which allergen-specific IgE produced locally in the nasal mucosa contributes to pathogenesis. The term local LAR has been proposed to describe Th2-type nasal mucosal inflammatory diseases in which antigen-specific IgE antibodies are produced locally in the nasal mucosa, the nasal allergen provocation test (NAPT) is positive, and systemic atopy is not proven [6]. We discuss the clinical implications of local allergy with a focus on the management of NAPT-positive patients without atopic rhinitis
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