Abstract
Chronic rhinitis is a very common disease that can be divided in various phenotypes. Historically, the condition has been classified into the allergic rhinitis (AR) and non-allergic non-infectious rhinitis (NAR) forms, based on the results of the classical biomarkers of atopy: skin prick test and serum allergen-specific IgE However, this classification does not reflect the complexity of the rhinitis syndrome, as illustrated by the existence of non-atopic rhinitis patients who display a nasal reactivity to environmental allergens. This new phenotype has been termed local allergic rhinitis (LAR) and can be only recognized if an additional test such as the nasal allergen challenge (NAC) is integrated in the diagnostic algorithm for chronic rhinitis. Recent data shows that the NAC is a very safe and reliable technique ready for the clinical practice. LAR is a differentiated rhinitis phenotype which often commences during childhood and quickly progresses towards a clinical worsening and the association of comorbidities in other mucosal organs. Recent evidence supports the existence of a bronchial counterpart of LAR (local allergic asthma), which highlights the pathophysiological links between the upper and lower airways and reinforces the united airways concept. Importantly, several controlled studies have demonstrated the ability of allergen immunotherapy to control LAR symptoms while the therapy is being administered. This review emphasizes the need to implement the NAC in the clinical practice in order to facilitate the recognition of LAR patients, allowing for an early prescription of specific therapies with disease-modifying potential.
Highlights
Chronic rhinitis affects up to 30% of the general population in Western countries and imposes a significant burden to healthcare systems in terms of both direct and indirect costs [1]
One simple classification divides the disorder between allergic rhinitis (AR) and non-allergic non-infectious rhinitis [3,4]
In the above-mentioned study, we report a very high reproducibility for the nasal allergen challenge (NAC) (97.32%, PPV 100%, NPV 92.92%) when assessed by Lebel symptoms score and acoustic rhinometry [68]
Summary
Chronic rhinitis affects up to 30% of the general population in Western countries and imposes a significant burden to healthcare systems in terms of both direct and indirect costs [1]. NAR is a highly heterogeneous entity comprising disorders characterized by either immunological or neurogenic inflammation [4,5] To discriminate these phenotypes, two biomarkers were historically available: a skin prick test (SPT) and the serum allergen-specific IgE (sIgE) [6]. A significant proportion of healthy subjects displays positivity for SPT or serum sIgE [7], demonstrating that the correlation with the pattern of nasal symptoms is crucial to interpret IgE-sensitization tests. In this regard, an additional in vivo biomarker like the nasal allergen challenge (NAC) can help identify the clinically relevant allergens in individual patients [8]. We will summarize the main epidemiological, pathophysiological, diagnostic, and therapeutic features of LAR, with special focus on the need for the implementation of the NAC in the clinical algorithms of rhinitis, and on the promising results of AIT as a treatment option for LAR patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
