Natural Evolution of Local Allergic Rhinitis

Abstract

Local allergic rhinitis (LAR) affects an important group of non-atopic rhinitis patients. However, whether LAR is a first step in the development of classical allergic rhinitis (AR) with systemic atopy or not, it is still unknown. In this study we have evaluated the natural evolution of LAR and possible conversion to AR. A prospective follow-up study has been carried out in 346 LAR patients with up to 18 months of evolution and positive response to nasal provocation test with at least one aeroallergen. Clinical questionnaire, spirometry, skin prick testing, and serum specific IgE antibodies to common aeroallergens were evaluated yearly. The clinical profile of patients was a non-smoker woman with moderate/severe persistent perennial rhinitis, without family history of atopy and city dwelling. At initial evaluation conjunctivitis (52,43%) and asthma (18,45%) were the most frequent comorbidities, and D. pteronyssinus (54,4%) the main involved aeroallergen detected by nasal allergen provocation test. Data from 176 LAR patients who have completed 4 years of evaluation showed worsening of rhinitis in 26,2%, new association to conjunctivitis and asthma in 7.8% and 5.8% respectively. New systemic sensitization to aeroallergens was detected by SPT and/or serum specific IgE in 6.81% of patients. These sensitisations appeared during first 2-3 years of evolution. These data support that LAR and classical AR can be two independent entities, because only a small proportion of LAR patients converted to AR over time. However in order to better support these differences a longer follow-up study is actually in progress.