Phenotypes of allergic rhinitis: the application of stratified and personalized medicine in the rhinitis field

Abstract

Classification of allergic rhinitis (AR) on the basis of phenotypes has facilitated their characterization and has helped practicing clinicians efficiently approach rhinitis patients. Nasal provocation test (NPT) with an allergen allows evaluating of the reaction not only in the shock organ, but also on the mucous membranes in general. To develop and describe a method for diagnosing neutrophilic, basophilic and eosinophilic phenotypes of AR by conducting a NPT with an allergen and determining the increase in tryptase, myeloperoxidase (MPO) and eosinophilic cationic protein(ECP) levels in nasal lavage and oral fluid. In 46 patients with AR and 28 healthy volunteers before and 30 min after the NPT with Dermathophagoides pt. determined the result by estimating the release of MPO from neutrophils, tryptase from mast cell and basophil, ECP from eosinophils in nasal lavage, oral fluid NPT with a minimally selected concentration of allergen (by dilution skin test) did not cause the development of clinical symptoms, but allowed to verify the response of the nasal mucosa to an allergen intake. After a NPT, 27 (90%) patients with AR showed a significant increase in tryptase level after 30 min (p = 0.043) in contrast to healthy volunteers. The diagnostic criterion for an increase in the level of tryptase was + 5%. After the NPT, it was revealed that 53% of patients with AR experienced a significant increase (over 16%) of MPO in nasal lavage (p = 0.03). In 23 (76.6%) patients with AR, a positive increase in the level of ECP was detected. Before provocation, the level was 829.9 [673.3; 986.6] pg / ml, and 30 minutes after it was 1080.9 [896.6; 1265.3] pg / ml, p = 0.001. The level of eosinophilia in smears imprints most correlated with the level of eosinophilic cationic protein (R = 0.62).An increase in biomarkers in nasal lavage and oral fluid when an allergen is exposed to a shock organ (nasal mucosa) confirms the involvement of mast cells, eosinophils and mucosal neutrophils in the allergic process. There was not the growth in the control. Pathogenetic mechanisms of allergy are polymorphic. The results demonstrate the diagnostic potential of NPT with an allergen. These correlations of increased biomarkers in nasal lavage and oral fluid after NPT confirm the idea of a single mucosal immunity. The developed NPT with the determination of biomarkers in nasal lavage is a method for diagnosing neutrophilic, basophilic and eosinophilic phenotypes of AR.