Detection of local allergic rhinitis in children with chronic, difficult‐to‐treat, non‐allergic rhinitis using multiple nasal provocation tests

Abstract

Background There is little evidence on the incidence and characteristics of local allergic rhinitis (LAR) in children. Most studies have included subjects with perennial rhinitis only, and results are based on the investigation of no more than three allergens per study. Our aim was to determine the proportion of children with LAR amongst children with chronic, difficult‐to‐treat, perennial or seasonal, rhinitis but no evidence of sensitization to aeroallergens, or other alternative diagnosis. Methods We performed multiple nasal provocation tests (M‐NPTs) with four locally relevant aeroallergens (Phleum pratense, Olea europea, Alternaria alternata, and Dermatophagoides pteronyssinus) in children with absence of aeroallergen sensitization, seen during a calendar year in a specialized rhinitis clinic. We additionally performed single NPT to children with allergic rhinitis (AR; positive control group). The result of the NPT was based on symptoms and acoustic rhinometry. Identification of nasal hyper‐reactivity (NHR) triggers was through a questionnaire. Results Local allergic rhinitis was confirmed in 29.2% (7/24) of the negative SPT/blood testing population. All but one of the children reacted to one allergen and one to two. All AR children had positive single NPT with results similar to the LAR. There were no differences in age at examination and rhinitis onset, gender distribution, family atopy, and past or current environment of residency, while the prevalence of reported NHR triggers was comparable amongst the three groups. Conclusion This is the first pediatric study where the seasonal or perennial rhinitis population was thoroughly tested for LAR against four aeroallergens. LAR is present in a considerable proportion of children with chronic, difficult‐to‐treat rhinitis and no sensitization to aeroallergens, and therefore, the performance of NPT should be strongly considered in these cases. There were no distinct clinical characteristics between LAR, AR, and non‐allergic rhinitis in children.

Local allergic rhinitis: a pediatric perspective

“…There are a limited number of studies investigating LAR in the pediatric population (Table I). [35][36][37][38][39][40][41][42][43] The first pediatric study assessing nasal reactivity to allergens and nasal-specific IgE in non-atopic individuals was carried out by Fuiano et al 35 in 2010. Two years later, the same study group found that 64% of children…”

Allergy development is influenced by microbial breast milk composition and early exposure to animals

“…The diagnosis of allergic rhinitis remains a diagnostic challenge, in particular when sIgE is only present locally. 16 In addition, more accurate biomarkers are needed for better diagnosis and prediction of disease progression, 17,18 as well as for targetted immunotherapy. 19 This issue of PAI contains other articles that deserve your attention.…”

“…However, their data also suggested that sIgE detection in nasal secretions with the biochip used in the study was not sensitive enough to substitute for the serum sIgE measurements. The diagnosis of allergic rhinitis remains a diagnostic challenge, in particular when sIgE is only present locally . In addition, more accurate biomarkers are needed for better diagnosis and prediction of disease progression, as well as for targetted immunotherapy …”

Local rhinitis needs allergen‐challenges for diagnosis, late infancy supplementation of probiotics prevents eczema, and milk oral immunotherapy is effective in the long term

“…As usual, I would like to highlight several articles in this issue: In my first choice, Olympia Tsilochristou et al have investigated a cohort of children with "local allergic" rhinitis. 4 When systematically testing the children with chronic, difficult-to-treat, perennial or seasonal rhinitis but without evidence of sensitization to aeroallergens, they found 29.2% of children reacting to a nasal provocation test to one of the most relevant allergens in their area (Phleum pratense, Olea europaea, Alternaria alternata, or Dermatophagoides pteronyssinus). This study shows that allergies are probably largely underdiagnosed in chronic rhinitis patients who are often dismissed as non-allergic on the basis only of negative testing.…”