Diagnostic Tools in Allergic Rhinitis

Abstract

Allergic mechanisms account for most cases of chronic rhinitis. This condition is associated with significant impairment of quality of life and high indirect costs. The identification of the allergic triggers of rhinitis has been historically based on the performance of atopy test [skin prick test (SPT) and serum allergen-specific (s)IgE]. Nevertheless, these tests only denote sensitization, and atopy and allergy represent two different phenomena. It is now clear that allergic phenotypes of rhinitis can exist in both atopic (allergic rhinitis, AR) and non-atopic (local allergic rhinitis, LAR) individuals. Moreover, both allergic phenotypes can coexist in the same rhinitis patient (dual allergic rhinitis, DAR). Therefore, a diagnostic approach merely based on atopy tests is associated with a significant rate of misdiagnosis. The confirmation of the allergic etiology of rhinitis requires the performance of in vivo test like the nasal allergen challenge (NAC). NAC is mandatory for the diagnosis of LAR and DAR, and helps decide the best management approach in difficult cases of AR. Nevertheless, NAC is a laborious technique requiring human and technical resources. The basophil activation test (BAT) is a patient-friendly technique that has shown promising results for LAR and DAR diagnosis. In this review, the diagnostic usefulness for chronic rhinitis of SPT, NAC, olfactory tests, serum sIgE, BAT and the quantification of inflammatory mediators in nasal samples will be discussed. The accurate performance of an etiologic diagnosis of rhinitis patients will favor the prescription of specific therapies with disease-modifying potential like allergen immunotherapy.

Diagnosis and Management of Allergic Rhinitis in Asthmatic Children

“…SPT is the main in vivo test recommended by international guidelines, regarded as the most sensitive and specific test for atopy identification. 56 Of note, positive SPT alone does not confirm the AR diagnosisin fact, the detected sensitization must be consistent with the patient’s clinical history in order to sustain a cause-effect relationship. The measurement of serum-specific IgE represents an in vitro test to explore the sensitization profile.…”

“…From the methodological point of view, ImmunoCAP system (Thermo Fisher Scientific, TFS, Uppsala) allows a single allergen evaluation, whilst the Immuno-Solid Phase Allergen Chip (ImmunoCAP ISAC from TFS), and the Allergy Explorer-ALEX system (Macroarray DX Wien, Austria) evaluate several allergens at the same time. All the mentioned tests have high sensibility and specificity, regardless of age and medication, 56 providing the opportunity to confirm AR diagnosis even during the course of antihistaminic treatment, which on the opposite hampers the skin reactivity and the reliability of SPT. Specific IgE detection is also helpful in differentiating cross-sensitization and to guide AIT extract selection.…”

“…(Macroarray DX Wien, Austria) evaluate several allergens at the same time. All the mentioned tests have high sensibility and specificity, regardless of age and medication, 56 providing the opportunity to confirm AR diagnosis even during the course of antihistaminic treatment, which on the opposite hampers the skin reactivity and the reliability of SPT. Specific IgE detection is also helpful in differentiating cross-sensitization and to guide AIT extract selection.…”

Allergy, Anaphylaxis, and Nonallergic Hypersensitivity: IgE, Mast Cells, and Beyond

“…A diagnosis of IgE-dependent allergy is founded on the association of a convincing clinical history and proven sensitization to the culprit allergen. The gold standard for allergy diagnosis is a positive challenge test reaction to a culprit allergen, e.g., nasal allergen challenge or oral food allergen challenge test [139][140][141]; a positive test, i.e., yielding a reaction to the culprit allergen, is a reliable proof of genuine allergy. However, challenge tests bear a non-negligible risk of severe allergic reactions and therefore can only be performed by specialized medical staff in appropriate settings with high costs and lengthy delays [142].…”

Organ‐specific allergen challenges in airway allergy: Current utilities and future directions

“…Because allergen challenges are widely implemented in occupational medicine, this article will focus on areas of clinical medicine where their use has been scarcer. 15 Similarly, other types of specific challenges (e.g., lysine-acetylsalicylate provocations) are beyond the scope of this article.…”