How to Diagnose and Treat Local Allergic Rhinitis: A Challenge for Clinicians

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.

Local allergic rhinitis: a pediatric perspective

“…A further evaluation of the non-sensitized patients with NAC, nasal sIgE, and/or BAT is helpful to reveal patients with LAR. 59 (Table II).…”

Allergic rhinitis and the phenomenon of entopy

“…Одна группа исследователей [43] предположила, что ЛАР не вписывается в номенклатуру классического аллергического (атопического) ринита по сравнению с неаллергическим, и, по-видимому, является новым, отдельным фенотипом ринита. Однако другая группа ученых [20,44,45] обосновала ЛАР как эндотип аллергического ринита, поскольку при данной патологии присутствуют главные атопические биомаркеры, но не на системном уровне, а на уровне слизистой носа. Более того, недавно полученные факты свидетельствуют о том, что кроме ЛАК существуют и другие формы энтопии в аспекте концепции единых дыхательных путей: локальная аллергическая астма [22] и локальный аллергический конъюнктивит [21].…”

“…Лечение больных ЛАР в общих принципах соответствует терапии классического аллергического ринита. Рекомендуются режим гипоаллергенного быта, спреи с топическими кортикостероидами, антигистаминные средства, антагонисты рецепторов лейкотриенов, интраназальные кромоны, моноклональные антитела против IgE -группа биолоджиков (омализумаб) и аллерген-специфическая иммунотерапия [45,51,52]. Однако существует проблема выбора метода аллерген-специфической иммунотерапии (подкожный или сублингвальный), решение которой пока остается открытым для дискуссии [52].…”

Potential Differences between Local and Systemic Allergic Rhinitis Induced by Birch Pollen

“…LAR is characterized by the local production of IgE in the nasal mucosa during natural exposure to aeroallergens. Typically, these patients have negative SPTs and sIgE results but have a positive response to the nasal provocation test (NPT) to aeroallergens [2, 3]. As in SAR, IgE-dependent pathomechanism is also present in patients with LAR.…”

“…As in SAR, IgE-dependent pathomechanism is also present in patients with LAR. However, there is much doubt as to whether the local IgE mechanism is present in all patients [3, 4]. Moreover, there is a question about the difference between SAR and LAR mechanism regardless of the obvious systemic production of allergen-specific IgE in the latter case.…”