Immediate and dual response to nasal challenge with Dermatophagoides pteronyssinus in local allergic rhinitis

Background: Local allergic rhinitis (LAR) remains an underdiagnosed condition characterized by the local production of IgE antibodies during the natural exposure to aeroallergens. The prevalence of LAR in adult patients with a previous diagnosis of non-AR was assessed. Material and Methods: Eighty-four patients with perennial nasal allergy symptoms but a negative skin prick test and specific IgE antibodies against common inhalant allergens were included in the study. Nasal provocation tests were performed with the inhalant allergens Dermatophagoides pteronyssinus, Alternaria, and cat allergen, followed by the detection of nasal-specific IgE antibodies in the lavage during the challenge. Results: LAR was confirmed in 21 (25%) study patients. In the remaining 63 (75%) patients, non-AR was diagnosed. In addition, LAR was found following exposure to D. pteronyssinus in 19 (22.6%) patients, Alternaria in 3 (3.6%) patients, and the cat allergen in 1 (1.2%) patient. In 2 patients, concomitant allergies to D. pteronyssinus and Alternaria were observed. Conclusion: LAR can be a form of chronic perennial rhinitis that has previously been considered to be non-AR.

Section: Discussionsupporting

confidence: 79%

Local Allergic Rhinitis in Adult Patients with Chronic Nasal Symptoms

Krajewska-Wojtys¹,

Jarząb²,

Zawadzińska³

et al. 2017

“…In recent years, local allergic rhinitis (LAR) has been defined as a new phenotype of allergic rhinitis characterized by nasal symptoms of allergic rhinitis in the absence of sensitivity in a skin prick test (SPT) or serum-specific IgE, a positive response to a specific nasal provocation test (NPT) and the presence of a Th2 immune inflammatory response in the nasal mucosa with local production of specific IgE [1,2,3,4,5]. Powe et al [6] enounced ‘entopy' by describing the activation of a Th2 immune response in the nasal mucosa of nonallergic rhinitis patients.…”

Section: Introductionmentioning

confidence: 99%

The Relevance of Nasal Provocation Testing in Children with Nonallergic Rhinitis

Duman

Bostancı

Özmen

et al. 2016

Background: It is important to understand that allergic rhinitis, whether seasonal or perennial, may be difficult to distinguish clinically from the nonallergic forms of rhinitis. Objective: This study aimed to investigate the presence of local allergic rhinitis (LAR) in children who have allergic rhinitis symptoms in the absence of skin test positivity and specific IgE by performing a nasal provocation test (NPT). Methods: Our study followed a case-controlled, prospective design. Twenty-eight patients and 30 healthy children were included in the study in a pollen-free season. The NPTs with a grass mix, Dermatophagoides pteronyssinus (DP) and D. farinae (DF) allergens were performed with an interval of 1 week. The total symptom score and visual analog scale, nasal eosinophilia and pulmonary function tests were evaluated before and after each NPT. The change to nasal flow and resistance was recorded by anterior rhinomanometry. Results: The symptom frequencies before the NPTs were as follows: nasal congestion 100%; itching 82.1%; rhinorrhea 75% and sneezing 71.4%. The NPT was positive in 7 (25%) patients. In the NPT-positive group there was a statistically significant decrease in nasal flow at the concentrations of 10 and 100 IR/ml for DF (p = 0.026, p = 0.031, respectively). In the NPT-positive group total nasal resistance for DP was increased at the concentrations of 0.1 and 10 IR/ml, and for DF at 10 and 100 IR/ml (p = 0.049, p = 0.041, p = 0.022, p = 0.035, respectively). Conclusions: We emphasize that the diagnosis of LAR should be taken into consideration by pediatricians and pediatric allergy specialists.

“…Specific IgE identified using the enzyme allergosorbent test (EAST) can be detected in nasal secretions but not in the serum of these patients [1]. This type of allergy is limited to the nasal mucosa and therefore referred to as local allergic rhinitis [2,3], entopy [4] or allergic rhinitis with a negative skin test [5]. Clinical symptoms, nasal secretions and the profile of cytokine production of local allergic rhinitis are similar to classic allergic rhinitis [6,7].…”

Section: Introductionmentioning

confidence: 99%

Local Allergic Nasal Reactions Convert to Classic Systemic Allergic Reactions: A Long-Term Follow-Up

Sennekamp¹,

Joest²,

Filipiak-Pittroff³

et al. 2015

Background: There is poor knowledge about the evolution of the negative skin test in local allergy over time. Does the negative skin test of patients with local allergies remain negative permanently or does it become positive? Methods: We describe our long-term observation concerning the evolution of the negative skin test over time. This is a retrospective, follow-up study using data from the medical records of a group of patients with local allergy. A total of 42 patients aged between 3 and 70 years (median age: 31.5 years) were studied. The duration of follow-up varied from 1 to 27 years. Skin tests were performed using the skin-prick test and intracutaneous techniques for pollen, molds, mites, feathers (goose and duck) and animal danders. Nasal provocation tests were conducted with the same allergens. Additionally, specific IgE in 17 patients was measured by enzyme allergosorbent test. Results: During the period of observation, the negative skin test reactions converted into positive reactions in 17 patients (40%). In addition to the negative skin reactions, 55% of the patients also presented positive skin reactions. The conversion rate was higher in children and adolescents than in adults. In 4 patients, conversions occurred >7 years after the initial examination. Specific IgE was negative in all but 2 patients, in whom the conversion in the skin test was accompanied by a switch from negative to positive specific IgE. Conclusion: Conversions from local to classic systemic respiratory allergic reactions appear to be a common phenomenon.