Local Respiratory Allergy: From Rhinitis Phenotype to Disease Spectrum

Abstract

Local respiratory allergy (LRA) is defined by the negativity of atopy tests, a clinical history suggestive of airway allergy and a positive response to the nasal and/or bronchial allergen challenge. The clinical spectrum of LRA is comprised of three conditions: local allergic rhinitis (LAR) and local allergic asthma in non-atopic patients, and dual allergic rhinitis (coexistence of allergic rhinitis and LAR) in atopic individuals. LRA is an independent disease phenotype not progressing to atopy over time, but naturally evolving to the clinical worsening and the onset of comorbidities. Published data suggests that LRA is mediated through the mucosal synthesis of allergen-specific (s)IgE, which binds to FcϵRI on resident mast cells, and in >50% of cases traffics to the blood stream to sensitize circulating basophils. To date, 4 clinical trials have demonstrated the capacity of allergen immunotherapy (AIT) to decrease nasal, conjunctival and bronchial symptoms, to improve quality of life, to increase the threshold dose of allergen eliciting respiratory symptoms, and to induce serum sIgG4 in LRA individuals. Collectively, these data indicate that local allergy is a relevant disease mechanisms in both atopic and non-atopic patients with airway diseases.

Neuronal-Immune Cell Units in Allergic Inflammation in the Nose

“…Allergic rhinitis has become a global healthcare challenge frequently linked with allergic asthma that impacts upon the quality of life, social and educational activity, and results in an increased financial burden on healthcare [110][111][112]. In recent years, new forms of respiratory atopic disorders, such as local allergic rhinitis, local allergic asthma, "dual" allergic rhinitis, and local allergic conjunctivitis, have been described [113][114][115][116][117]. Although local allergic rhinitis was described approximately a decade ago, its detailed immunopathogenesis is not understood yet.…”

Assessment of allergen tolerance breakdown levels in local and classical allergic rhinitis

“…24,5 2022, Т. 24, № 5 кое содержание в крови общего и специфических IgE, а также отрицательные результаты кожных проб [22,27]. Иными словами, срыв толерантности к аллергенам, по-видимому, происходил при обострениях локальных и системных атопий на разных уровнях, локальном и системном [16].…”

“…В наше время наблюдается рост атопических аллергических болезней, особенно аллергического ринита, и под воздействием новых, ранее не известных человечеству факторов, наблюдается эволюция этих заболеваний, что проявляется повышением их гетерогенности [1,3,32]. В последние годы были идентифицированы принципиально новые формы атопических состояний с локализацией в респираторном тракте, что получило наименование «спектр локальных аллергий дыхательной системы» [27]. Данная группа вклю-чает локальный аллергический ринит (ЛАР), отличающийся от классического аллергического ринита (КАР) и описанный раньше всех других локальных форм [21], «двойной» аллергический ринит [13], локальную аллергическую астму [7] и локальный аллергический конъюнктивит [34].…”

Innate and adaptive immunity in allergic airway disease

“…The phenomenon of local allergic rhinitis (LAR) or entopy is now known to occur, whereby individuals with allergic rhinitis have local nasal IgE, no detectable plasma IgE, but respond to nasal allergen challenge and can be treated with allergen-specific immunotherapy (AIT). LAR may remain localized, transmute into allergic rhinitis and, like allergic rhinitis, LAR is also a risk factor for asthma [8,9,10…”