Medical algorithm: Diagnosis and treatment of local allergic rhinitis

Eguiluz‐Gracia, Ibon; Testera‐Montes, Almudena; Rondón, Carmen

doi:10.1111/all.14848

Cited by 17 publications

(35 citation statements)

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“…Allergic phenotypes of rhinitis are characterized by the positivity of the nasal challenge with at least one relevant allergen ( 5 ). The presence of atopy, positive skin prick test (SPT) and/or detectable serum allergen-specific IgE (sIgE), further classifies allergic patients with rhinitis into several sub-phenotypes ( 3 ).…”

Section: Subsections Relevant For the Subjectmentioning

confidence: 99%

“…The presence of atopy, positive skin prick test (SPT) and/or detectable serum allergen-specific IgE (sIgE), further classifies allergic patients with rhinitis into several sub-phenotypes ( 3 ). AR subjects display positive SPT results with all allergens testing positive in the nasal allergen challenge (NAC) ( 5 ). AR is also the most studied phenotype and according to ARIA ( Allergic Rhinitis and its Impact on Asthma ) guidelines can be divided according to its temporality (intermittent vs. persistent) and severity (mild vs. moderate-severe).…”

Section: Subsections Relevant For the Subjectmentioning

confidence: 99%

“…DAR patients typically display perennial nasal symptoms with seasonal exacerbations, positive SPT to seasonal allergens (pollens) only, and positive NAC with both seasonal and perennial allergens (house dust mites or molds) ( 6 ). On the other hand, NAR is defined by the negativity of the NAC with all relevant allergens ( 5 ). The coexistence of NAR and AR in the same rhinitis patients is also a common clinical scenario and this phenotype is termed mixed rhinitis (MR) ( 7 ).…”

Section: Subsections Relevant For the Subjectmentioning

confidence: 99%

“…Recently, our understanding about the physiopathology of AR has increased and new allergic endophenotypes of rhinitis have been described in both non-atopic and atopic individuals ( 3 , 4 ). Together with the high rate of polysensitization among AR patients and the existence of atopic patients with non-allergic rhinitis (NAR), this fact reveals the complexity of the etiologic diagnosis of rhinitis and emphasized the importance of differentiating between allergy and atopy ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Tools in Allergic Rhinitis

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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.

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Section: Subsections Relevant For the Subjectmentioning

confidence: 99%

Section: Subsections Relevant For the Subjectmentioning

confidence: 99%

Section: Subsections Relevant For the Subjectmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic Tools in Allergic Rhinitis

et al. 2021

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“…Of note, the atopy-based classification of airway diseases is being gradually replaced by an allergy-grounded division based on the presence of airway allergen-specific reactivity. In this regard, AR and AA patients display positive NAC or BAC results, together with positive SPT and detectable serum sIgE ( 8 ). Importantly, some non-atopic subjects with rhinitis and asthma also display positive NAC and BAC responses, and these phenotypes have been termed local allergic rhinitis (LAR) ( 9 ) and local allergic asthma (LAA) ( 10 ), respectively.…”

Section: Introductionmentioning

confidence: 99%

Local Respiratory Allergy: From Rhinitis Phenotype to Disease Spectrum

et al. 2021

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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.

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