Prevalence of antigen‐specific immunoglobulin E on mucosal brush biopsy of the inferior turbinates in patients with nonallergic rhinitis

Abstract

This study demonstrated that, using MBB of the inferior turbinates, antigen-specific IgE to at least 1 airborne allergen is detectable in 100% of the idiopathic, NAR study population. This rate of sensitization is notably higher than previous reports, suggesting that the prevalence of atopic disease in the general population may be higher than current estimates. Testing for local sensitization should be considered as part of the complete evaluation for atopic disease.

Total and allergen‐specific immunoglobulin E in the serum and nasal mucosa of a nonallergic population

“…Of the 12 participants with at least 1 grade 0/1 sensitization in the nose, 11 of them were sensitized only to outdoor allergens, notably White oak and ragweed. It has also been reported that individuals with nonallergic rhinitis (NAR) were more likely to test positive for oak and ragweed IgE in the nasal cavity using MBB if the epithelium was sampled during the outdoor pollen season . In a study of Japanese cedar pollen, sIgE in tears peaked sooner than serum IgE during the pollen season (March‐June) and decreased during the rest of the year, while serum levels remained high .…”

“…sIgE can be produced either in the larger lymphoid structures of the body, such as the spleen and regional lymph nodes, or directly in the mucosal tissues of the aerodigestive tract . As a result, local sIgE levels may be present even when serum sIgE levels are absent . Local production of sIgE has been demonstrated in the mucosal epithelium of the sinonasal cavity, bronchial mucosa, esophageal mucosa, and adenotonsillar tissue in individuals with clinical disease, regardless of atopic status.…”

Esophageal IgE, IgG4, and mucosal eosinophilia in individuals with dysphagia

“…Reisacher reported that positive nasal MBB samples had a mean total IgE of 13.6 kU/L in individuals with allergic rhinitis, whereas negative MBB samples had a mean total IgE of 4.6 kU/L . However, other MBB samples from both the nose and oral cavity yielded detectable sIgE when the total IgE levels were 4.75 kU/L and 4.9 kU/L, respectively . The development of more sensitive assays, mucosal stains to better identify pathologic tissue, and standardized, systematic biopsy protocols will all help to optimize mucosal antibody detection in the future.…”

“…However, it is also possible that evidence for allergen sensitization may be present in the locally symptomatic esophageal tissue, but not in the skin or serum. Previous studies using both mucosal brush biopsy (MBB) and solid tissue biopsy (STB) demonstrated that specific IgE to airborne and food allergens may be present in locally symptomatic nasal and oral cavity mucosa, even when SPT and sIgE testing to those allergens is negative . Moreover, Rodon and colleagues determined that individuals who demonstrated only local sensitization to grass pollen had similar subjective and objective improvements from subcutaneous immunotherapy as individuals with evidence of atopy on skin or serum testing …”

Local allergic rhinitis

“…All these methods may be good alternatives that need to be evaluated in LAR patients. Regarding invasive methods, the mucosal brush biopsy of the inferior turbinate has been used for the detection of nasal sIgE in a small group of patients with negative SPT [41]. However, the study did not include a group of healthy controls so sensitivity and specificity are still unknown.…”