Specific IgE antibodies in nasal secretion from patients with allergic rhinitis and with negative or weakly positive RAST on the serum

Abstract

Summary Nasal secretions from eighteen patients with allergic rhinitis with a positive case history, intradermal test and nasal provocation test, but with negative or only weakly positive RAST (radioallergosorbent test) on the serum against a total of thirty‐five allergens, were studied. In the RAST an immunosorbent‐purified anti‐IgE with Dɛ2 specificity was used, which raised the detection limit. Nasal secretion was collected by washing the nasal mucosa with 0.9% and 18% NaCl solution respectively, and the latter secretion was also lyophilized and concentrated. In ten cases RAST was slightly positive on the nasal secretion, and in three of the concentrated secretions the RAST value was higher than on the serum. In none of the serum or nasal secretion samples was RAST positive according to the cut off value for a positive result defined by the reference system used in Phadebas RAST®. From these results it is concluded that RAST analyses of nasal secretion from patients with allergic rhinitis is of no appreciable value in routine clinical allergological diagnosis. However, the increased sensitivity of RAST obtained with isotope‐labelled anti‐Dɛ2 may be useful in the serological diagnosis of patients with low grade allergy having low levels of IgE antibodies in serum.

B-lymphocyte lineage cells and the respiratory system

“…216–222 It is not uncommon for individuals with allergic rhinitis or chronic rhinosinusitis (CRS) to manifest antigen-specific IgE in nasal secretions or nasal tissue with no apparent specific IgE in the serum for the same antigen, and documented cases exist in which nasal antigen challenge responses are elicited in individuals that lack skin test sensitivity. 215, 217, 218, 220 A survey study found that 19% of patients with rhinitis and polyposis had specific IgE in the nose but not the serum. 223 More recent studies, that used time resolved fluorescence immunosorbent assays to determine the relative proportions of total and specific immunoglobulins in the airways and circulation, concluded that the majority of the total body aeroallergen-specific antibodies of the IgE and IgA isotypes are produced in the airways, and that systemic sensitization largely reflects spillover of immunoglobulins from the mucosal site of their production into the circulation.…”

Durchführung des nasalen Provokationstests bei Erkrankungen der oberen Atemwege

“…Es ist demnach möglich, dass bei nasaler Allergie weder an der Haut noch im Serum spezifisches IgE nachweisbar ist. Der Nachweis einer Allergie gelingt in diesen seltenen Fällen nur durch nasalen Provokationstest an der Nasenschleimhaut selbst [25].…”

Seeking allergy when it hides: which are the best fitting tests?

“…The first recognitions that IgE may be present exclusively in the nasal mucosa date back to the 1970s [9,10] and this phenomenon was occasionally reconsidered [11-14]. In 2003 the term “entopy” was proposed to differentiate local IgE production from atopy [13] but the recent definition by Rondon et al as local allergic rhinitis (LAR) seems more convincing [15].…”