Turbinate-Specific IgE in Normal and Rhinitic Patients

Abstract

Background Specific immunoglobulin E (sIgE) within the nasal airway is likely to be the most ideal marker of allergic status, but little is known of the normative values in asymptomatic patients and those with rhinitis. Objective The aim of this study was to assess the diagnostic characteristics of inferior turbinate tissue biopsy sIgE in asymptomatic and rhinitic patients. Methods A diagnostic cross-sectional study was undertaken, involving patients who underwent inferior turbinate surgery with or without other surgical interventions. Inferior turbinate tissue biopsy was performed during surgery and was assessed for allergen sIgE (dust mite, grass [temperate or subtropical], and animal epithelium) using an automated immunoassay. Tissue sIgE was assessed among asymptomatic patients and those with nasal symptoms. Data were presented as median (interquartile range). A receiver operating curve was used to predict the diagnostic utility of turbinate tissue sIgE in determining allergic rhinitis. Results A total of 160 patients (41.89 ± 14.65 years, 36.9% females) were included. The median tissue sIgE concentration among the asymptomatic nonatopic group of patients was 0.09 (0.08–0.10) kUA/L and tissue sIgE > 0.10 kUA/L was determined as a positive threshold. Inferior turbinate tissue sIgE was shown to be a predictive test for allergic rhinitis (area under curve: 0.87, 95% confidence interval: 0.84–0.90) with 90% sensitivity and 89% negative predictive value. Conclusion Inferior turbinate tissue biopsy sIgE is a sensitive tool to predict allergic rhinitis. The threshold value of 0.1 kUA/L corresponded well with the asymptomatic nonatopic group of patients. This method detects sIgE in the nasal mucosa and may be a useful test for allergic rhinitis in future research.

How to Diagnose and Treat Local Allergic Rhinitis: A Challenge for Clinicians

“…Yet this low sensitivity might be partially explained by technical or dilution effects [71], it cannot be excluded that a proportion of LAR patients do not have sIgE in the nasal secretions, as previously mentioned. Of note, the published literature shows a consistent proportion of 20–25% of SPT + rhinitis patients who do not have detectable nasal sIgE (some of them even no serum sIgE) [41,72,73,74]. Several samples have been used to measure nasal sIgE (secretions, scraping, brushing, tissue homogenates, etc.)…”

Nasal IgE in subjects with allergic and non-allergic rhinitis

“…33,34 As obtaining biopsies are invasive, new techniques for immunological analysis present an appealing concept. 30,35 CONCLUSION Nasal IgE is present in a substantial amount in subjects with AR þ HDM allergy, but not in NAR. In a non-selected population with NAR, exclusive local production of IgE is absent.…”

The Distinguishing Clinical Features of Nonallergic Rhinitis Patients

“…The methods for inferior turbinate tissue biopsy have been previously reported. 10 Briefly, the anterior portion of the inferior turbinate head was cut, placed in a cryovial without liquid, and stored in vapor phase liquid nitrogen. The tissue samples were homogenized on ice with 1 mL mixture of phosphate-buffered saline (960 lL) and protease inhibitor (40 lL, cOmplete TM Protease Inhibitor Cocktail, Sigma-Aldrich, Australia) per 0.5 g of tissue.…”

“…Inferior turbinate tissue biopsy for specific IgE has previously been used as a test to detect both systemic and local AR. 10 The presence of tissue-specific IgE (threshold >0.1 kUA/L) predicts systemic allergy with 90% sensitivity and 89% NPV. 10 Those who fall below this threshold likely represent NAR.…”

“…10 The presence of tissue-specific IgE (threshold >0.1 kUA/L) predicts systemic allergy with 90% sensitivity and 89% NPV. 10 Those who fall below this threshold likely represent NAR. The combination of systemic (serum-specific IgE and SPTs) and local test (nasal tissue-specific IgE) for allergy therefore represents a more rigorous approach to ruling out allergy as an underlying cause of rhinitis.…”