Update on pathomechanisms and treatments in allergic rhinitis

Abstract

Allergic rhinitis (AR) is a global health problem with increasing prevalence and association with an enormous medical and socioeconomic burden. New recognition of immune cells such as type 2 innate lymphocytes (ILC2s), T helper (Th2) 2 cells, follicular helper T cells, follicular regulatory T cells, regulatory T cells, B cells, dendritic cells, and epithelial cells in AR pathogenesis has been updated in this review paper. An in‐depth understanding of the mechanisms underlying AR will aid the identification of biomarkers associated with disease and ultimately provide valuable parameters critical to guide personalized targeted therapy. As the only etiological treatment option for AR, allergen‐specific immunotherapy (AIT) has attracted increasing attention, with evidence for effectiveness of AIT recently demonstrated in several randomized controlled trials and long‐term real‐life studies. The exploration of biologics as therapeutic options has only involved anti‐IgE and anti‐type 2 inflammatory agents; however, the cost‐effectiveness of these agents remains to be elucidated precisely. In the midst of the currently on‐going COVID‐19 pandemic, a global life‐threatening disease, although some studies have indicated that AR is not a risk factor for severity and mortality of COVID‐19, this needs to be confirmed in multi‐centre, real‐life studies of AR patients from different parts of the world.

Pathogenesis of allergic diseases and implications for therapeutic interventions

“…In addition, the relatively expensive price of biologics also limits their application to some extent. 522 – 524 …”

Diagnosis and Management of Allergic Rhinitis in Asthmatic Children

“…Production of allergen-specific IgG4, T regulatory cells and inhibition of specific IgE have been described as the key immunological effects of allergen immunotherapy. [73][74][75] Two main routes are currently practiced for AIT administration: subcutaneous (SCIT) and sublingual (SLIT). Both have similar efficacy in AR with a safety profile that favours SLIT.…”

A review of recent advances in exosomes and allergic rhinitis

“…Numerous studies indicate that several cell types play a role in allergic rhinitis’ occurrence and progression. These cells consist mainly of epithelial cells, dendritic cells (DCs), type 2 follicular helper T cells (Tfh2), basophils, mast cells, Th2 cells, B cells, group 2 innate lymphoid cells (ILC2s), eosinophils and neutrophils ( Drazdauskaite et al, 2020 ; Zhang et al, 2022 ). Among these cells, the ILC2s play a crucial role in airway inflammation as a component of the Th2 innate immunity.…”