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Rhinitis and Related Upper Respiratory Conditions pp 37–58Cite as

Local Allergic Rhinitis

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Abstract

A significant proportion of patients with chronic rhinitis display negative skin prick test and serum allergen-specific IgE (sIgE). These individuals have been historically classified in the nonallergic rhinitis (NAR) phenotype. Nevertheless, in recent years a significant corpus of evidence has demonstrated that many chronic rhinitis patients without systemic IgE sensitization display nasal reactivity upon nasal allergen provocation test (NAPT). This disease phenotype has been termed local allergic rhinitis (LAR). Epidemiological studies show that LAR is a prevalent disease in children and adults, with moderate-to-severe symptoms that worsen over time. LAR is a stable phenotype and not merely an initial state of allergic rhinitis (AR) with systemic atopy. LAR and AR share many clinical features, including the common association to asthma and conjunctivitis. LAR pathophysiology is unknown but in some patients sIgE can be demonstrated directly in the nasal secretions and/or indirectly via positive responses in basophil activation test (BAT). LAR can coexist with other chronic rhinitis phenotypes, but most importantly with AR. The diagnosis currently relies on the performance of NAPT with single or multiple allergens. This technique has high sensitivity, specificity, and reproducibility, and it is considered the gold standard. The BAT and the measurement of nasal sIgE can also contribute to the LAR diagnosis. Local allergic rhinitis patients benefit from the same therapeutic strategies than AR individuals, including avoidance of allergen exposure and pharmacotherapy. Moreover, good-quality data supports the effectiveness and safety of allergen immunotherapy for LAR, which also suggests that LAR is an IgE-mediated disease.

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  1. Allergy Unity, IBIMA-Hospital Regional Universitario of Málaga-UMA, ARADyAL, Málaga, Spain

    Carmen Rondón, Ibon Eguiluz-Gracia, Gador Bogas, Esther Barrionuevo, María Salas, Maria J. Torres & Paloma Campo

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    Jonathan A. Bernstein

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Rondón, C. et al. (2018). Local Allergic Rhinitis. In: Bernstein, J. (eds) Rhinitis and Related Upper Respiratory Conditions. Springer, Cham. https://doi.org/10.1007/978-3-319-75370-6_5

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