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Local Allergic Rhinitis

  • Baki Yılmaz
  • Cemal Cingi
  • William Reisacher
Chapter

Abstract

Local allergic rhinitis (LAR) forms a subset of allergic rhinitis (AR), in which systemic antibodies (sIgE) to the triggering allergen cannot be detected or do not exist in the blood or skin, but within the nasal mucosa, they are present and trigger the response. In LAR individuals, the NAPT (nasal allergen provocation test) is positive. It is implicit within allergic rhinitis that the nasal and sinusal mucosa contain sIgE, otherwise a Type I hypersensitivity reaction could not occur, but a specific check for this is seldom undertaken if the symptomatology fits allergic rhinitis and systemic testing (skin and serum) for sIgE is positive. LAR is a frequent component within chronic rhinosinusitis. It is highly probable that patients with LAR or AR show severe symptoms of a chronic nature such as those found in conjunctivitis, asthma or sensitisation to multiple allergens. Where a patient has a clinical picture fitting AR, but cutaneous tests and serum sIgE levels are negative, further investigations are recommended, since otherwise all such cases will be classified as non-allergic rhinitis. Where local sIgE is detectable following naturally occurring exposure to airborne allergens and NAPT is positive, resulting in raised levels of localised tryptase, eosinophil cationic protein (ECP) and sIgE, this helps to make the diagnosis of LAR.

Keywords

Local allergic rhinitis (LAR) NAPT (nasal allergen provocation test) Local sIgE Localised tryptase Eosinophil cationic protein (ECP) 

References

  1. 1.
    Rondón C, Campo P, Herrera R, Blanca-Lopez N, Melendez L, Canto G, et al. Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis. J Allergy Clin Immunol. 2011;128:1192–7.PubMedGoogle Scholar
  2. 2.
    Rondón C, Campo P, Galindo L, Blanca-López N, Cassinello MS, Rodriguez-Bada JL, et al. Prevalence and clinical relevance of local allergic rhinitis. Allergy. 2012;6:1282–8.Google Scholar
  3. 3.
    Rondón C, Canto G, Blanca M. Local allergic rhinitis: a new entity, characterization and further studies. Curr Opin Allergy Clin Immunol. 2010;10(1):1–7.PubMedGoogle Scholar
  4. 4.
    Connell JT. Quantitative intranasal pollen challenges. 3. The priming effect in allergic rhinitis. J Allergy. 1969;43:33–44.PubMedGoogle Scholar
  5. 5.
    Rondón C, Campo P, Togias A, Fokkens WJ, Durham SR, Powe DG, Mullol J, Blanca M. Local allergic rhinitis: concept, pathophysiology, and management. J Allergy Clin Immunol. 2012;129(6):1460–7.PubMedGoogle Scholar
  6. 6.
    Rondón C, Romero JJ, López S, Antúnez C, Martín-Casañez E, Torres MJ, et al. Local IgE production and positive nasal provocation test in patients with persistent nonallergic rhinitis. J Allergy Clin Immunol. 2007;119:899–905.PubMedGoogle Scholar
  7. 7.
    Rondón C, Doña I, López S, Campo P, Romero JJ, Torres MJ, et al. Seasonal idiopathic rhinitis with local inflammatory response and specific IgE in absence of systemic response. Allergy. 2008;63:1352–8.PubMedGoogle Scholar
  8. 8.
    Rondón C, Fernández J, López S, Campo P, Doña I, Torres MJ, et al. Nasal inflammatory mediators and specific-IgE production after nasal challenge with grass in local allergic rhinitis. J Allergy Clin Immunol. 2009;124:1005–11.PubMedGoogle Scholar
  9. 9.
    López S, Rondón C, Torres MJ, Campo P, Canto G, Fernandez R, et al. Immediate and dual response to nasal challenge with Dermatophagoides pteronyssinus in local allergic rhinitis. Clin Exp Allergy. 2010;40:1007–14.PubMedGoogle Scholar
  10. 10.
    Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008. Allergy. 2008;63(suppl 86):8–160.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Rondón C, Fernandez F, Canto G, Blanca M. Local allergic rhinitis: concept, clinical manifestations, and diagnostic approach. J Investig Allergol Clin Immunol. 2010;20:364–71.PubMedGoogle Scholar
  12. 12.
    Reisacher W, Bremberg M. Prevalence of antigen-specific IgE on mucosal brush biopsy of the inferior turbinates in patients with non-allergic rhinitis. Int Forum Allergy Rhinol. 2014;4:292–7.PubMedGoogle Scholar
  13. 13.
    Rondón C, Campo P, Zambonino MA, Blanca-Lopez N, Torres MJ, Melendez L, Herrera R, Guéant-Rodriguez RM, Guéant JL, Canto G, Blanca M. Follow-up study in local allergic rhinitis shows a consistent entity not evolving to systemic allergic rhinitis. J Allergy Clin Immunol. 2013;133(4):1026–31.PubMedGoogle Scholar
  14. 14.
    Eckl-Dorna J, Pree I, Reisinger J, et al. The majority of allergen-specific IgE in the blood of allergic patients does not originate from blood-derived B cells or plasma cells. Clin Exp Allergy. 2012;42:1347–55.PubMedGoogle Scholar
  15. 15.
    Zuidscherwoude M, van Spriel AB. The origin of IgE memory and plasma cells. Cell Mol Immunol. 2012;9:373–4.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Carney AS, Powe DG, Huskisson RS, Jones NS. Atypical nasal challenges in patients with idiopathic rhinitis: more evidence for the existence of allergy in the absence of atopy? Clin Exp Allergy. 2002;32:1436–40.PubMedGoogle Scholar
  17. 17.
    Wedbäck A, Enbom H, Eriksson NE, Movérare R, Malcus I. Seasonal non-allergic rhinitis (SNAR)—a new disease entity? A clinical and immunological comparison between SNAR, seasonal allergic rhinitis and persistent non-allergic rhinitis. Rhinology. 2005;43:86–92.PubMedGoogle Scholar
  18. 18.
    Reisacher W. Total and allergen-specific IgE in the serum and nasal mucosa of a non-allergic population. Int Forum Allergy Rhinol. 2016;6(6):618–23.PubMedGoogle Scholar
  19. 19.
    KleinJan A, Vinke JG, Severijnen LWFM, Fokkens WJ. Local production and detection of (specific) IgE in nasal B-cells and plasma cells of allergic rhinitis patients. Eur Respir J. 2000;15:491–7.PubMedGoogle Scholar
  20. 20.
    McMenamin C, Girn B, Holt PG. The distribution of IgE plasma cells in lymphoid and non-lymphoid tissues of high-IgE responder rats: differential localization of antigen-specific and ‘bystander’ components of the IgE response to inhaled antigen. Immunology. 1992;77:592–6.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Durham SR, Gould HJ, Thienes CP, Jacobson MR, Masuyama K, Rak S, et al. Expression of epsilon germ-line gene transcripts and mRNA for the epsilon heavy chain of IgE in nasal B cells and the effects of topical corticosteroid. Eur J Immunol. 1997;27:2899–906.PubMedGoogle Scholar
  22. 22.
    Powe DG, Huskisson RS, Carney AS, Jenkins D, Jones NS. Evidence for an inflammatory pathophysiology in idiopathic rhinitis. Clin Exp Allergy. 2001;31:864–72.PubMedGoogle Scholar
  23. 23.
    van Zele T, Gevaert P, Holtappels G, van Cauwenberge P, Bachert C. Local immunoglobulin production in nasal polyposis is modulated by superantigens. Clin Exp Allergy. 2007;37:1840–7.PubMedGoogle Scholar
  24. 24.
    Sabirov A, Hamilton RG, Jacobs JB, Hillman DE, Lebowitz RA, Watts JD. Role of local immunoglobulin E specific for Alternaria alternata in the pathogenesis of nasal polyposis. Laryngoscope. 2008;118:4–9.PubMedGoogle Scholar
  25. 25.
    Takhar P, Corrigan CJ, Smurthwaite L, O’Connor BJ, Durham SR, Lee TH, et al. Class switch recombination to IgE in the bronchial mucosa of atopic and nonatopic patients with asthma. J Allergy Clin Immunol. 2007;119:213–8.PubMedGoogle Scholar
  26. 26.
    Humbert M, Durham SR, Ying S, Kimmitt P, Barkans J, Assoufi B. IL-4 and IL-5 mRNA and protein in bronchial biopsies from patients with atopic and nonatopic asthma: evidence against “intrinsic” asthma being a distinct immunopathologic entity. Am J Respir Crit Care Med. 1996;154:1497–504.PubMedGoogle Scholar
  27. 27.
    Huggins KG, Brostoff J. Local production of specific IgE antibodies in allergic-rhinitis patients with negative skin tests. Lancet. 1975;6:148–50.Google Scholar
  28. 28.
    Deuschl H, Johansson SG. Specific IgE antibodies in nasal secretion from patients with allergic rhinitis and with negative or weakly positive RAST on the serum. Clin Allergy. 1977;6:195–202.Google Scholar
  29. 29.
    Platts-Mills TA. Local production of IgG, IgA and IgE antibodies in grass pollen hay fever. J Immunol. 1979;6:2218–25.Google Scholar
  30. 30.
    Marcucci F, Sensi L. A new method for IgE detection in nasal mucosa. Clin Exp Allergy. 1989;6:157–62.Google Scholar
  31. 31.
    Powe DG, Jagger C, Kleinjan A, Carney AS, Jenkins D, Jones NS. “Entopy”: localized mucosal allergic disease in the absence of systemic responses for atopy. Clin Exp Allergy. 2003;6:1374–9.Google Scholar
  32. 32.
    Fuiano N, Incorvaia C. The importance of measuring nasal IgE in children and adults with rhinitis and negative skin tests. Int J Allergy Clin Immunol. 2007;6:58–61.Google Scholar
  33. 33.
    Ohashi Y, Nakai Y, Kuroki K, et al. Topical immunology of nasal allergy and mucosal IgE antibodies. Arch Otorhinolaryngol. 1985;241:169–74.PubMedGoogle Scholar
  34. 34.
    Ahn CN. Local production of antigen-specific IgE in different anatomic subsites of allergic fungal rhinosinusitis patients. Otolaryngol Head Neck Surg. 2009;141:97–103.PubMedGoogle Scholar
  35. 35.
    Reisacher W. Detecting local IgE from mucosal brush biopsy (MBB) of the inferior turbinates using microarray analysis. Int Forum Allergy Rhinol. 2013;3:399–403.PubMedGoogle Scholar
  36. 36.
    Reisacher WR. Mucosal brush biopsy testing (MBBT) of the inferior turbinate to detect local, antigen-specific IgE. Int Forum Allergy Rhinol. 2012;2:69–74.PubMedGoogle Scholar
  37. 37.
    Fuiano N, Fusilli S, Incorvaia C. A role for measurement of nasal IgE antibodies in diagnosis of Alternaria-induced rhinitis in children. Allergol Immunopathol (Madr). 2012;6:71–4.Google Scholar
  38. 38.
    Carney A, Jones N. Nasal challenge in patients with idiopathic rhinitis: evidence for ‘localised allergy. Allergologie. 1998;11:581.Google Scholar
  39. 39.
    Rondón C, Romero JJ, Lopex S, et al. Positive nasal allergen provocation test and nasal specific-IgE to grass pollen in patients with idiopathic rhinitis. In: 63rd Annual Meeting of the American Academy of Allergy Asthma and Immunology, San Diego, California, USA; 2007. p. 1228.Google Scholar
  40. 40.
    Reichelmann H, Deutschle T, Friemel E, Gross H, Bachem M. Biological markers in nasal secretions. Eur Resp J. 2003;21:600–5.Google Scholar
  41. 41.
    Lü FX, Esch RE. Novel nasal secretion collection method for the analysis of allergen specific antibodies and inflammatory biomarkers. J Immunol Methods. 2010;356:6–17.PubMedGoogle Scholar
  42. 42.
    Rondón C, Blanca-López N, Aranda A, Herrera R, Rodriguez-Bada JL, Canto G, et al. Local allergic rhinitis: allergen tolerance and immunologic changes after preseasonal immunotherapy with grass pollen. J Allergy Clin Immunol. 2011;127:1069–71.PubMedGoogle Scholar
  43. 43.
    Rondón C, Doña I, Torres MJ, Campo P, Blanca M. Evolution of patients with nonallergic rhinitis supports conversion to allergic rhinitis. J Allergy Clin Immunol. 2009;123:1098–102.PubMedGoogle Scholar
  44. 44.
    Watson N, Bodtke K, Coleman RA, et al. Role of IgE in hyperresponsiveness induced by passive sensitization of human airways. Am J Respir Crit Care Med. 1997;155:839–44.PubMedGoogle Scholar
  45. 45.
    Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CC, Schuller D, Spector SL, Tilles SA. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122:S1–84.Google Scholar
  46. 46.
    Banov CH, Lieberman P. Efficacy of azelastine nasal spray in the treatment of vasomotor (perennial nonallergic) rhinitis. 1Ann. Allergy Asthma Immunol. 2001;86:28–35.Google Scholar
  47. 47.
    Wallace DV, Dykewicz MS. The diagnosis and management of rhinitis: An updated practice parameter. J Allergy Clin Immunol. 2008;122:S1–84.Google Scholar
  48. 48.
    Shamsi Z, Hindmarch I. Sedation and antihistamines: a review of inter-drug differences using proportional impairment ratios. Hum Psychopharmacol. 2000;15:S3–30. IV.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Hindmarch I. Psychometric aspects of antihistamines. Allergy. 1995;50:48–54. IV.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Casale TB, Blaiss MS, Gelfand E, Gilmore T, Harvey PD, Hindmarch I, et al. First do no harm: managing antihistamine impairment in patients with allergic rhinitis. J Allergy Clin Immunol. 2003;111:S835–42. IV.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Bender BG, Berning S, Dudden R, Milgrom H, Tran ZV. Sedation and performance impairment of diphenhydramine and second-generation antihistamines: a meta-analysis. J Allergy Clin Immunol. 2003;111:770–6. Ia.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Baki Yılmaz
    • 1
  • Cemal Cingi
    • 2
  • William Reisacher
    • 3
  1. 1.Private Practice, Caddebostan Mah. Cemil Topuzlu Cad. (Intermed Doktor Ofisleri Kat 3)IstanbulTurkey
  2. 2.Eskişehir Osmangazi University, Medical FacultyDepartment of OtorhinolaryngologyEskisehirTurkey
  3. 3.Otolaryngology DepartmentWeill Cornell Medical CollegeNew YorkUSA

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