The importance of mold sensitivity in nonallergic rhinitis patients

Area of Science:

• Allergy and Immunology
• Otorhinolaryngology
• Clinical Diagnostics

Background:

• Some patients diagnosed with nonallergic rhinitis (NAR) or idiopathic rhinitis (IR) show local specific immunoglobulin E (sIgE) production in nasal mucosa.
• Positive nasal allergen provocation tests (NAPT) have also been observed in these patients, suggesting a potential local allergic response.

Purpose of the Study:

• To evaluate the presence of local allergic rhinitis (LAR) in patients with rhinitis symptoms triggered by indoor and outdoor molds.
• To investigate the diagnostic utility of NAPT in identifying LAR in patients initially diagnosed with NAR.

Main Methods:

• Forty NAR patients with persistent rhinitis and negative skin-prick tests (SPTs) and serum sIgE levels were included.
• Twenty healthy subjects served as a control group.
• Nasal allergen provocation tests (NAPT) were conducted using Aspergillus fumigatus or a mixture of Alternaria alternata and Cladosporium herbarum extracts.

Main Results:

• Nasal lavage fluid analysis showed no significant differences in tryptase and mold sIgE levels between patients and controls.
• NAPT was positive in 66.6% of NAR patients exposed to Aspergillus fumigatus.
• NAPT was positive in 69.2% of NAR patients exposed to a mixture of Alternaria alternata and Cladosporium herbarum.

Conclusions:

• Local allergic rhinitis (LAR) may be present in a significant proportion of patients diagnosed with NAR based on negative SPTs or serum sIgE.
• Nasal allergen provocation testing (NAPT) appears to be a valuable tool for diagnosing LAR in patients with persistent rhinitis symptoms.
• This study is the first to assess local nasal allergic responses to both indoor and outdoor molds in this patient population.