Local allergic rhinitis: Implications for management

Area of Science:

• Allergology
• Immunology
• Otorhinolaryngology

Background:

• Local Allergic Rhinitis (LAR) is a distinct phenotype of rhinitis characterized by nasal allergen-specific IgE (sIgE) without systemic sensitization.
• LAR affects both children and adults, leading to moderate-to-severe symptoms, reduced quality of life, and potential progression.
• It is a stable condition, not merely an early stage of Allergic Rhinitis (AR).

Purpose of the Study:

• To define Local Allergic Rhinitis (LAR) as a distinct clinical entity.
• To highlight the diagnostic challenges and methods for identifying LAR.
• To discuss therapeutic strategies for LAR management.

Main Methods:

• Diagnosis relies on the Nasal Allergen Provocation Test (NAPT), considered the gold standard.
• Nasal sIgE measurement and Basophil Activation Test (BAT) can aid in diagnosis.
• Clinical presentation and exclusion of systemic atopy are key.

Main Results:

• LAR patients exhibit nasal reactivity to allergens despite negative skin prick tests and serum sIgE.
• Nasal type 2 inflammation markers are present in LAR, similar to AR.
• LAR shares a significant comorbidity with asthma development.

Conclusions:

• LAR is an underdiagnosed condition that requires consideration in patients with rhinitis symptoms and no systemic atopy.
• NAPT is a reliable diagnostic tool for LAR.
• Standard AR treatments, including allergen immunotherapy, are effective for LAR.