Emerging Novel Biomarkers in Allergic Rhinitis: A Narrative Review

Allergic rhinitis (AR) is a highly prevalent, immunoglobulin E (IgE)-mediated inflammatory condition that significantly impacts global public health. While conventional biomarkers such as total and specific IgE and eosinophil counts are widely used, their limitations in diagnostic precision and treatment response prediction have prompted research into novel biomarkers. This review synthesizes emerging evidence from the past 15 years on innovative molecular markers implicated in AR pathogenesis and management. A comprehensive literature search identified preclinical and clinical studies investigating promising biomarkers, including periostin, microRNA-155, hypoxia-inducible factor 1-alpha (HIF-1α), Granzyme A (GZMA), CD39, and several serum and nasal fluid proteins such as orosomucoid (ORM), apolipoprotein H (APOH), and serpin family b member 3 (SERPINB3). Preclinical models highlighted their roles in immune regulation, barrier dysfunction, and inflammatory cascades. Clinical trials confirmed their diagnostic, prognostic, and therapeutic monitoring potential. Notably, periostin and miRNA-155 were associated with disease severity and responsiveness to sublingual immunotherapy, while proteins such as ORM and APOH predicted glucocorticoid (GC) treatment outcomes. CD39 and cytokine profiles showed promise for stratifying disease severity. Despite these advances, most biomarkers remain in investigational stages. Future work should emphasize multicenter validation and standardized protocols, and integration into biomarker panels for personalized AR care. This review underscores the evolving landscape of AR biomarker research and its translational potential in precision medicine.