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Berghi O, Dumitru M, Cergan R, Musat G, Serboiu C, Vrinceanu D. Local Allergic Rhinitis-A Challenge for Allergology and Otorhinolaryngology Cooperation (Scoping Review). Life (Basel) 2024; 14:965. [PMID: 39202707 PMCID: PMC11355242 DOI: 10.3390/life14080965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 09/03/2024] Open
Abstract
Local allergic rhinitis (LAR) represents a medical provocation for allergists and otorhinolaryngologists. LAR is considered to be a subtype of allergic rhinitis (AR) that affects a great percentage of patients who were, for decades, diagnosed as having chronic non-allergic rhinitis. The clinical picture is represented by rhinorrhea, sneezing, and nasal itching correlated with specific pollen season or dust, mold, or pet interior exposure. Usual assessment of AR (skin prick testing and serum IgE assessment) produces negative results. Specialized centers in allergology and ENT around the globe use a nasal allergen challenge, assessment of local IgE, basophil activation test (BAT), and nasal cytology in the diagnostic approach to the disease, taking into account their current limitations. The impact of LAR on quality-of-life indicators is the same as in AR. Treatment for LAR is similar to that for AR and is the same as for AR: allergen exposure avoidance, drug therapy, and allergen immunotherapy. This scoping review gathers the current up-to-date open access evidence available on PubMed on the subject of LAR.
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Affiliation(s)
- Ovidiu Berghi
- Allergology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Mihai Dumitru
- ENT Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Romica Cergan
- Anatomy Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Gabriela Musat
- ENT Department, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Crenguta Serboiu
- Histology and Molecular Biology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Daniela Vrinceanu
- ENT Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
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Casula E, Letizia Manca M, Manconi M. An integrative review on the uses of plant-derived bioactives formulated in conventional and innovative dosage forms for the local treatment of damaged nasal cavity. Int J Pharm 2021; 610:121229. [PMID: 34715259 DOI: 10.1016/j.ijpharm.2021.121229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/09/2021] [Accepted: 10/21/2021] [Indexed: 12/22/2022]
Abstract
Plants and their derivates have been used as medicines for centuries and today is being re-discovered their usefulness for the human health. The therapeutic properties of phytochemicals are re-evaluated under the light of medical and pharmacological research, pushed by a constantly growing market demand, where consumers trust more natural products than synthetic drugs. New studies are enlightening the effectiveness of phytochemicals against a wide range of ailments, nevertheless very few evaluate the efficacy of topical formulations based on natural bioactive molecules in the treatment of nasal mucosal diseases. This review aims at exploring this little covered topic. An overview on the properties and functionality of the nasal mucosa and the different diseases affecting it has been provided. We summarized various nasal dosage forms containing natural bioactive and explored how innovative delivery systems loading phytochemicals can improve the treatment results. Finally, the potential use of novel nanocarriers for the treatment of nasal ailments has been covered as well.
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Affiliation(s)
- Eleonora Casula
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, Via Ospedale 72, 09124 Cagliari, Italy
| | - Maria Letizia Manca
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, Via Ospedale 72, 09124 Cagliari, Italy.
| | - Maria Manconi
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, Via Ospedale 72, 09124 Cagliari, Italy
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Kim YH. Appropriate Antigen Concentrations and Timing of a Nasal Provocation Test. Yonsei Med J 2021; 62:750-757. [PMID: 34296553 PMCID: PMC8298870 DOI: 10.3349/ymj.2021.62.8.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We aimed to determine appropriate antigen concentrations and the right time to evaluate intranasal changes when performing a nasal provocation test (NPT). Also, we sought to analyze the diagnostic usefulness of individual nasal symptom and peak nasal inspiratory flow (PNIF). MATERIALS AND METHODS We divided 46 patients into allergic rhinitis (AR) group (n=19) and a non-allergic rhinitis (NAR) group (n=27). We performed intranasal challenge with 100 AU/mL of Dermatophagoides pteronyssinus (DP) and measured changes in nasal symptoms [scored using the visual analogue scale (VAS)] and PNIF%. If the patient showed significant changes, VAS and PNIF were assessed again after another 15 minutes. In patients without significant changes, we administered 1000 AU/mL and measured changes in nasal symptoms and PNIF% after 15 and 30 minutes. RESULTS Fifteen minutes after the 100 AU/mL challenge, the AR group showed more significant VAS changes in all nasal symptoms, total nasal symptom score (TNSS), and PNIF% change than the NAR group. Among the AR group, patients who did not respond to 100 AU/mL exhibited less significant differences relative to the NAR group, even after 1000 AU/mL challenge. Receiver operating characteristic curve analysis for VAS changes 15 minutes after 100 AU/mL challenge revealed that all nasal symptoms had area under the curve (AUC) values of ≥0.84 (p<0.001). TNSS change had an AUC value of 0.929 (p<0.001), while PNIF% change had an AUC value of 0.834. CONCLUSION We could determine the optimal concentration (100 AU/mL), timing (15 minutes after challenge), and parameters (changes in TNSS and PNIF%) when performing NPT.
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Affiliation(s)
- Young Hyo Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, Inha University School of Medicine, Incheon, Korea.
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Joo SH, Hyun KJ, Kim YH. Korean Modification of Nasal Provocation Test with House Dust Mites Antigen following EAACI Guidelines. Clin Exp Otorhinolaryngol 2020; 14:382-389. [PMID: 32631039 PMCID: PMC8606291 DOI: 10.21053/ceo.2020.00563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives We evaluated the usefulness of the standardized nasal provocation test (NPT) protocol recently published by the European Academy of Allergy and Clinical Immunology (EAACI) and compared the utility of several parameters for diagnosing allergic rhinitis (AR) caused by house dust mites (HDM). Subjective parameters were nasal and ocular symptoms measured using a visual analog scale (VAS), and objective parameters were peak nasal inspiratory flow (PNIF), minimal cross-sectional area (MCA), and total nasal volume (TNV). Methods Before and after spraying Dermatophagoides pteronyssinus (DP) allergen (1,000 AU/mL, 100 μL) into both nostrils of 13 patients with AR (AR group) and 22 patients with non-AR (NAR group), we used VAS scores to measure nasal symptoms (nasal obstruction, rhinorrhea, sneezing, and itching) and ocular symptoms and assessed PNIF, MCA, and TNV. Results The AR group had significantly worse symptoms than the NAR group 15 minutes after DP challenge (P<0.001). After 30 minutes, nasal obstruction and rhinorrhea remained worse in the AR group (P<0.001); a similar but less marked difference was seen for sneezing (P=0.012) and itching (P=0.039). Ocular symptoms, PNIF, MCA, and TNV differed between groups after both 15 and 30 minutes (P<0.05). The area under the receiver operating characteristic curve was higher for nasal obstruction (0.977), rhinorrhea (0.906), and TNV (0.979) than for sneezing (0.755), itching (0.673), and MCA (0.836). Conclusion NPT performed according to the EAACI guidelines could help diagnose AR caused by HDM. TNV and VAS changes in nasal obstruction and rhinorrhea had higher diagnostic accuracy than other parameters.
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Affiliation(s)
- Soo Hyun Joo
- Department of Otorhinolaryngology, Head and Neck Surgery, Inha University School of Medicine, Incheon, Republic of Korea , Incheon, Korea
| | - Ki Jong Hyun
- Department of Otorhinolaryngology, Head and Neck Surgery, Inha University School of Medicine, Incheon, Republic of Korea , Incheon, Korea
| | - Young Hyo Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, Inha University School of Medicine, Incheon, Republic of Korea , Incheon, Korea
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Eguiluz-Gracia I, Ariza A, Testera-Montes A, Rondón C, Campo P. Allergen Immunotherapy for Local Respiratory Allergy. Curr Allergy Asthma Rep 2020; 20:23. [PMID: 32430550 DOI: 10.1007/s11882-020-00920-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIESW Local respiratory allergy (LRA) is an eosinophilic phenotype of chronic airway disease. Three entities have been described within the LRA spectrum: local allergic rhinitis (LAR) and local allergic asthma (LAA) in non-atopic patients, and dual allergic rhinitis (DAR) in atopic patients (coexistence of LAR and allergic rhinitis). In this article, we aim to review the current evidence on the therapeutic options for LRA. RECENT FINDINGS No controlled study has assessed the effect of standard therapy (oral antihistamines, intranasal or inhaled corticosteroids, bronchodilators) in LRA subjects. Three randomized clinical trials and one observational study demonstrated that allergen immunotherapy (AIT) is able to control nasal and ocular symptoms, decrease the need for rescue medication, and improve quality of life in LAR individuals. Nasal or inhaled steroids can be expected to improve eosinophilic inflammation in LRA patients but cannot change the natural course of the disease. Moreover, the long-term and disease-modifying effects of AIT in LRA subjects need to be investigated.
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Affiliation(s)
- I Eguiluz-Gracia
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - A Ariza
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA and ARADyAL, Málaga, Spain
| | - A Testera-Montes
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - C Rondón
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain.
| | - P Campo
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
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Jung AY, Kim YH. Reversal of Olfactory Disturbance in Allergic Rhinitis Related to OMP Suppression by Intranasal Budesonide Treatment. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:110-124. [PMID: 31743968 PMCID: PMC6875474 DOI: 10.4168/aair.2020.12.1.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/21/2019] [Accepted: 09/30/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE We evaluated the severity of olfactory disturbance (OD) in the murine model of allergic rhinitis (AR) and local allergic rhinitis (LAR) in mice. We also investigated the therapeutic effect of an intranasal steroid on OD. METHODS Forty BALB/c mice were divided into 5 groups (n = 8 for each). The control group was sensitized intraperitoneally (i.p.) and challenged intranasally (i.n.) with saline. Mice in the AR group got i.p. and i.n. ovalbumin (OVA) administration for AR induction. The LAR group was challenged i.n. with 1% OVA for inducing local nasal allergic inflammation, without inducing the systemic allergy. The OD group got an i.p. methimazole administration (75 mg/kg) to induce total destruction of olfactory mucosa. Mice in the intranasal budesonide group received i.n. budesonide (12.8 μ per time, 30 minutes after the i.n. OVA challenge) while using OVA to cause systemic allergies. We conducted a buried-food pellet test to functionally assess the degree of OD in each group by measuring the time taken until finding hidden food. We evaluated the damage to olfactory epithelium using histopathologic evaluation and compared the degree of olfactory marker protein (OMP) expression in olfactory epithelium using immunofluorescent staining. RESULTS Mice of the AR (81.3 ± 19.8 seconds) and LAR groups (66.2 ± 12.7 seconds) spent significantly more time to detect the pellets than the control group (35.6 ± 12.2 seconds, P < 0.01). After treatment, the intranasal budesonide group exhibited significantly better results (35.8 ± 11.9 seconds) compared with the AR and LAR groups (P < 0.01). The AR and LAR groups showed considerable olfactory epithelial damage and suppression of OMP expression compared with the control group. In the intranasal budesonide group, the olfactory lesions and OMP expression had improved substantially. CONCLUSIONS OD may be caused by olfactory epithelial damage and suppression of OMP expression in nasal allergic inflammation and could be reversed using an intranasal steroid.
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Affiliation(s)
- Ah Yeoun Jung
- Department of Otorhinolaryngology, Inha University School of Medicine, Incheon, Korea
| | - Young Hyo Kim
- Department of Otorhinolaryngology, Inha University School of Medicine, Incheon, Korea.
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How to Diagnose and Treat Local Allergic Rhinitis: A Challenge for Clinicians. J Clin Med 2019; 8:jcm8071062. [PMID: 31331047 PMCID: PMC6678883 DOI: 10.3390/jcm8071062] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023] Open
Abstract
Chronic rhinitis is a very common disease that can be divided in various phenotypes. Historically, the condition has been classified into the allergic rhinitis (AR) and non-allergic non-infectious rhinitis (NAR) forms, based on the results of the classical biomarkers of atopy: skin prick test and serum allergen-specific IgE However, this classification does not reflect the complexity of the rhinitis syndrome, as illustrated by the existence of non-atopic rhinitis patients who display a nasal reactivity to environmental allergens. This new phenotype has been termed local allergic rhinitis (LAR) and can be only recognized if an additional test such as the nasal allergen challenge (NAC) is integrated in the diagnostic algorithm for chronic rhinitis. Recent data shows that the NAC is a very safe and reliable technique ready for the clinical practice. LAR is a differentiated rhinitis phenotype which often commences during childhood and quickly progresses towards a clinical worsening and the association of comorbidities in other mucosal organs. Recent evidence supports the existence of a bronchial counterpart of LAR (local allergic asthma), which highlights the pathophysiological links between the upper and lower airways and reinforces the united airways concept. Importantly, several controlled studies have demonstrated the ability of allergen immunotherapy to control LAR symptoms while the therapy is being administered. This review emphasizes the need to implement the NAC in the clinical practice in order to facilitate the recognition of LAR patients, allowing for an early prescription of specific therapies with disease-modifying potential.
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Wanjun W, Qiurong H, Yanqing X, Mo X, Nili W, Jing L. Responsiveness of Nasal Provocation Testing-But Not Skin Test and Specific Immunoglobulin E Blood Level-Correlates With Severity of Allergic Rhinitis in Dermatophagoides Species-Sensitized Patients. Am J Rhinol Allergy 2018; 32:236-243. [PMID: 29909644 DOI: 10.1177/1945892418779435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background The results of skin and blood allergen testing are not consistently relevant to clinical manifestations in allergic patients. Objective The aim of the study was to investigate the relationship between severity of allergic rhinitis and different allergen diagnostic tests in Dermatophagoides species-sensitized patients. Methods Study subjects included 65 rhinitis patients-50 with Dermatophagoides pteronyssinus (DP) sensitization (DP+) and 15 without DP sensitization (DP-), and 15 DP+ and 37 DP- healthy controls (HCs) confirmed by allergen skin prick (SPT) and blood specific immunoglobulin E (sIgE) tests. The Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was tested. All subjects underwent DP nasal provocation test (DP-NPT). Visual analogue scoring (VAS) of nasal symptoms and nasal airway resistance (NAR) were measured before and after NPT. Correlations between the 3 allergen tests and score of RQLQ were performed. Results All rhinitis subjects had significantly higher VAS and NAR after DP-NPT than HCs ( P < .01). All DP+ rhinitis, 40% of DP- rhinitis subjects, 13.3% of DP+ HCs and 0% of DP- HCs had positive DP-NPT. Dose of positive DP-NPT positively correlated with SPT diameter and sIgE level in all tested subjects ( P < .001). Score of RQLQ positively correlated with dose of DP-NPT ( P < .001), but not with SPT diameter and sIgE level in rhinitis patients. Conclusion Although DP nasal provocation, skin prick wheal size and blood sIgE level correlate with each other, only nasal provocation testing is associated with severity of nasal symptoms. It is suggested that NPT should be performed to verify a clinically relevant allergy.
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Affiliation(s)
- Wang Wanjun
- 1 Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hu Qiurong
- 1 Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xie Yanqing
- 1 Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xian Mo
- 1 Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Nili
- 1 Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li Jing
- 1 Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,2 Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, Guangzhou Medical University, Guangzhou, China
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Park KI, Jang TY, Yang SC, Hong HS, Kim YH. Correlation of Nasal Eosinophilia and Response after Nasal Provocation Test in Patients with Nonallergic Rhinitis. Otolaryngol Head Neck Surg 2018; 159:231-237. [DOI: 10.1177/0194599818768806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives We aimed to evaluate the relationship between nasal eosinophilia and nasal hyperresponsiveness to allergen extract. Study Design Retrospective chart review. Setting Academic tertiary rhinologic practice. Subjects and Methods We performed allergy tests (skin prick test and multiple allergosorbent test) and nasal cytology for 194 patients with rhinitis symptoms (76 males and 118 females; age, 11-69 years). According to the results, they were classified into 4 groups: group A (allergic rhinitis with eosinophilia, n = 26), group B (allergic rhinitis without eosinophilia, n = 77), group C (nonallergic rhinitis with eosinophilia syndrome, n = 20), and group D (nonallergic rhinitis without eosinophilia, n = 71). We performed a nasal provocation test (NPT) using house dust mite extract and assessed the changes in symptoms and the decrease in acoustic parameters (total nasal volume and minimal cross-sectional area [MCA]). Results Patients in group C were more likely to have severe rhinorrhea and sneezing than those in group D ( P < .001). After NPT, group C had greater aggravation of nasal obstruction than group D ( P < .001). Group C also showed markedly greater MCA changes as compared with group D 15 minutes after the antigen challenge ( P = .002). There was significant correlation between the number of eosinophils and an increase in nasal obstruction ( r = 0.319, P = .0009), rhinorrhea ( r = 0.302, P = .0017), sneezing ( r = 0.219, P = .0241), change in the total nasal volume 15 minutes after NPT ( r = 0.287, P = .0028), and change in the MCA 15 minutes ( r = 0.322, P = .0008) and 30 minutes ( r = 0.250, P = .0098) after NPT. Conclusion In patients with NAR, nasal eosinophilia is associated with provocative response after NPT. Further research should be performed to elucidate the mechanisms that underlie this phenomenon.
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Affiliation(s)
- Ki-Ik Park
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Tae Young Jang
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Seung-Chan Yang
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Hyung Sun Hong
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Young Hyo Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea
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Hamizan AW, Rimmer J, Alvarado R, Sewell WA, Kalish L, Sacks R, Harvey RJ. Positive allergen reaction in allergic and nonallergic rhinitis: a systematic review. Int Forum Allergy Rhinol 2017; 7:868-877. [PMID: 28727909 DOI: 10.1002/alr.21988] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/02/2017] [Accepted: 06/18/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The diagnosis of allergic rhinitis (AR) is based on cutaneous and serological assessment to determine immunoglobulin E (IgE)-mediated disease. However, discrepancies between these tests and nasal provocation exist. Patients diagnosed as non-allergic rhinitis (NAR) but with positive nasal allergen provocation test (NAPT) may represent a local allergic condition or entopy, still suitable to allergy interventions. The objective of this study was to determine the frequency of nasal reactivity toward allergens among AR and NAR patients, and to describe the diagnostic characteristics of NAPT methodologies. METHODS EMBASE (1947-) and Medline (1946-) were searched until December 8, 2015. A search strategy was used to identify studies on AR or NAR patients subjected to diagnostic local nasal provocation. All studies providing original NAPT data among the AR or NAR population were included. Meta-analysis of proportion data was presented as a weighted probability % (95% confidence interval [CI]). RESULTS The search yielded 4504 studies and 46 were included. The probability of nasal allergen reactivity for the AR population was 86.3% (95% CI, 84.4 to 88.1) and in NAR was 24.7% (95% CI, 22.3 to 27.2). Reactivity was high with pollen for both AR 97.1% (95% CI, 94.2 to 99.2) and NAR 47.5% (95% CI, 34.8 to 60.4), and lowest with dust for both AR 79.1% (95% CI, 76.4 to 81.6) and NAR 12.2% (95% CI, 9.9 to 14.7). NAPT yielded high positivity when defined by subjective end-points: AR 91.0% (95% CI, 86.6 to 94.8) and NAR 30.2% (95% CI, 22.9 to 37.9); and lower with objective end-points: AR 80.8% (95% CI, 76.8 to 84.5) and NAR 14.1% (95% CI, 11.2 to 17.2). CONCLUSION Local allergen reactivity is demonstrated in 26.5% of patients previously considered non-allergic. Similarly, AR, when defined by skin-prick test (SPT) or serum specific IgE (sIgE), may lead to 13.7% of patients with inaccurate allergen sensitization or non-allergic etiologies.
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Affiliation(s)
- Aneeza W Hamizan
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Department of Otolaryngology and Head and Neck Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Janet Rimmer
- St Vincent's Clinic, St Vincent's Hospital, Sydney, Australia.,The Woolcock Institute, Sydney University, Sydney, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - William A Sewell
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia.,Garvan Institute, Sydney, Australia
| | - Larry Kalish
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Otolaryngology-Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia
| | - Raymond Sacks
- Department of Otolaryngology-Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Rondón C, Bogas G, Barrionuevo E, Blanca M, Torres MJ, Campo P. Nonallergic rhinitis and lower airway disease. Allergy 2017; 72:24-34. [PMID: 27439024 DOI: 10.1111/all.12988] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2016] [Indexed: 12/17/2022]
Abstract
In the past years, several investigators have demonstrated the existence of local nasal responses in some patients with typical allergic rhinitis symptoms but without atopy and have defined a new phenotype called local allergic rhinitis (LAR) or 'entopy'. In a percentage of LAR subjects, the upper airway disease is also associated with lower airway symptoms. After the description of this phenotype, the differential diagnosis between LAR and nonallergic rhinitis (NAR) has become a challenge for the clinician. To correctly identify LAR patients is of high importance for treatment and management of these patients, and for an appropriate inclusion of patients in clinical trials and genetics studies. The treatment of LAR patients, in contrast with NAR, is oriented to allergen avoidance and specific treatment. Allergen immunotherapy, the aetiological treatment for allergic respiratory diseases, has demonstrated to be an effective and safe treatment in LAR, increasing immunological tolerance, and reducing the clinical symptoms and the use of medication. In this article, the important and novel aspects of LAR in terms of mechanisms, diagnosis and treatment will be discussed. Also, the involvement of the lower airway and the potential role of IgE in the bronchial disease will be also reviewed.
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Affiliation(s)
- C. Rondón
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - G. Bogas
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - E. Barrionuevo
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - M. Blanca
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - M. J. Torres
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - P. Campo
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
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Campo P, Salas M, Blanca-López N, Rondón C. Local Allergic Rhinitis. Immunol Allergy Clin North Am 2016; 36:321-32. [PMID: 27083105 DOI: 10.1016/j.iac.2015.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This review focuses on local allergic rhinitis, a new phenotype of allergic rhinitis, commonly misdiagnosed as nonallergic rhinitis. It has gained attention over last decade and can affect patients from all countries, ethnic groups and ages, impairing their quality of life, and is frequently associated with conjunctivitis and asthma. Diagnosis is based on clinical history, the demonstration of a positive response to nasal allergen provocation test and/or the detection of nasal sIgE. A positive basophil activation test may support the diagnosis. Recent studies have demonstrated that allergen immunotherapy is an effective immune-modifying treatment, highlighting the importance of early diagnosis.
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Affiliation(s)
- Paloma Campo
- Regional University Hospital of Malaga, Plaza Hospital Civil s/n pabellon 6, Málaga 29009, Spain
| | - María Salas
- Regional University Hospital of Malaga, Plaza Hospital Civil s/n pabellon 6, Málaga 29009, Spain
| | - Natalia Blanca-López
- Allergy Service, Hospital Infanta Leonor, Gran Vía del Este, 80, Madrid 28031, Spain
| | - Carmen Rondón
- Regional University Hospital of Malaga, Plaza Hospital Civil s/n pabellon 6, Málaga 29009, Spain.
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