Skip to main content
SpringerLink
Log in

Local Allergic Rhinitis

  • Chapter
  • First Online:
All Around the Nose

  • 118 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  4. Connell JT. Quantitative intranasal pollen challenges. 3. The priming effect in allergic rhinitis. J Allergy. 1969;43:33–44.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  15. Zuidscherwoude M, van Spriel AB. The origin of IgE memory and plasma cells. Cell Mol Immunol. 2012;9:373–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  27. Huggins KG, Brostoff J. Local production of specific IgE antibodies in allergic-rhinitis patients with negative skin tests. Lancet. 1975;6:148–50.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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. Marcucci F, Sensi L. A new method for IgE detection in nasal mucosa. Clin Exp Allergy. 1989;6:157–62.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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. Ohashi Y, Nakai Y, Kuroki K, et al. Topical immunology of nasal allergy and mucosal IgE antibodies. Arch Otorhinolaryngol. 1985;241:169–74.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  38. Carney A, Jones N. Nasal challenge in patients with idiopathic rhinitis: evidence for ‘localised allergy. Allergologie. 1998;11:581.

    Google Scholar 

  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. Reichelmann H, Deutschle T, Friemel E, Gross H, Bachem M. Biological markers in nasal secretions. Eur Resp J. 2003;21:600–5.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  47. Wallace DV, Dykewicz MS. The diagnosis and management of rhinitis: An updated practice parameter. J Allergy Clin Immunol. 2008;122:S1–84.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  49. Hindmarch I. Psychometric aspects of antihistamines. Allergy. 1995;50:48–54. IV.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Private Practice, Caddebostan Mah. Cemil Topuzlu Cad. (Intermed Doktor Ofisleri Kat 3), Istanbul, Turkey

    Baki Yılmaz

  2. Eskişehir Osmangazi University, Medical Faculty, Department of Otorhinolaryngology, Eskisehir, Turkey

    Cemal Cingi

  3. Otolaryngology Department, Weill Cornell Medical College, New York, NY, USA

    William Reisacher

Authors
  1. Baki Yılmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cemal Cingi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William Reisacher
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Eskişehir Osmangazi University, Medical Faculty, Department of Otorhinolaryngology, Eskisehir, Turkey

    Cemal Cingi

  2. Department of Otorhinolaryngology, Medical Faculty, Kirikkale University, Kirikkale, Turkey

    Nuray Bayar Muluk

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Yılmaz, B., Cingi, C., Reisacher, W. (2020). Local Allergic Rhinitis. In: Cingi, C., Bayar Muluk, N. (eds) All Around the Nose. Springer, Cham. https://doi.org/10.1007/978-3-030-21217-9_40

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-21217-9_40

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-21216-2

  • Online ISBN: 978-3-030-21217-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation