Nasal inflammatory mediators and specific IgE production after nasal challenge with grass pollen in local allergic rhinitis

Background. Efficacy of allergen immunotherapy (AIT) in local allergic rhinitis (LAR) is a new subject of research. The presence of asthmatic symptoms in patients with LAR in the context of AIT is unexplored. Objective. The efficacy and safety of AIT in patients with LAR towards birch pollen were investigated. The possibility of concomitant local allergic asthma in studied patients and the impact of AIT on it were examined. Methods. 36 patients with LAR towards birch were included in three years of AIT in a double-blind, placebo-control study. Primary outcome measurement was the mean changes in the combined symptom and medication scores (CSMSs) after AIT, and the second is the changes in the quality of life (QoL). Skin prick tests, serum, nasal allergen-specific IgE to birch, nasal and bronchial provocation challenge tests with birch allergen, methacholine tests, and spirometry were carried out at baseline and after AIT. Results. Mean CSMSs of three years of AIT were significantly decreased in the active group from 5.88 (range: 4.11-9.01) to 1.98 (range: 1.22-4.51; p<0.05). After three years of AIT, there was a significant increase of toleration for birch allergen from the mean concentration of 6250±1200 SQ-U/ml up to 45000±2500 SQ-U/ml (p=0.02) during repeated nasal challenges. 16 patients with LAR had the positive results of methacholine tests, and 11 of them had a positive bronchial challenge to birch allergen. After AIT, the significant decrease of bronchial responsiveness to birch allergen in 5 from 7 patients was confirmed (p=0.03). QoL assessed by the use of the RQLQ score was improved after AIT from 1.84 (95% CI: 1.53-1.97) to 1.45 (95% CI: 1.32-1.62) score in the active group after three years of AIT therapy (p=0.03). Conclusion. AIT to birch can be useful and safe in a patient with local allergic rhinitis and also with concomitant asthmatic symptoms. Further studies are needed.

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Potential Differences between Local and Systemic Allergic Rhinitis Induced by Birch Pollen

International Archives of Allergy and Immunology ◽

10.1159/000509438 ◽

2020 ◽

Vol 181 (11) ◽

pp. 831-838

Author(s):

Andrzej Bozek ◽

Jolanta Zalejska Fiolka ◽

Anna Krajewska Wojtys ◽

Beata Galuszka ◽

Anna Cudak

Keyword(s):

Allergic Rhinitis ◽

Birch Pollen ◽

Provocation Test ◽

Basophil Activation Test ◽

Specific Ige ◽

Immunological Parameters ◽

Local Allergic Rhinitis ◽

Before And After ◽

Intermittent Allergic Rhinitis ◽

Bet V1

Introduction: Different endotypes of rhinitis are known, but its pathomechanism has not been conclusively established. For example, the precise difference between systemic allergic rhinitis (SAR) and local allergic rhinitis (LAR) is still being checked. Comparison of patients with LAR and with allergies to birch of those with intermittent allergic rhinitis, same allergy, or with non-allergic rhinitis (NAR) was the purpose of this study. Methods: Twenty-six patients with LAR, 18 with SAR and allergy to birch, and 21 with NAR were included. Patients who met the inclusion criteria were selected to undergo the following procedures at baseline: medical examinations, nasal provocation test (NPT), detection of nasal-specific IgE to birch as well as basophil activation test (BAT). All immunological parameters were detected before and after NPT. Results: Concentration of nasal IgE to Bet v1 increased comparably in the LAR and SAR groups after NPT to birch as follows: in 21 (81%) patients with LAR, 14 (78%) with SAR, and in everyone in the NAR group. Serum concentration of allergen-specific IgE to Bet v1 increased significantly from a median of 20.7 (25–75% interval: 11.2–35.6) IU/mL to 29.9 (13.6–44.1) (p = 0.028) after NPT in patients with SAR. Allergen-specific IgE to Bet v1 was absent in all patients with LAR and NAR before and after NPT. BAT with Bet v1 was positive in 22 (85%) patients with LAR, in 14 (78%) with SAR, and 2 (9.5%) with NAR. Conclusion: These obtained data suggest there are no potential mechanisms that could explain LAR compared to SAR.

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Allergic rhinitis to grass pollen: Measurement of inflammatory mediators of mast cell and eosinophils in native nasal fluid lavage and in serum out of and during pollen season

Journal of Allergy and Clinical Immunology ◽

10.1016/s0091-6749(97)70281-1 ◽

1997 ◽

Vol 100 (6) ◽

pp. 832-837 ◽

Cited By ~ 31

Author(s):

G DILORENZO ◽

P MANSUETO ◽

M MELLUSO ◽

G CANDORE ◽

A COLOMBO ◽

...

Keyword(s):

Allergic Rhinitis ◽

Mast Cell ◽

Inflammatory Mediators ◽

Grass Pollen ◽

Pollen Season ◽

Nasal Fluid

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Influence of Allergen Immunotherapy on Substance P Release by Nasal Challenge of Grass Pollen Sensitized Allergic Rhinitis Patients

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2006.12.604 ◽

2007 ◽

Vol 119 (1) ◽

pp. S315

Author(s):

R. Gawlik ◽

B. Jawor ◽

B. Rogala ◽

L.M. DuBuske

Keyword(s):

Allergic Rhinitis ◽

Substance P ◽

Grass Pollen ◽

Allergen Immunotherapy ◽

Nasal Challenge ◽

P Release ◽

Substance P Release

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Diagnosis and Treatment of Local Allergic Rhinitis

Pathogens ◽

10.3390/pathogens11010080 ◽

2022 ◽

Vol 11 (1) ◽

pp. 80

Author(s):

Tetsuya Terada ◽

Ryo Kawata

Keyword(s):

Allergic Rhinitis ◽

Current Knowledge ◽

Provocation Test ◽

Basophil Activation Test ◽

Specific Ige ◽

Nasal Discharge ◽

Initial State ◽

Positive Type ◽

Chronic Rhinitis ◽

Local Allergic Rhinitis

Some patients with chronic rhinitis have a positive nasal allergen provocation test (NAPT) without systemic IgE sensitization by skin prick tests or serum allergen-specific IgE (sIgE). This novel concept is called local allergic rhinitis (LAR) and affects children and adults worldwide, but is underdiagnosed. LAR is not just the initial state of allergic rhinitis (AR), it is a unique form of chronic rhinitis that is neither classical AR nor non-AR. Many of the features of AR and LAR are similar, such as a positive NAPT, positive type 2 inflammatory markers, including the nasal discharge of sIgE, and a high incidence of asthma. A differential diagnosis of LAR needs to be considered in patients with symptoms suggestive of AR in the absence of systemic atopy, regardless of age. The diagnostic method for LAR relies on positive responses to single or multiple allergens in NAPT, the sensitivity, specificity, and reproducibility of which are high. The basophil activation test and measurement of IgE in nasal secretions also contribute to the diagnosis of LAR. Treatment for LAR is similar to that for AR and is supported by the efficacy and safety of allergen exposure avoidance, drug therapy, and allergen immunotherapy. This review discusses current knowledge on LAR.

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