Nasal Allergen Neutralizing Antibodies Correlate Closely with Tolerated Intranasal Allergen Challenge Dose Following Grass Pollen Subcutaneous Immunotherapy in Patients with Local Allergic Rhinitis

Allergic rhinitis affects 20 to 30% of adults in both the United States and Europe and perhaps a somewhat higher percentage of children. In addition to nasal and ocular symptoms directly related to the allergic process, interference of these symptoms with sleep leads to daytime sleepiness and impaired quality of life. Patients miss work because of symptoms but an even greater problem is interference with work productivity, or presenteeism, which has been reported to be the biggest contributor to the total economic cost of allergic rhinitis. There has been increasing awareness that many patients with either seasonal or perennial symptoms but negative skin and in vitro tests for allergen sensitivity have local nasal allergy, diagnosable by the presence of allergen-specific IgE in their nasal secretions or a positive nasal allergen challenge or both. The pharmaceutical management of allergic rhinitis rests on symptomatic treatment with antihistamines that perhaps are more effectively administered intranasally than orally and intranasal corticosteroids. Allergen immunotherapy is very effective, even for local allergic rhinitis, and the shortcomings of subcutaneous immunotherapy of inconvenience and safety are reduced by the introduction of sublingual immunotherapy (SLIT). Use of the latter is currently somewhat limited by the lack of appropriate dosing information for SLIT liquids and the limited number of allergens for which SLIT tablets are available.

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Subcutaneous immunotherapy suppresses Th2 inflammation and induces neutralizing antibodies, but sublingual immunotherapy suppresses airway hyperresponsiveness in grass pollen mouse models for allergic asthma

Clinical & Experimental Allergy ◽

10.1111/cea.13169 ◽

2018 ◽

Vol 48 (8) ◽

pp. 1035-1049 ◽

Cited By ~ 6

Author(s):

L. Hesse ◽

U. Brouwer ◽

A. H. Petersen ◽

R. Gras ◽

L. Bosman ◽

...

Keyword(s):

Allergic Asthma ◽

Mouse Models ◽

Grass Pollen ◽

Airway Hyperresponsiveness ◽

Neutralizing Antibodies ◽

Sublingual Immunotherapy ◽

Subcutaneous Immunotherapy ◽

Th2 Inflammation

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Efficacy and Safety of Subcutaneous Immunotherapy for Local Allergic Rhinitis: A Meta-Analysis of Randomized Controlled Trials

American Journal of Rhinology and Allergy ◽

10.1177/19458924211050547 ◽

2021 ◽

pp. 194589242110505

Author(s):

Wanting Zhu ◽

Pei Gao ◽

Qidi Zhang ◽

Jianjun Chen

Keyword(s):

Clinical Trials ◽

Allergic Rhinitis ◽

Meta Analysis ◽

Cochrane Library ◽

Subcutaneous Immunotherapy ◽

Life Questionnaire ◽

Immunologic Response ◽

Efficacy And Safety ◽

Local Allergic Rhinitis ◽

Significant Difference

Background Subcutaneous immunotherapy (SCIT) has been used for treating local allergic rhinitis (LAR) patients. However, the clinical efficacy and safety were still questioned. Objective This study was designed to estimate the efficacy and safety of SCIT for treating LAR patients through meta-analysis. Methods We systemically searched MEDLINE, Cochrane Library, and Embase publications. Randomized, double-blind, clinical trials for the efficacy and safety of Allergen Immunotherapy (AIT) for LAR were included. A meta-analysis of 4 clinical endpoints (combined symptom and medication scores [CSMS], symptom scores [SS], medication scores [MS] and rhinoconjunctivitis quality of life questionnaire [RQLQ]) and adverse events (AEs)) was performed after bias and heterogeneity assessments. The immunologic response results were summarized. Results Four RCTs with 134 patients were included. Four studies for analyzing primary outcomes (CSMS, SS, MS) and AEs, three for RQLQ results. The results indicated an important significant difference between SCIT and placebo groups, list as follows: CSMS (SMD = −2.42, 95% CI: −3.60 to −1.25, P < .0001), SS (SMD = −2.08, 95% CI −3.68 to −0.48, P = .01), MS (SMD = −1.43, 95% CI: −2.65 to −0.21, P = 0.02), RQLQ (SMD = −0.70, 95% CI −1.29 to −0.12, P = .02), Local AEs (RR = 4.13, 95% CI 1.08 to 15.77, P = .04). For immunologic response, significantly increased serum sIgG4 levels and improvements of allergen tolerance was observed after SCIT. Conclusions Our meta-analysis suggests that SCIT has a significant effect on improving symptoms and reducing medicine consumption for LAR patients. Larger and multicenter clinical trials are needed to clarify the safety and long-term efficacy.

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Immunotherapy with Grass Pollen in Patients with “Local Allergic Rhinitis”

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2009.12.178 ◽

2010 ◽

Vol 125 (2) ◽

pp. AB37 ◽

Cited By ~ 1

Author(s):

C. Rondón ◽

S. López ◽

J. Lisbona ◽

L. Meléndez ◽

M.J. Torres ◽

...

Keyword(s):

Allergic Rhinitis ◽

Grass Pollen ◽

Local Allergic Rhinitis

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Local allergic rhinitis: Allergen tolerance and immunologic changes after preseasonal immunotherapy with grass pollen

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2010.12.013 ◽

2011 ◽

Vol 127 (4) ◽

pp. 1069-1071.e7 ◽

Cited By ~ 41

Author(s):

Carmen Rondón ◽

Natalia Blanca-López ◽

Ana Aranda ◽

Rocío Herrera ◽

José Luis Rodriguez-Bada ◽

...

Keyword(s):

Allergic Rhinitis ◽

Grass Pollen ◽

Local Allergic Rhinitis

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How to Diagnose and Treat Local Allergic Rhinitis: A Challenge for Clinicians

Journal of Clinical Medicine ◽

10.3390/jcm8071062 ◽

2019 ◽

Vol 8 (7) ◽

pp. 1062 ◽

Cited By ~ 8

Author(s):

Ibon Eguiluz-Gracia ◽

Natalia Pérez-Sánchez ◽

Gádor Bogas ◽

Paloma Campo ◽

Carmen Rondón

Keyword(s):

Allergic Rhinitis ◽

Clinical Practice ◽

Allergen Challenge ◽

Diagnostic Algorithm ◽

Specific Ige ◽

Common Disease ◽

Reliable Technique ◽

Prick Test ◽

Chronic Rhinitis ◽

Local Allergic Rhinitis

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

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2009.07.018 ◽

2009 ◽

Vol 124 (5) ◽

pp. 1005-1011.e1 ◽

Cited By ~ 77

Author(s):

Carmen Rondón ◽

Javier Fernández ◽

Soledad López ◽

Paloma Campo ◽

Inmaculada Doña ◽

...

Keyword(s):

Allergic Rhinitis ◽

Inflammatory Mediators ◽

Grass Pollen ◽

Specific Ige ◽

Local Allergic Rhinitis ◽

Nasal Challenge

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Diagnostic Tools in Allergic Rhinitis

Frontiers in Allergy ◽

10.3389/falgy.2021.721851 ◽

2021 ◽

Vol 2 ◽

Author(s):

Almudena Testera-Montes ◽

Raquel Jurado ◽

Maria Salas ◽

Ibon Eguiluz-Gracia ◽

Cristobalina Mayorga

Keyword(s):

Allergic Rhinitis ◽

Allergen Challenge ◽

Indirect Costs ◽

Basophil Activation Test ◽

Diagnostic Tools ◽

Management Approach ◽

Prick Test ◽

Chronic Rhinitis ◽

Local Allergic Rhinitis

Allergic mechanisms account for most cases of chronic rhinitis. This condition is associated with significant impairment of quality of life and high indirect costs. The identification of the allergic triggers of rhinitis has been historically based on the performance of atopy test [skin prick test (SPT) and serum allergen-specific (s)IgE]. Nevertheless, these tests only denote sensitization, and atopy and allergy represent two different phenomena. It is now clear that allergic phenotypes of rhinitis can exist in both atopic (allergic rhinitis, AR) and non-atopic (local allergic rhinitis, LAR) individuals. Moreover, both allergic phenotypes can coexist in the same rhinitis patient (dual allergic rhinitis, DAR). Therefore, a diagnostic approach merely based on atopy tests is associated with a significant rate of misdiagnosis. The confirmation of the allergic etiology of rhinitis requires the performance of in vivo test like the nasal allergen challenge (NAC). NAC is mandatory for the diagnosis of LAR and DAR, and helps decide the best management approach in difficult cases of AR. Nevertheless, NAC is a laborious technique requiring human and technical resources. The basophil activation test (BAT) is a patient-friendly technique that has shown promising results for LAR and DAR diagnosis. In this review, the diagnostic usefulness for chronic rhinitis of SPT, NAC, olfactory tests, serum sIgE, BAT and the quantification of inflammatory mediators in nasal samples will be discussed. The accurate performance of an etiologic diagnosis of rhinitis patients will favor the prescription of specific therapies with disease-modifying potential like allergen immunotherapy.

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