Local Allergic Rhinitis: Is There a Role for Systemic Allergy Immunotherapy?

Allergen immunotherapy (AIT), the etiologic treatment of allergic rhinoconjunctivitis and allergic asthma, has been shown to be an effective and safe treatment in patients with allergic respiratory disease. The efficacy of AIT in reducing symptoms and medication requirements has been demonstrated not only during treatment but also after it is discontinued. AIT is the only treatment that has the ability to modify the natural course of allergic rhinoconjunctivitis and asthma. In recent years, a new entity—local allergic rhinitis (LAR)—has been reported, which is characterized by the presence of a local allergic response to inhalant allergens, with negative skin tests and no detection of specific IgE antibodies in the peripheral blood. Patients had a nasal-specific response after nasal allergen challenge and a nasal Th2 inflammatory response with specific IgE antibodies, and showed clinical improvement with the classical treatment for allergic rhinitis (antihistamines and nasal corticosteroids). Ongoing evidence indicates that these patients benefit from subcutaneous AIT and supports this indication for LAR.