Local allergic rhinitis: a new entity, characterization and further studies

The purpose of this review is to describe new insights into the pathophysiology and clinical characterization of 'local allergic rhinitis', a new phenotype of rhinitis that may affect individuals previously diagnosed with nonallergic rhinitis.Several studies have shown the existence of local allergic rhinitis with nasal production of specific IgE (sIgE) antibodies in the absence of atopy in over 40% of nonallergic rhinitis patients. Evidence for this entity is supported by the clinical symptoms, the local production of sIgE and a leukocyte-lymphocyte inflammatory pattern, with an increase in the nasal fluids of eosinophils, mast cells and T lymphocytes during natural exposure to aeroallergens, as well as a positive immediate and dual response to a nasal allergen provocation test with local production of tryptase and eosinophil cationic protein and an increase of nasal sIgE to inhalant allergens.On the basis of these new findings, an advanced diagnostic approach is proposed in patients with symptoms suggestive of allergic rhinitis but negative results in skin prick test and serum sIgE. Detection of local sIgE in nasal secretions during natural exposure to aeorallergens and a positive nasal allergen provocation test with local production of tryptase, eosinophil cationic protein and sIgE are useful to detect patients with local allergic rhinitis.