Local allergic rhinitis with negative skin test and serum sIgE - how to diagnose it?

"Local allergic rhinitis" is 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:

- symptoms
- local production of sIgE
- leukocyte-lymphocyte inflammatory pattern, with an increase in the nasal fluids of eosinophils, mast cells and T lymphocytes during natural exposure to aeroallergens
- positive nasal allergen provocation test with local production of tryptase and eosinophil cationic protein and an increase of nasal sIgE to inhalant allergens

An advanced diagnostic approach is proposed in patients with symptoms suggestive of allergic rhinitis but negative results in skin prick test and serum sIgE.

This diagnostic approach to local allergic rhinitis includes:

- detection of local sIgE in nasal secretions during natural exposure to aeorallergens
- positive nasal allergen provocation test with local production of tryptase, eosinophil cationic protein and sIgE

References:

Local allergic rhinitis: a new entity, characterization and further studies. Rondon, Carmen, Canto, Gabriela, Blanca, Miguel. Current Opinion in Allergy & Clinical Immunology. 10(1):1-7, February 2010.
Pearls and Pitfalls of Allergen Testing - JCAAI http://goo.gl/6ThcC and http://goo.gl/Bfnhn
Nonallergic rhinitis, CCJM 2012 review.
Image source: Wikipedia, a Creative Commons license.

2 comments:

  1. I think I have local allergic rhinitis. See http://camoo.freeshell.org/allergies.html

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  2. I think I have local allergic rhinitis. I have a webpage about my struggle to diagnose and help myself: http://camoo.freeshell.org/allergies.html
    It illustrates just how sick you can be with rhinitis. I got almost no help from doctors with this, because I have very few specific symptoms, only malaise and fatigue. And allergy testing was negative. So I had to help myself, and I wrote about how I slowly figured it out by experimenting.
    I used to have allergies according to blood tests, although skin-prick tests have never been positive. So I may be the opposite of what you discuss elsewhere: nonallergic rhinitis turning into allergic rhinitis over time. My allergies may be on the way out. I sure hope so!

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