Local allergic rhinitis (LAR) - Twitter summary from the 2012 WSAAI meeting

This summary was compiled from the tweets posted by @MatthewBowdish, an allergist/immunologist, who attended the 2012 Western Society of Allergy, Asthma and Immunology (WSAAI) meeting. The tweets were labeled #WSAAI. The text was edited and modified by me.

Local allergic rhinitis (LAR)

Hal Nelson discussed local allergic rhinitis (LAR):

Non-allergic rhinitis has many causes: atrophic, medications, vasomotor, hormonal, vasculitis, irritants, anatomical (polyps).

What is local allergic rhinitis (LAR)?

Local allergic rhinitis is defined as allergy symptoms with negative skin tests and positive nasal challenge. Mast cell mediators are likely playing a role in LAR.

15-29% of patients with chronic rhinitis don't have evidence of sensitization.

History of LAR

LAR has been identified since the 1920s. A classic study on local AR was published in the Lancet in 1975 (Huggins and Brostoff). In included only 14 patients, but all negative to SPT and sIgE for HDM - all 14 patients were positive on nasal challenge and positive IgE on nasal secretion RAST.

How common is LAR?

Overall, local allergic rhinitis affects more than 45% of patients previously diagnosed with non-allergic idiopathic rhinitis. In seasonal idiopathic rhinitis patients, 62.5% had positive nasal challenges to grass. Nasal challenges were positive to house dust mite (HDM) in 56% of idiopathic rhinitis patients (non-allergic rhinitis not explained by other causes).

What is the prognosis of LAR?

About 24% of local allergic rhinitis will go on to develop positive SPT/sIgE.

How to diagnose and treat LAR?

There is no data on the stability of nasal challenge extracts, but Hal Nelson makes them up weekly.

Immunotherapy works in local allergic rhinitis and may be best indicator of this clinical entity.

This summary was compiled from some of the tweets posted by @MatthewBowdish . The tweets were labeled #WSAAI and they reached more than 3,000 people. I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future. Here is how to do it: Twitter for Physicians: How to use Twitter to keep track of the latest news and scientific meetings, and share information with colleagues and patients.


Nonallergic rhinitis, CCJM 2012 review.

Disclaimer: The text was edited, modified, and added to by me.

Comments from Twitter

Nathan Hare M.D. @AllergyTalk: Nonallergic rhinitis: Common problem, chronic symptoms. Great Discussion bit.ly/HbYikn #allergy

@Allergy Not so impressed with CCJM review of NAR bit.ly/HbYikn - Barely mentioned local AR - may affect 40% of NAR. A big miss in the CCJM review... 40% of patients with NAR may have locally produced IgE bit.ly/I8Vxid

@AllergyTalk: the actual % is lower- I looked at your reference- it is actually 40% of pts who have NAR & pos intranasal challenge

@Allergy: I was waiting for your tweet on that...:) No one knows the actual prevalence yet - see here: bit.ly/Hie3Ft

@AllergyTalk: good point- I have actually started wondering about that when talking to pts about " chronic" rhinitis. I agree though- it will prob be a fair amt of the "non-allergic" rhinitis pts.  I now routinely include a discussion of local IgE prod with my pts with rhinitis and neg skin &/or IgE titers.

@Allergy: right, that's the point... It seems like a lot a of NAR have local AR, hot research topic, but mentioned in 1 sentence in CCJM

@AllergyTalk:  I read it quickly during the workday and liked the NAR discussion, but completely missed they left out the local IgE info. They also split NAR into so many subtypes it made my head hurt- I don't have time to sub sub classify chronic rhinitis each time.

Dr. Ellis @DrAnneEllis: It's always in the differential for sure and I tell my px's of that possibility also. Wish it were easier 2 prove :)

@AllergyTalk: They should design a test like the rapid strep test looking for allergen spec IgE in snot after nasal challenge

@AllergyTalk: nasal challenge extracts...Hal Nelson makes them up weekly. Any published protocol for this & how to make extracts?

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