This summary was compiled from the tweets posted by allergists/immunologists who attended the 2013 annual meeting of the American Academy of Allergy Asthma and Immunology (AAAAI) (see the list at the end). The tweets were labeled #AAAAI. The text was edited and modified by me.
Dr Gevaert presented on understanding the concept of local IgE production.
Many of us have seen patients like this: typical seasonal allergic rhinitis symptoms but negative skin tests. In many European countries, the standard practice is to follow up such a patient with series of nasal allergen challenges; they are often positive. LAR is much harder to diagnose accurately in N. America where nasal allergen provocation test (NAPT) is not part of the routine practice.
IgE is the least abundant class of immunoglobulin in human serum, it is much more tissue based and bound to cell surfaces. Many authors have published studies demonstrating local production of IgE in nasal tissue in both AR and presumed non-allergic rhinitis.
Local allergic rhinitis is considered a subset of AR - systemic skin and blood tests are negative but there is a positive nasal allergen provocation test.
There are challenges to the diagnosis of local IgE production. Options include NAPT, nasal biopsies, measuring IgE in nasal secretions via sponge or filter disc absorption studies.
Local AR does improve following Allergen-specific SCIT treatment.
This summary was compiled from some of the tweets posted by the following allergists:
Diagnostic approach in patients with LAR, source: J Allergy Clin Immunol. 2012 Jun;129(6):1460-7: