Is the Evidence of Local Allergic Rhinitis Growing?

Carmen Rondón; Ibon Eguiluz-Gracia; Paloma Campo

Disclosures

Curr Opin Allergy Clin Immunol. 2018;18(4):342-349. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: To examine the recent advances on epidemiological studies, diagnostic approach and clinical management of local allergic rhinitis (LAR) in adults and children.

Recent findings: Evidence about LAR is growing especially in pediatric and Asian populations. The prevalence of LAR is lower in Asian countries compared with western countries in both children and adults. LAR is considered a chronic condition and an independent rhinitis phenotype that affects up to 26.5% of nonatopic rhinitis patients. The disease rapidly progress toward the clinical worsening with associated onset of asthma and conjunctivitis, which further impairs patient's quality of life. Nasal Allergen Provocation Test is the diagnostic gold standard that can be complemented by basophil activation test and the detection of specific IgE in nasal secretions. Allergen immunotherapy induces a significant and early improvement in both clinical symptoms and quality of life in LAR patients.

Summary: LAR is a common entity, with different prevalence depending on geographical locations. LAR has to be considered in the process of differential diagnosis in children and adults with rhinitis. Diagnosis of LAR is crucial in order to start an etiologic treatment such as allergen immunotherapy, which has proven to be very effective in these patients.

Introduction

Local allergic rhinitis (LAR) is a new phenotype of allergic rhinitis that in the past years has caused an enormous interest and discussion among researchers and clinicians interested in the allergic response of the upper airway. In the last decade, an important effort was made in order to increase the knowledge about LAR in terms of pathophysiology, diagnosis and treatment. Still, many aspects of LAR are not well known.

Recently, a significant number of articles have been published, many of them focused on prevalence of LAR within allegedly nonallergic rhinitis (NAR) patients, especially in Asian countries. It is noteworthy that several of these publications are focused in paediatric populations, increasing the prior evidence that LAR frequently started in childhood.[1] Also, there have been important developments in terms of diagnosis and treatment of the disease. In that sense, recent data supports the fact that allergen immunotherapy (AIT) is the treatment of choice for LAR patients, not only those sensitized to house dust mites (HDM)[2] but also to grass[3,4] and birch pollen.[5] This article will summarize and emphasize the recent developments in this field.

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