Local allergic rhinitis - a new phenotype of allergic rhinitis

摘要

Local allergic rhinitis is a new phenotype of rhinitis. The purpose of this review is to discuss the aetiopathophysiology and clinical picture that underlies this form of rhinitis that is typically associated with non-atopic non-allergic rhinitis subjects. Allergic rhinitis is an IgE-mediated inflammatory response of the nasal mucosa after allergen exposure characterised by symptoms that include nasal obstruction, rhinorrhoea, itching and sneezing. The diagnosis is based on a thorough history, clinical examination, and positive skin-prick testing (SPT) or serum specific IgE (slgE) antibodies to aero-allergens. In non-allergic rhinitis (NAR), an allergic cause has been ruled out after negative SPT and the absence of slgE antibodies to aeroallergens. Many subjects previously diagnosed with NAR, when challenged, developed typical local nasal allergic symptoms, with production of slgE. It is hypothesised that allergic T-helper cell type 2 (Th2) disease pathways could be present in the nasal mucosa of patients with 'non-allergic rhinitis', despite the absence of systemic atopic responses. The term entopy has been proposed to describe this concept of localised allergic responses in the absence of systemic atopy.