Allergy Service, Carlos Haya Hospital, Málaga, Spain.
J Allergy Clin Immunol. 2012 Jun;129(6):1460-7. doi: 10.1016/j.jaci.2012.02.032. Epub 2012 Apr 18.
Local allergic rhinitis (LAR) is a localized nasal allergic response in the absence of systemic atopy characterized by local production of specific IgE (sIgE) antibodies, a T(H)2 pattern of mucosal cell infiltration during natural exposure to aeroallergens, and a positive nasal allergen provocation test response with release of inflammatory mediators (tryptase and eosinophil cationic protein). Although the prevalence remains to be established, a number of patients previously given a diagnosis of nonallergic rhinitis or idiopathic rhinitis are now being classified as having LAR. Culprit allergens responsible include house dust mite, grass and olive pollens, and many others. For the diagnosis of LAR, neither skin prick testing nor determination of the presence of serum sIgE antibodies is useful, and a nasal allergen provocation test is needed to identify the culprit allergen or allergens. In a certain proportion of cases, local sIgE can be detected, and conjunctivitis, asthma, or both can be associated. Whether patients with LAR will have systemic atopy in the future is a matter of debate. Further studies are needed for examine the prevalence of this phenomenon in different areas, to improve the diagnostic methods to better identify these patients, and to develop therapeutic approaches, including the use of immunotherapy.
局部过敏性鼻炎（LAR）是一种在无全身过敏的情况下发生的局部鼻过敏反应，其特征为局部产生特异性 IgE（sIgE）抗体、在天然暴露于变应原时黏膜细胞浸润呈 T(H)2 模式，以及对鼻变应原激发试验有阳性反应并释放炎症介质（类胰蛋白酶和嗜酸性粒细胞阳离子蛋白）。尽管其患病率尚待确定，但许多以前被诊断为非过敏性鼻炎或特发性鼻炎的患者现在被归类为患有 LAR。引起过敏的变应原包括屋尘螨、草和橄榄花粉，以及许多其他变应原。对于 LAR 的诊断，皮肤点刺试验和血清 sIgE 抗体的存在都没有用，需要进行鼻变应原激发试验来确定致病变应原或变应原。在一定比例的病例中，可以检测到局部 sIgE，并且可以伴有结膜炎、哮喘或两者兼有。患有 LAR 的患者将来是否会发生全身过敏是一个有争议的问题。需要进一步的研究来检查这种现象在不同地区的流行情况，改进诊断方法以更好地识别这些患者，并开发治疗方法，包括免疫疗法的应用。
