Allergy Unit, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain.
Research Laboratory-Allergy Unit, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain.
Allergy. 2018 Feb;73(2):470-478. doi: 10.1111/all.13272. Epub 2017 Sep 15.
The knowledge about the natural history of local allergic rhinitis (LAR) is limited. One unmet question is to demonstrate whether LAR should be considered the first step in the development of allergic rhinitis (AR) or an independent phenotype. The aim of this study was to prospectively evaluate the natural history of a population with LAR, the potential conversion to AR with systemic atopy and the development of asthma during 10 years.
This is the second phase of a 10-year follow-up study of a cohort of 176 patients with LAR of recent onset and 115 age- and sex-matched healthy controls prospectively evaluated from 2005 to 2016. Clinical-demographic questionnaire, spirometry, skin prick test and specific IgE were evaluated yearly. Nasal allergen provocation tests (NAPT) with Dermatophagoides pteronyssinus, Alternaria alternata, Olea europaea and grass pollen were performed at baseline, and after 5 and 10 years.
After 10-year LAR, patients experienced a significant and clinically relevant worsening of the rhinitis, with increase in emergency assistance, development of asthma, loss of allergen tolerance and impairment of the quality of life. This worsening became significant after 5 years and progressed throughout 10 years. A similar rate of development of AR with systemic atopy was detected in patients and controls (9.7% vs 7.8%, log-rank P=.623). In 5 patients, conversion to systemic atopy occurred >10 years (3%).
LAR is a well-differentiated clinical entity with a low rate of development of systemic atopy, a natural evolution towards worsening and a risk factor for suffering asthma.
局部过敏性鼻炎 (LAR) 的自然病史知识有限。一个未得到满足的问题是，是否应将 LAR 视为过敏性鼻炎 (AR) 发展的第一步，还是一个独立的表型。本研究旨在前瞻性评估具有 LAR 的人群的自然病史，全身性过敏患者向 AR 转变的可能性，以及 10 年内哮喘的发生。
这是一项为期 10 年的队列研究的第二阶段，该研究对 2005 年至 2016 年期间前瞻性评估的 176 例近期发病的 LAR 患者和 115 名年龄和性别匹配的健康对照者进行了为期 10 年的随访。每年评估临床人口统计学问卷、肺活量测定、皮肤点刺试验和特异性 IgE。在基线、第 5 年和第 10 年进行屋尘螨、交链孢霉、欧洲橄榄和草花粉的鼻过敏原激发试验 (NAPT)。
在 LAR 10 年后，患者经历了显著且具有临床相关性的鼻炎恶化，包括紧急援助增加、哮喘发作、过敏原耐受性丧失和生活质量受损。这种恶化在第 5 年后变得明显，并持续了 10 年。在患者和对照组中，全身性过敏患者的 AR 发展率相似 (9.7%对 7.8%，对数秩检验 P=.623)。5 例患者 >10 年发生全身性过敏转变 (3%)。
LAR 是一种明确的临床实体，全身性过敏的发展率低，自然病程向恶化发展，是患哮喘的危险因素。
