Shin Yoo Seob, Jung Chang-Gyu, Park Hae-Sim
Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon.
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Keimyung University, Dongsan Medical Center, Daegu, South Korea.
Curr Opin Allergy Clin Immunol. 2018 Feb;18(1):10-15. doi: 10.1097/ACI.0000000000000413.
Local allergic rhinitis (LAR) is a recently classified subtype of rhinitis defined by a nasal allergic response in patients without systemic evidence of atopy. Recent studies have reported the prevalence, clinical course, culprit allergens, diagnostic methods and treatment outcomes of LAR. The purpose of this review is to summarize the most relevant and updated scientific evidence for LAR, especially focusing on its prevalence and clinical characteristics.
LAR is found in a significant proportion (3.7-61.9%) of patients previously diagnosed with nonallergic rhinitis, but the prevalence may differ among ethnic groups and countries. Common allergens of LAR are similar to those of allergic rhinitis, in which house dust mites are the most common cause, followed by grass pollen, tree pollen, weed pollen and animal dander confirmed by provocation tests. Although the nasal provocation test to a single allergen is considered the gold standard method, the detection of allergen-specific IgE and other inflammatory mediators from nasal secretions and the basophil activation test can assist in the diagnosis of LAR. Conjunctivitis and asthma are the most common comorbid conditions, and the occurrence rate of asthma increases over period. However, the conversion rate to allergic rhinitis was not significantly different between LAR and healthy controls.
LAR is a well-differentiated entity of rhinitis, which should be considered in patients with persistent and severe symptoms without any systemic evidence of atopy. Further research is needed to investigate the long-term outcome, and geographic and ethnic differences of LAR.
局部变应性鼻炎（LAR）是一种最近分类的鼻炎亚型，定义为无全身性特应性证据的患者出现鼻变应性反应。近期研究报告了LAR的患病率、临床病程、致病变应原、诊断方法及治疗结果。本综述旨在总结LAR最相关和最新的科学证据，尤其关注其患病率和临床特征。
在先前诊断为非变应性鼻炎的患者中，相当一部分（3.7%-61.9%）被发现患有LAR，但患病率在不同种族和国家可能有所不同。LAR的常见变应原与变应性鼻炎相似，其中屋尘螨是最常见病因，其次是草花粉、树花粉、杂草花粉和动物皮屑，这已通过激发试验得到证实。虽然对单一变应原的鼻激发试验被认为是金标准方法，但检测鼻分泌物中的变应原特异性IgE和其他炎症介质以及嗜碱性粒细胞活化试验有助于LAR的诊断。结膜炎和哮喘是最常见的合并症，哮喘的发生率随时间增加。然而，LAR与健康对照者之间转变为变应性鼻炎的转化率无显著差异。
LAR是一种已明确区分的鼻炎类型，对于有持续且严重症状但无任何全身性特应性证据的患者应予以考虑。需要进一步研究以调查LAR的长期结局以及地理和种族差异。
