Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain.
Research Laboratory-Allergy Unit, Hospital Regional Universitario de Málaga, UMA, Málaga, Spain.
Clin Exp Allergy. 2019 Jan;49(1):6-16. doi: 10.1111/cea.13192. Epub 2018 Jul 5.
A significant proportion of rhinitis patients without systemic IgE-sensitisation tested by skin prick test and serum allergen-specific IgE (sIgE) display nasal reactivity upon nasal allergen provocation test (NAPT). This disease phenotype has been termed local allergic rhinitis (LAR). LAR is an underdiagnosed entity affecting children and adults from different parts of the world, with moderate-to-severe symptoms, impairment of quality of life and rapid progression to symptom worsening. LAR is a stable phenotype and not merely an initial state of AR. Allergic rhinitis and LAR share many clinical features including a positive NAPT response, markers of type 2 nasal inflammation including sIgE in nasal secretions and a significant rate of asthma development. LAR should be considered as a differential diagnosis in those subjects of any age with symptoms suggestive of AR but no evidence of systemic atopy. Although LAR pathophysiology is partially unknown, in some patients sIgE can be demonstrated directly in the nasal secretions and/or indirectly via positive responses in basophil activation test (BAT). LAR can coexist with other rhinitis phenotypes, especially AR. The diagnosis currently relies on the positivity of NAPT to a single or multiple allergens. NAPT has high sensitivity, specificity and reproducibility, and it is considered the gold standard. BAT and the measurement of nasal sIgE can also contribute to LAR diagnosis. LAR patients benefit from the same therapeutic strategies than AR individuals, including the avoidance of allergen exposure and the pharmacotherapy. Moreover, several recent studies support the effectiveness and safety of allergen immunotherapy for LAR, which opens a window of treatment opportunity in these patients.
相当比例的鼻炎患者，经皮试和血清过敏原特异性 IgE（sIgE）检测无系统性 IgE 敏化，但在鼻变应原激发试验（NAPT）中显示出鼻内反应。这种疾病表型被称为局部过敏性鼻炎（LAR）。LAR 是一种诊断不足的疾病，影响来自世界不同地区的儿童和成人，其症状中度至重度，生活质量受损，症状恶化迅速。LAR 是一种稳定的表型，不仅仅是 AR 的初始状态。过敏性鼻炎和 LAR 具有许多共同的临床特征，包括 NAPT 反应阳性、鼻腔分泌物中 sIgE 等 2 型鼻内炎症标志物以及哮喘发展的高发生率。在任何年龄有 AR 症状但无全身过敏证据的患者中，都应考虑将 LAR 作为鉴别诊断。尽管 LAR 的发病机制尚不完全清楚，但在一些患者中，sIgE 可直接在鼻分泌物中检测到，和/或间接通过嗜碱性粒细胞激活试验（BAT）的阳性反应检测到。LAR 可与其他鼻炎表型共存，尤其是 AR。目前的诊断依赖于 NAPT 对单一或多种变应原的阳性反应。NAPT 具有高敏感性、特异性和可重复性，被认为是金标准。BAT 和鼻 sIgE 的测量也有助于 LAR 的诊断。LAR 患者与 AR 患者一样受益于相同的治疗策略，包括避免接触过敏原和药物治疗。此外，最近的几项研究支持 LAR 过敏原免疫治疗的有效性和安全性，为这些患者提供了治疗机会。
