Eguiluz-Gracia Ibon, Fernandez-Santamaria Ruben, Testera-Montes Almudena, Ariza Adriana, Campo Paloma, Prieto Ana, Perez-Sanchez Natalia, Salas Maria, Mayorga Cristobalina, Torres Maria Jose, Rondon Carmen
Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain.
Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain.
Allergy. 2020 Jul;75(7):1689-1698. doi: 10.1111/all.14206. Epub 2020 Feb 12.
Allergic rhinitis (AR) and local allergic rhinitis (LAR) are defined by nasal reactivity to aeroallergens with and without positive skin prick test (SPT), respectively. In this study, we aimed to investigate whether both types of allergen-specific reactivity can coexist in the same individual.
Forty-eight patients with perennial rhinitis symptoms and positive SPT with seasonal allergens only (discrepant group) were subjected to consecutive nasal allergen challenges (NAC) with seasonal (NAC-S) and perennial allergens (NAC-P). A nasal lavage was collected before and after the NACs to measure eosinophil cationic protein (ECP). A basophil activation test (BAT) with seasonal and/or perennial allergens was performed in ten patients from the discrepant group and in six seasonal allergic rhinitis (SAR), eight perennial local allergic rhinitis (LAR), six nonallergic rhinitis (NAR), and six healthy control (HC) individuals.
All patients in the discrepant group tested positive in the NAC-S, and 41 of them (85.4%), also in the NAC-P (group A). Conversely, seven patients tested negative in the NAC-P (group B). ECP in the nasal lavage increased after the NAC-P in the group A (P = .004), but not in the group B. The BAT with seasonal allergens was positive in 100% of SAR and group A cases, whereas the BAT with perennial allergens was positive in 37.5% and 60% of LAR and group A cases, respectively. All NAR and HC subjects tested negative for the BAT.
This study shows that nasal reactivity to aeroallergens with and without positive SPT can coexist in the same patient. We propose the term dual allergic rhinitis for this rhinitis phenotype.
变应性鼻炎（AR）和局部变应性鼻炎（LAR）分别定义为鼻腔对气传变应原产生反应且皮肤点刺试验（SPT）阳性和阴性的情况。在本研究中，我们旨在调查这两种变应原特异性反应是否能在同一个体中共存。
48例仅有季节性变应原导致常年性鼻炎症状且SPT阳性的患者（差异组），接受了季节性变应原（NAC-S）和常年性变应原（NAC-P）的连续鼻腔变应原激发试验（NAC）。在NAC前后收集鼻腔灌洗液以测量嗜酸性粒细胞阳离子蛋白（ECP）。对差异组中的10例患者以及6例季节性变应性鼻炎（SAR）、8例常年性局部变应性鼻炎（LAR）、6例非变应性鼻炎（NAR）和6例健康对照（HC）个体进行了季节性和/或常年性变应原的嗜碱性粒细胞活化试验（BAT）。
差异组中的所有患者在NAC-S试验中均呈阳性，其中41例（85.4%）在NAC-P试验中也呈阳性（A组）。相反，7例患者在NAC-P试验中呈阴性（B组）。A组患者在NAC-P试验后鼻腔灌洗液中的ECP升高（P = 0.004），而B组未升高。季节性变应原的BAT在100%的SAR和A组病例中呈阳性，而常年性变应原的BAT在LAR和A组病例中分别有37.5%和60%呈阳性。所有NAR和HC受试者的BAT检测均为阴性。
本研究表明，鼻腔对气传变应原产生反应且SPT阳性和阴性的情况可在同一患者中共存。我们建议将这种鼻炎表型称为双重变应性鼻炎。
