REVIEWS Local Allergic Rhinitis: Concept, Clinical Manifestations, and Diagnostic Approach

Local allergic rhinitis is a newly described type of rhinitis involving nasal production of specifi c immunoglobulin (sIg) E antibodies in the absence of atopy. It can affect patients previously diagnosed with non-allergic rhinitis. Evidence for this entity is supported by clinical symptoms, local production of sIgE, a type 2 helper T cell infl ammatory pattern in nasal secretions during natural exposure to aeroallergens, and a positive response to nasal allergen provocation with local nasal production of sIgE to aeroallergens, tryptase, and eosinophil cationic protein (ECP). Based on these new fi ndings, an advanced diagnostic approach is proposed in patients with symptoms suggestive of allergic rhinitis but negative results in skin prick test and serum sIgE determination. Detection of local sIgE in nasal secretions during natural exposure to aeorallergens and a positive nasal allergen provocation test with local production of tryptase, ECP, and sIgE are useful for detecting patients with local allergic rhinitis. Key words: Local allergic rhinitis. Local IgE. Nasal challenge. NARES. Nonallergic rhinitis. ■ Resumen La rinitis alérgica local es un nuevo tipo de rinitis con producción nasal de anticuerpos IgE específi cos en ausencia de atopia sistémica que puede afectar a sujetos previamente diagnosticados de rinitis no alérgica. Esta nueva entidad se apoya en la existencia de síntomas clínicos de rinitis, producción local de IgE específi ca y presencia de un patrón infl amatorio Th2 en las secreciones nasales durante l