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Die (ausschließlich) lokale IgE-Produktion in der Nasenschleimhaut

Evidenz für die „lokale allergische Rhinitis“

Local (exclusive) IgE production in the nasal mucosa

Evidence for local allergic rhinitis

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Zusammenfassung

Hintergrund

Die IgE-Produktion nur in der Nasenschleimhaut, ohne dass IgE mit den üblichen Allergietestverfahren im Serum oder zellgebunden in Hauttestungen nachweisbar wären, bedingt eine Sonderform der allergischen Rhinitis (AR), die lokale allergische Rhinitis (LAR). Früher wurde bei Patienten mit saisonalen, intermittierenden Symptomen oder mit perennialen, persistierenden Beschwerden häufig eine nichtallergische Rhinitis (NAR) diagnostiziert. Die Evidenz für diese Entität wird durch klinische Symptome, lokalen Nachweis spezifischer Immunglobuline vom Typ E (sIgE), Nachweis von Zellprodukten von T-Helferzellen vom Typ 2, Tryptase und ECP („eosinophil catonic protein“) im Nasensekret nach Allergenexposition beschrieben.

Diagnostik

Nach Anamnese, Hauttest und und In-vitro-Diagnostik aus dem Serum sollte bei passender Anamnese zeitnah nach Allergenkontakt die Quantifizierung des nasalen spezifischen IgE und nasale Provokationstests mit infrage kommenden Allergenen erfolgen. Bei einigen Patienten mit zuvor nicht nachweisbarer Allergie (NAR) entsteht mit der Zeit eine AR oder LAR, LAR-Patienten können im natürlichen Krankheitsverlauf eine AR entwickeln.

Therapie

Alle Medikamentengruppen, die auch bei der AR wirksam sind, können bei der LAR eingesetzt werden. Spezifischen Immuntherapien werden derzeit evaluiert.

Abstract

Background

IgE production at the site of the nasal mucosa without systemic allergic sensitization in skin tests or in serum represents so-called “local allergic rhinitis (LAR)” as a subgroup of patients with symptoms of allergic rhinitis (AR). Formerly, in case of negative allergological test results, seasonal (intermittent) or perennial (persistent) allergic symptoms have been diagnosed as “non-allergic rhinitis” (NAR). However, there is evidence for specific Th2 cytokine, tryptase, and ECP (eosinophil catonic protein) production in the nasal secretion after allergen exposure in these patients without systemic sensitization.

Diagnosis

Taking this into account, we recommend performing an allergen-specific nasal challenge and measuring the (local) nasal IgE-levels in addition to standard allergy tests in clinical routine in this subgroup of patients. These tests should be perfomed while or shortly after allergen exposure. In addition, an update of the allergy testing should be performed after a time interval since it has been demonstrated that patients formerly diagnosed with NAR may develop LAR or AR, or patients with LAR may develop AR in the future.

Treatment

The pharmacological therapeutic options in LAR are in line with the treatment of AR. If and to what extent this subgroup of AR patients benefit from allergen-specific immunotherapy (SIT) is currently being evaluated in clinical trials.

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  1. Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183, Wiesbaden, Deutschland

    L. Klimek, L. von Bernus & O. Pfaar

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  1. L. Klimek
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  2. L. von Bernus
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  3. O. Pfaar
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Correspondence to L. Klimek.

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Klimek, L., von Bernus, L. & Pfaar, O. Die (ausschließlich) lokale IgE-Produktion in der Nasenschleimhaut. HNO 61, 217–223 (2013). https://doi.org/10.1007/s00106-012-2584-0

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