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Lokale allergische Rhinitis auf Alternaria alternata

Nachweis bei Patienten mit persistierender nasaler Symptomatik

Local allergic rhinitis to Alternaria alternata

Evidence for local IgE production exclusively in the nasal mucosa

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Zusammenfassung

Die heute als „lokale allergische Rhinitis“ (LAR) bezeichnete Sonderform der allergischen Rhinitis (AR) ist durch eine (ausschließlich) lokale, direkt in der Nasenschleimhaut stattfindende IgE-Produktion (spezifische Immunglobuline vom Typ E (sIgE) charakterisiert. Der Nachweis von IgE mit den üblichen Allergietestverfahren im Serum oder in Hauttestungen ist jedoch nicht möglich, weshalb bei diesen Patienten in der Vergangenheit häufig eine nichtallergische Rhinitis diagnostiziert wurde.

Die Diagnose der LAR wird durch klinische Symptome, den lokalen Nachweis von sIgE im Nasensekret und/oder eine positive nasale Allergenprovokationstestung gestellt. Erste diagnostische Schritte beinhalten die ausführliche Anamnese, einen Hauttest und die In-vitro-Diagnostik aus dem Serum. Bei passender Anamnese sollte darauf die Quantifizierung des nasalen spezifischen IgE und der nasalen Provokationstests mit in Frage kommenden Allergenen folgen.

Wir berichten über zwei Fälle einer LAR auf Alternaria alternata mit persistierenden Symptomen einer allergischen Rhinitis, die durch nasale Provokationstestungen und Nachweis von spezifischen IgE-Antikörpern auf Alternaria alternata im Nasensekret diagnostiziert wurden.

Dies sind gemäß aktueller Literaturrecherche die weltweit zweiten Fallbeschreibungen einer LAR auf Alternaria alternata.

Abstract

In a subgroup of patients with symptoms of allergic rhinitis (AR), no systemic sensitization can be detected in skin tests or serum. These patients are considered to be afflicted with so-called “local allergic rhinitis” (LAR) with IgE-production exclusively at the site of the nasal mucosa. Patients without any positive allergy test results but seasonal (intermittent) or perennial (persistent) allergic symptoms were often misdiagnosed as having “non-allergic rhinitis” (NAR) in the past.

However, there is evidence for a specific IgE-production in the nasal mucosa in these patients without systemic sensitization. The diagnosis of LAR is confirmed by clinical symptoms, the detection of specific IgE production in the nasal mucosa and/or nasal provocation tests.

We report on two cases of LAR to Alternaria alternata with symptoms of persistent allergic rhinitis that have been diagnosed by positive allergenspecific nasal challenge tests and specific IgE determinations in nasal secretions.

According to an actual literature research, this is the second report published on LAR caused by Alternaria alternata.

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Correspondence to L. Klimek.

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Interessenkonflikt

L. Klimek, C. Bardenhewer, M. Spielhaupter, C. Harai, K. Becker und O. Pfaar geben an, dass kein Interessenkonflikt besteht.

Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Zu Hintergrundinformationen, Grundlagen und speziellen klinischen Aspekten der lokalen allergischen Rhinitis verweisen die Autoren auf die in der HNO bereits publizierte Übersichtsarbeit [1].

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Klimek, L., Bardenhewer, C., Spielhaupter, M. et al. Lokale allergische Rhinitis auf Alternaria alternata. HNO 63, 364–372 (2015). https://doi.org/10.1007/s00106-015-0005-x

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