Advertisement

Local Allergic Rhinitis

  • Carmen Rondón
  • Ibon Eguiluz-Gracia
  • Gador Bogas
  • Esther Barrionuevo
  • María Salas
  • Maria J. Torres
  • Paloma Campo
Chapter
First Online:

Abstract

A significant proportion of patients with chronic rhinitis display negative skin prick test and serum allergen-specific IgE (sIgE). These individuals have been historically classified in the nonallergic rhinitis (NAR) phenotype. Nevertheless, in recent years a significant corpus of evidence has demonstrated that many chronic rhinitis patients without systemic IgE sensitization display nasal reactivity upon nasal allergen provocation test (NAPT). This disease phenotype has been termed local allergic rhinitis (LAR). Epidemiological studies show that LAR is a prevalent disease in children and adults, with moderate-to-severe symptoms that worsen over time. LAR is a stable phenotype and not merely an initial state of allergic rhinitis (AR) with systemic atopy. LAR and AR share many clinical features, including the common association to asthma and conjunctivitis. LAR pathophysiology is unknown but 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 chronic rhinitis phenotypes, but most importantly with AR. The diagnosis currently relies on the performance of NAPT with single or multiple allergens. This technique has high sensitivity, specificity, and reproducibility, and it is considered the gold standard. The BAT and the measurement of nasal sIgE can also contribute to the LAR diagnosis. Local allergic rhinitis patients benefit from the same therapeutic strategies than AR individuals, including avoidance of allergen exposure and pharmacotherapy. Moreover, good-quality data supports the effectiveness and safety of allergen immunotherapy for LAR, which also suggests that LAR is an IgE-mediated disease.

Keywords

Allergen immunotherapy Allergic rhinitis Atmospheric allergen load Basophil activation test Local allergic rhinitis Local IgE Nasal allergen provocation test Nonallergic rhinitis Pathophysiology Phenotypes 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet. 2011;378(9809):2112–22.PubMedCrossRefGoogle Scholar
  2. 2.
    Papadopoulos NG, Guibas GV. Rhinitis subtypes, endotypes, and definitions. Immunol Allergy Clin N Am. 2016;36(2):215–33.CrossRefGoogle Scholar
  3. 3.
    Canonica GW, Bousquet J, Mullol J, Scadding GK, Virchow JC. A survey of the burden of allergic rhinitis in Europe. Allergy. 2007;62(Suppl 85):17–25.CrossRefPubMedGoogle Scholar
  4. 4.
    Muraro A, Clark A, Beyer K, Borrego LM, Borres M, Lodrup Carlsen KC, et al. The management of the allergic child at school: EAACI/GA2LEN task force on the allergic child at school. Allergy. 2010;65(6):681–9.PubMedCrossRefGoogle Scholar
  5. 5.
    de la Hoz Caballer B, Rodriguez M, Fraj J, Cerecedo I, Antolin-Amerigo D, Colas C. Allergic rhinitis and its impact on work productivity in primary care practice and a comparison with other common diseases: the Cross-sectional study to evAluate work Productivity in allergic Rhinitis compared with other common dIseases (CAPRI) study. Am J Rhinol Allergy. 2012;26(5):390–4.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Bousquet J, Van Cauwenberge P, Khaltaev N, Aria Workshop G, World Health O. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108(5 Suppl):S147–334.CrossRefPubMedGoogle Scholar
  7. 7.
    Dykewicz MS, Hamilos DL. Rhinitis and sinusitis. J Allergy Clin Immunol. 2010;125(2 Suppl 2):S103–15.PubMedCrossRefGoogle Scholar
  8. 8.
    Rondon C, Bogas G, Barrionuevo E, Blanca M, Torres MJ, Campo P. Nonallergic rhinitis and lower airway disease. Allergy. 2017;72(1):24–34.PubMedCrossRefGoogle Scholar
  9. 9.
    Ellis AK, Keith PK. Nonallergic rhinitis with eosinophilia syndrome and related disorders. Clin Allergy Immunol. 2007;19:87–100.PubMedGoogle Scholar
  10. 10.
    Lacroix JS, Landis BN. Neurogenic inflammation of the upper airway mucosa. Rhinology. 2008;46(3):163–5.PubMedGoogle Scholar
  11. 11.
    Van Gerven L, Alpizar YA, Wouters MM, Hox V, Hauben E, Jorissen M, et al. Capsaicin treatment reduces nasal hyperreactivity and transient receptor potential cation channel subfamily V, receptor 1 (TRPV1) overexpression in patients with idiopathic rhinitis. J Allergy Clin Immunol. 2014;133(5):1332–9. 9 e1–3PubMedCrossRefGoogle Scholar
  12. 12.
    Ellegard E, Karlsson G. Nasal congestion during pregnancy. Clin Otolaryngol Allied Sci. 1999;24(4):307–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Chhabra N, Houser SM. The diagnosis and management of empty nose syndrome. Otolaryngol Clin N Am. 2009;42(2):311–30. ixCrossRefGoogle Scholar
  14. 14.
    Campo P, Aranda A, Rondon C, Donia I, Diaz-Perales A, Canto G, et al. Work-related sensitization and respiratory symptoms in carpentry apprentices exposed to wood dust and diisocyanates. Ann Allergy Asthma Immunol. 2010;105(1):24–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Grammer LC 3rd. Occupational rhinitis. Immunol Allergy Clin N Am. 2016;36(2):333–41.CrossRefGoogle Scholar
  16. 16.
    Perez-Alzate D, Blanca-Lopez N, Dona I, Agundez JA, Garcia-Martin E, Cornejo-Garcia JA, et al. Asthma and rhinitis induced by selective immediate reactions to paracetamol and non-steroidal anti-inflammatory drugs in aspirin tolerant subjects. Front Pharmacol. 2016;7:215.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Graf P. Rhinitis medicamentosa: a review of causes and treatment. Treat Respir Med. 2005;4(1):21–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Cho SH, Bachert C, Lockey RF. Chronic rhinosinusitis phenotypes: an approach to better medical care for chronic rhinosinusitis. J Allergy Clin Immunol Pract. 2016;4(4):639–42.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Hamilos DL. Drivers of chronic rhinosinusitis: inflammation versus infection. J Allergy Clin Immunol. 2015;136(6):1454–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Zhang N, Van Zele T, Perez-Novo C, Van Bruaene N, Holtappels G, DeRuyck N, et al. Different types of T-effector cells orchestrate mucosal inflammation in chronic sinus disease. J Allergy Clin Immunol. 2008;122(5):961–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Davila I, Rondon C, Navarro A, Anton E, Colas C, Dordal MT, et al. Aeroallergen sensitization influences quality of life and comorbidities in patients with nasal polyposis. Am J Rhinol Allergy. 2012;26(5):e126–31. Epub 2012/11/22PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Roberts G, Ollert M, Aalberse R, Austin M, Custovic A, DunnGalvin A, et al. A new framework for the interpretation of IgE sensitization tests. Allergy. 2016;71(11):1540–51.PubMedCrossRefGoogle Scholar
  23. 23.
    Dordal MT, Lluch-Bernal M, Sanchez MC, Rondon C, Navarro A, Montoro J, et al. Allergen-specific nasal provocation testing: review by the rhinoconjunctivitis committee of the Spanish Society of Allergy and Clinical Immunology. J Invest Allergol Clin Immunol. 2011;21(1):1–12. quiz follow Epub 2011/03/05Google Scholar
  24. 24.
    Krajewska-Wojtys A, Jarzab J, Gawlik R, Bozek A. Local allergic rhinitis to pollens is underdiagnosed in young patients. Am J Rhinol Allergy. 2016;30(6):198–201.PubMedCrossRefGoogle Scholar
  25. 25.
    Rondon C, Canto G, Blanca M. Local allergic rhinitis: a new entity, characterization and further studies. Curr Opin Allergy Clin Immunol. 2010;10(1):1–7. Epub 2009/12/17CrossRefPubMedGoogle Scholar
  26. 26.
    Rondon C, Fernandez J, Lopez S, Campo P, Dona I, Torres MJ, et al. Nasal inflammatory mediators and specific IgE production after nasal challenge with grass pollen in local allergic rhinitis. J Allergy Clin Immunol. 2009;124(5):1005–11. e1. Epub 2009/10/03PubMedCrossRefGoogle Scholar
  27. 27.
    Rondon C, Romero JJ, Lopez S, Antunez C, Martin-Casanez E, Torres MJ, et al. Local IgE production and positive nasal provocation test in patients with persistent nonallergic rhinitis. J Allergy Clin Immunol. 2007;119(4):899–905. Epub 2007/03/06PubMedCrossRefGoogle Scholar
  28. 28.
    Rondon C, Campo P, Herrera R, Blanca-Lopez N, Melendez L, Canto G, et al. Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis. J Allergy Clin Immunol. 2011;128(6):1192–7. Epub 2011/07/26PubMedCrossRefGoogle Scholar
  29. 29.
    Campo P, Rondon C, Gould HJ, Barrionuevo E, Gevaert P, Blanca M. Local IgE in non-allergic rhinitis. Clin Exp Allergy. 2015;45(5):872–81.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Rondon C, Campo P, Zambonino MA, Blanca-Lopez N, Torres MJ, Melendez L, et al. Follow-up study in local allergic rhinitis shows a consistent entity not evolving to systemic allergic rhinitis. J Allergy Clin Immunol. 2014;133(4):1026–31.PubMedCrossRefGoogle Scholar
  31. 31.
    Rondon C, Campo P, Galindo L, Blanca-Lopez N, Cassinello MS, Rodriguez-Bada JL, et al. Prevalence and clinical relevance of local allergic rhinitis. Allergy. 2012;67(10):1282–8. Epub 2012/08/24PubMedCrossRefGoogle Scholar
  32. 32.
    Carney AS, Powe DG, Huskisson RS, Jones NS. Atypical nasal challenges in patients with idiopathic rhinitis: more evidence for the existence of allergy in the absence of atopy? Clin Exp Allergy. 2002;32(10):1436–40.PubMedCrossRefGoogle Scholar
  33. 33.
    Bozek A, Ignasiak B, Kasperska-Zajac A, Scierski W, Grzanka A, Jarzab J. Local allergic rhinitis in elderly patients. Ann Allergy Asthma Immunol. 2015;114(3):199–202.CrossRefPubMedGoogle Scholar
  34. 34.
    Fuiano N, Fusilli S, Passalacqua G, Incorvaia C. Allergen-specific immunoglobulin E in the skin and nasal mucosa of symptomatic and asymptomatic children sensitized to aeroallergens. J Investig Allergol Clin Immunol. 2010;20(5):425–30.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Huggins KG, Brostoff J. Letter: local IgE antibodies in allergic rhinitis. Lancet. 1975;2(7935):618.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Klimek L, Bardenhewer C, Spielhaupter M, Harai C, Becker K, Pfaar O. Local allergic rhinitis to Alternaria Alternata: evidence for local IgE production exclusively in the nasal mucosa. HNO. 2015;63(5):364–72. Lokale allergische Rhinitis auf Alternaria alternata: Nachweis bei Patienten mit persistierender nasaler SymptomatikPubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Powe DG, Jagger C, Kleinjan A, Carney AS, Jenkins D, Jones NS. ‘Entopy’: localized mucosal allergic disease in the absence of systemic responses for atopy. Clin Exp Allergy. 2003;33(10):1374–9.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Cheng KJ, Xu YY, Liu HY, Wang SQ. Serum eosinophil cationic protein level in Chinese subjects with nonallergic and local allergic rhinitis and its relation to the severity of disease. Am J Rhinol Allergy. 2013;27(1):8–12.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Powe DG, Bonnin AJ, Jones NS. ‘Entopy’: local allergy paradigm. Clin Exp Allergy. 2010;40(7):987–97.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    van Rijswijk JB, Blom HM, KleinJan A, Mulder PG, Rijntjes E, Fokkens WJ. Inflammatory cells seem not to be involved in idiopathic rhinitis. Rhinology. 2003;41(1):25–30.PubMedGoogle Scholar
  41. 41.
    Blom HM, Godthelp T, Fokkens WJ, Klein Jan A, Holm AF, Vroom TM, et al. Mast cells, eosinophils and IgE-positive cells in the nasal mucosa of patients with vasomotor rhinitis. An immunohistochemical study. Eur Arch Otorhinolaryngol. 1995;252(Suppl 1):S33–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Huggins KG, Brostoff J. Local production of specific IgE antibodies in allergic-rhinitis patients with negative skin tests. Lancet. 1975;2(7926):148–50.PubMedCrossRefGoogle Scholar
  43. 43.
    Lopez S, Rondon C, Torres MJ, Campo P, Canto G, Fernandez R, et al. Immediate and dual response to nasal challenge with Dermatophagoides pteronyssinus in local allergic rhinitis. Clin Exp Allergy. 2010;40(7):1007–14. Epub 2010/03/27PubMedCrossRefGoogle Scholar
  44. 44.
    Rondon C, Dona I, Lopez S, Campo P, Romero JJ, Torres MJ, et al. Seasonal idiopathic rhinitis with local inflammatory response and specific IgE in absence of systemic response. Allergy. 2008;63(10):1352–8. Epub 2008/09/11PubMedCrossRefGoogle Scholar
  45. 45.
    Wedback A, Enbom H, Eriksson NE, Moverare R, Malcus I. Seasonal non-allergic rhinitis (SNAR)--a new disease entity? A clinical and immunological comparison between SNAR, seasonal allergic rhinitis and persistent non-allergic rhinitis. Rhinology. 2005;43(2):86–92.PubMedGoogle Scholar
  46. 46.
    Blanca-Lopez N, Campo P, Salas M, Garcia Rodriguez C, Palomares F, Blanca M, et al. Seasonal local allergic rhinitis in areas with high concentrations of grass pollen. J Investig Allergol Clin Immunol. 2016;26(2):83–91.PubMedCrossRefGoogle Scholar
  47. 47.
    Lee KS, Yu J, Shim D, Choi H, Jang MY, Kim KR, et al. Local immune responses in children and adults with allergic and nonallergic rhinitis. PLoS One. 2016;11(6):e0156979.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Rondon C, Campo P, Togias A, Fokkens WJ, Durham SR, Powe DG, et al. Local allergic rhinitis: concept, pathophysiology, and management. J Allergy Clin Immunol. 2012;129(6):1460–7. Epub 2012/04/21PubMedCrossRefGoogle Scholar
  49. 49.
    Cruz Niesvaara D, Rondon C, Almeida Quintana L, Correa A, Castillo Sainz R, Melendez L, et al. Evidence of local allergic rhinitis in areas with high and permanent aeroallergens exposure. J Allergy Clin Immunol. 2012;129(2):AB111.CrossRefGoogle Scholar
  50. 50.
    Roberts G, Xatzipsalti M, Borrego LM, Custovic A, Halken S, Hellings PW, et al. Paediatric rhinitis: position paper of the European academy of allergy and clinical immunology. Allergy. 2013;68(9):1102–16.PubMedGoogle Scholar
  51. 51.
    Kurukulaaratchy RJ, Karmaus W, Raza A, Matthews S, Roberts G, Arshad SH. The influence of gender and atopy on the natural history of rhinitis in the first 18 years of life. Clin Exp Allergy. 2011;41(6):851–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Arasi S, Pajno GB, Lau S, Matricardi PM. Local allergic rhinitis: a critical reappraisal from a paediatric perspective. Pediatr Allergy Immunol. 2016;27(6):569–73.PubMedCrossRefGoogle Scholar
  53. 53.
    Sennekamp J, Joest I, Filipiak-Pittroff B, von Berg A, Berdel D. Local allergic nasal reactions convert to classic systemic allergic reactions: a long-term follow-up. Int Arch Allergy Immunol. 2015;166(2):154–60.PubMedCrossRefGoogle Scholar
  54. 54.
    Fuiano N, Fusilli S, Incorvaia C. A role for measurement of nasal IgE antibodies in diagnosis of Alternaria-induced rhinitis in children. Allergol Immunopathol. 2012;40(2):71–4.CrossRefGoogle Scholar
  55. 55.
    Buntarickpornpan P, Veskitkul J, Pacharn P, Visitsunthorn N, Vichyanond P, Tantilipikorn P, et al. The prevalence and clinical characteristics of local allergic rhinitis in Thai children. J Allergy Clin Immunol. 2015;135(2):AB282.CrossRefGoogle Scholar
  56. 56.
    Zicari AM, Occasi F, Di Fraia M, Mainiero F, Porzia A, Galandrini R, et al. Local allergic rhinitis in children: novel diagnostic features and potential biomarkers. Am J Rhinol Allergy. 2016;30(5):329–34.PubMedCrossRefGoogle Scholar
  57. 57.
    Duman H, Bostanci I, Ozmen S, Dogru M. The relevance of nasal provocation testing in children with nonallergic rhinitis. Int Arch Allergy Immunol. 2016;170(2):115–21.PubMedCrossRefGoogle Scholar
  58. 58.
    Muramatsu M, Kinoshita K, Fagarasan S, Yamada S, Shinkai Y, Honjo T. Class switch recombination and hypermutation require activation-induced cytidine deaminase (AID), a potential RNA editing enzyme. Cell. 2000;102(5):553–63.PubMedCrossRefGoogle Scholar
  59. 59.
    He JS, Narayanan S, Subramaniam S, Ho WQ, Lafaille JJ, Curotto de Lafaille MA. Biology of IgE production: IgE cell differentiation and the memory of IgE responses. Curr Topic Microbiol Immunol. 2015;388:1–19.Google Scholar
  60. 60.
    Tong P, Wesemann DR. Molecular mechanisms of IgE class switch recombination. Curr Topic Microbiol Immunol. 2015;388:21–37.Google Scholar
  61. 61.
    Cameron L, Hamid Q, Wright E, Nakamura Y, Christodoulopoulos P, Muro S, et al. Local synthesis of epsilon germline gene transcripts, IL-4, and IL-13 in allergic nasal mucosa after ex vivo allergen exposure. J Allergy Clin Immunol. 2000;106(1 Pt 1):46–52.PubMedCrossRefGoogle Scholar
  62. 62.
    Gevaert P, Nouri-Aria KT, Wu H, Harper CE, Takhar P, Fear DJ, et al. Local receptor revision and class switching to IgE in chronic rhinosinusitis with nasal polyps. Allergy. 2013;68(1):55–63.PubMedCrossRefGoogle Scholar
  63. 63.
    KleinJan A, Vinke JG, Severijnen LW, Fokkens WJ. Local production and detection of (specific) IgE in nasal B-cells and plasma cells of allergic rhinitis patients. Eur Respir J. 2000;15(3):491–7.PubMedCrossRefGoogle Scholar
  64. 64.
    Eckl-Dorna J, Pree I, Reisinger J, Marth K, Chen KW, Vrtala S, et al. The majority of allergen-specific IgE in the blood of allergic patients does not originate from blood-derived B cells or plasma cells. Clin Exp Allergy. 2012;42(9):1347–55.PubMedCrossRefGoogle Scholar
  65. 65.
    Groot Kormelink T, Thio M, Blokhuis BR, Nijkamp FP, Redegeld FA. Atopic and non-atopic allergic disorders: current insights into the possible involvement of free immunoglobulin light chains. Clin Exp Allergy. 2009;39(1):33–42.PubMedCrossRefGoogle Scholar
  66. 66.
    Groot Kormelink T, Calus L, De Ruyck N, Holtappels G, Bachert C, Redegeld FA, et al. Local free light chain expression is increased in chronic rhinosinusitis with nasal polyps. Allergy. 2012;67(9):1165–72.PubMedCrossRefGoogle Scholar
  67. 67.
    Powe DG, Groot Kormelink T, Sisson M, Blokhuis BJ, Kramer MF, Jones NS, et al. Evidence for the involvement of free light chain immunoglobulins in allergic and nonallergic rhinitis. J Allergy Clin Immunol. 2010;125(1):139–45. e1–3PubMedCrossRefGoogle Scholar
  68. 68.
    Redegeld FA, van der Heijden MW, Kool M, Heijdra BM, Garssen J, Kraneveld AD, et al. Immunoglobulin-free light chains elicit immediate hypersensitivity-like responses. Nat Med. 2002;8(7):694–701.PubMedCrossRefGoogle Scholar
  69. 69.
    Rondon C, Canto G, Fernandez J, Blanca M. Are free light chain immunoglobulins related to nasal local allergic rhinitis? J Allergy Clin Immunol. 2010;126(3):677. Author reply -8. Epub 2010/08/10PubMedCrossRefGoogle Scholar
  70. 70.
    Hoffmann HJ, Santos AF, Mayorga C, Nopp A, Eberlein B, Ferrer M, et al. The clinical utility of basophil activation testing in diagnosis and monitoring of allergic disease. Allergy. 2015;70(11):1393–405.PubMedCrossRefGoogle Scholar
  71. 71.
    Min B, Paul WE. Basophils: in the spotlight at last. Nat Immunol. 2008;9(3):223–5.PubMedCrossRefGoogle Scholar
  72. 72.
    Campo P, Villalba M, Barrionuevo E, Rondon C, Salas M, Galindo L, et al. Immunologic responses to the major allergen of Olea Europaea in local and systemic allergic rhinitis subjects. Clin Exp Allergy. 2015;45(11):1703–12.PubMedCrossRefGoogle Scholar
  73. 73.
    Gomez E, Campo P, Rondon C, Barrionuevo E, Blanca-Lopez N, Torres MJ, et al. Role of the basophil activation test in the diagnosis of local allergic rhinitis. J Allergy Clin Immunol. 2013;132(4):975–6. e1–5PubMedCrossRefGoogle Scholar
  74. 74.
    Campo P, Salas M, Blanca-Lopez N, Rondon C. Local allergic rhinitis. Immunol Allergy Clin N Am. 2016;36(2):321–32.CrossRefGoogle Scholar
  75. 75.
    Jayaratnam A, Corrigan CJ, Lee TH. The continuing enigma of non-atopic asthma. Clin Exp Allergy. 2005;35(7):835–7.PubMedCrossRefGoogle Scholar
  76. 76.
    Humbert M, Durham SR, Ying S, Kimmitt P, Barkans J, Assoufi B, et al. IL-4 and IL-5 mRNA and protein in bronchial biopsies from patients with atopic and nonatopic asthma: evidence against “intrinsic” asthma being a distinct immunopathologic entity. Am J Respir Crit Care Med. 1996;154(5):1497–504.PubMedCrossRefGoogle Scholar
  77. 77.
    Humbert M, Grant JA, Taborda-Barata L, Durham SR, Pfister R, Menz G, et al. High-affinity IgE receptor (FcepsilonRI)-bearing cells in bronchial biopsies from atopic and nonatopic asthma. Am J Respir Crit Care Med. 1996;153(6 Pt 1):1931–7.PubMedCrossRefGoogle Scholar
  78. 78.
    Bentley AM, Durham SR, Kay AB. Comparison of the immunopathology of extrinsic, intrinsic and occupational asthma. J Invest Allergol Clin Immunol. 1994;4(5):222–32.Google Scholar
  79. 79.
    Humbert M, Ying S, Corrigan C, Menz G, Barkans J, Pfister R, et al. Bronchial mucosal expression of the genes encoding chemokines RANTES and MCP-3 in symptomatic atopic and nonatopic asthmatics: relationship to the eosinophil-active cytokines interleukin (IL)-5, granulocyte macrophage-colony-stimulating factor, and IL-3. Am J Respir Cell Mol Biol. 1997;16(1):1–8.PubMedCrossRefGoogle Scholar
  80. 80.
    Takhar P, Corrigan CJ, Smurthwaite L, O’Connor BJ, Durham SR, Lee TH, et al. Class switch recombination to IgE in the bronchial mucosa of atopic and nonatopic patients with asthma. J Allergy Clin Immunol. 2007;119(1):213–8.PubMedCrossRefGoogle Scholar
  81. 81.
    Platts-Mills TA. Local production of IgG, IgA and IgE antibodies in grass pollen hay fever. J Immunol. 1979;122(6):2218–25.PubMedGoogle Scholar
  82. 82.
    Zhang N, Holtappels G, Gevaert P, Patou J, Dhaliwal B, Gould H, et al. Mucosal tissue polyclonal IgE is functional in response to allergen and SEB. Allergy. 2011;66(1):141–8.PubMedCrossRefGoogle Scholar
  83. 83.
    Mouthuy J, Detry B, Sohy C, Pirson F, Pilette C. Presence in sputum of functional dust mite-specific IgE antibodies in intrinsic asthma. Am J Respir Crit Care Med. 2011;184(2):206–14.PubMedCrossRefGoogle Scholar
  84. 84.
    Pillai P, Fang C, Chan YC, Shamji MH, Harper C, Wu SY, et al. Allergen-specific IgE is not detectable in the bronchial mucosa of nonatopic asthmatic patients. J Allergy Clin Immunol. 2014;133(6):1770–2. e11PubMedCrossRefGoogle Scholar
  85. 85.
    Campo P, Antunez C, Rondon C, Mayorga C, Garcia R, Ruiz M, et al. Positive bronchial challenges to D. Pteronyssinus in asthmatic subjects in absence of systemic atopy. J Allergy Clin Immunol. 2011;127(2):AB6.CrossRefGoogle Scholar
  86. 86.
    Baroody FM, Naclerio RM. Nasal-ocular reflexes and their role in the management of allergic rhinoconjunctivitis with intranasal steroids. World Allergy Org J. 2011;4(1 Suppl):S1–5.CrossRefGoogle Scholar
  87. 87.
    Baroody FM, Shenaq D, DeTineo M, Wang J, Naclerio RM. Fluticasone furoate nasal spray reduces the nasal-ocular reflex: a mechanism for the efficacy of topical steroids in controlling allergic eye symptoms. J Allergy Clin Immunol. 2009;123(6):1342–8.PubMedCrossRefGoogle Scholar
  88. 88.
    Galletti JG, Guzman M, Giordano MN. Mucosal immune tolerance at the ocular surface in health and disease. Immunology. 2017;150(4):397–407.PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Leonardi A. Allergy and allergic mediators in tears. Exp Eye Res. 2013;117:106–17.PubMedCrossRefGoogle Scholar
  90. 90.
    Nicolai T, Bellach B, Mutius EV, Thefeld W, Hoffmeister H. Increased prevalence of sensitization against aeroallergens in adults in West compared with East Germany. Clin Exp Allergy. 1997;27(8):886–92.PubMedCrossRefGoogle Scholar
  91. 91.
    Rondon C, Campo P, Blanca-Lopez N, Torres MJ, Blanca M. More research is needed for local allergic rhinitis. Int Arch Allergy Immunol. 2015;167(2):99–100.PubMedCrossRefGoogle Scholar
  92. 92.
    Rondon C, Campo P, Eguiluz-Gracia I, Plaza C, Bogas G, Galindo P, et al. Local allergic rhinitis is an independent rhinitis phenotype: the results of a 10-year follow-up study. Allergy. 2018;73(2):470–78.PubMedCrossRefGoogle Scholar
  93. 93.
    Papadopoulos NG, Bernstein JA, Demoly P, Dykewicz M, Fokkens W, Hellings PW, et al. Phenotypes and endotypes of rhinitis and their impact on management: a PRACTALL report. Allergy. 2015;70(5):474–94.PubMedCrossRefGoogle Scholar
  94. 94.
    Wheatley LM, Togias A. Clinical practice. Allergic rhinitis. N Engl J Med. 2015;372(5):456–63.PubMedPubMedCentralCrossRefGoogle Scholar
  95. 95.
    Meltzer EO, Blaiss MS, Derebery MJ, Mahr TA, Gordon BR, Sheth KK, et al. Burden of allergic rhinitis: results from the Pediatric Allergies in America survey. J Allergy Clin Immunol. 2009;124(3 Suppl):S43–70.PubMedCrossRefGoogle Scholar
  96. 96.
    Committee for Medicinal Products for Human Use. European Medicines Agency Pre-Authorisation. Evaluation of Medicines for Human Use Guideline of the clinical development of products for specific immunotherapy for the treatment of allergic diseases; 2008.Google Scholar
  97. 97.
    Akdis CA, Akdis M. Mechanisms of allergen-specific immunotherapy and immune tolerance to allergens. World Allergy Org J. 2015;8(1):17.CrossRefGoogle Scholar
  98. 98.
    Jutel M, Agache I, Bonini S, Burks AW, Calderon M, Canonica W, et al. International consensus on allergy immunotherapy. J Allergy Clin Immunol. 2015;136(3):556–68.PubMedCrossRefGoogle Scholar
  99. 99.
    Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(Suppl 86):8–160.PubMedCrossRefGoogle Scholar
  100. 100.
    Walker SM, Pajno GB, Lima MT, Wilson DR, Durham SR. Grass pollen immunotherapy for seasonal rhinitis and asthma: a randomized, controlled trial. J Allergy Clin Immunol. 2001;107(1):87–93.PubMedCrossRefGoogle Scholar
  101. 101.
    Frew AJ, Powell RJ, Corrigan CJ, Durham SR, Group UKIS. Efficacy and safety of specific immunotherapy with SQ allergen extract in treatment-resistant seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2006;117(2):319–25.PubMedCrossRefGoogle Scholar
  102. 102.
    Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122(2 Suppl):S1–84.CrossRefPubMedGoogle Scholar
  103. 103.
    Pfaar O, Bachert C, Bufe A, Buhl R, Ebner C, Eng P, et al. Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (OGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto- Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD). Allergo J Int. 2014;23(8):282–319.PubMedPubMedCentralCrossRefGoogle Scholar
  104. 104.
    Calderon MA, Casale T, Cox L, Akdis CA, Burks AW, Nelson HS, et al. Allergen immunotherapy: a new semantic framework from the European Academy of Allergy and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL consensus report. Allergy. 2013;68(7):825–8.PubMedCrossRefGoogle Scholar
  105. 105.
    Burks AW, Calderon MA, Casale T, Cox L, Demoly P, Jutel M, et al. Update on allergy immunotherapy: American Academy of Allergy, Asthma & Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus report. J Allergy Clin Immunol. 2013;131(5):1288–96. e3PubMedCrossRefGoogle Scholar
  106. 106.
    Bernstein DI, Schwartz G, Bernstein JA. Allergic rhinitis: mechanisms and treatment. Immunol Allergy Clin N Am. 2016;36(2):261–78.CrossRefGoogle Scholar
  107. 107.
    Casale TB, Stokes JR. Immunotherapy: what lies beyond. J Allergy Clin Immunol. 2014;133(3):612–9. quiz 20PubMedCrossRefGoogle Scholar
  108. 108.
    von Moos S, Johansen P, Tay F, Graf N, Kundig TM, Senti G. Comparing safety of abrasion and tape-stripping as skin preparation in allergen-specific epicutaneous immunotherapy. J Allergy Clin Immunol. 2014;134(4):965–7. e4CrossRefGoogle Scholar
  109. 109.
    Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466–76.PubMedCrossRefGoogle Scholar
  110. 110.
    Bousquet J, Schunemann HJ, Samolinski B, Demoly P, Baena-Cagnani CE, Bachert C, et al. Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs. J Allergy Clin Immunol. 2012;130(5):1049–62.PubMedCrossRefGoogle Scholar
  111. 111.
    Canonica GW, Cox L, Pawankar R, Baena-Cagnani CE, Blaiss M, Bonini S, et al. Sublingual immunotherapy: world allergy organization position paper 2013 update. World Allergy Org J. 2014;7(1):6.CrossRefGoogle Scholar
  112. 112.
    Purello-D’Ambrosio F, Gangemi S, Merendino RA, Isola S, Puccinelli P, Parmiani S, et al. Prevention of new sensitizations in monosensitized subjects submitted to specific immunotherapy or not. A retrospective study. Clin Exp Allergy. 2001;31(8):1295–302.PubMedCrossRefGoogle Scholar
  113. 113.
    Des Roches A, Paradis L, Menardo JL, Bouges S, Daures JP, Bousquet J. Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. VI. Specific immunotherapy prevents the onset of new sensitizations in children. J Allergy Clin Immunol. 1997;99(4):450–3.PubMedCrossRefGoogle Scholar
  114. 114.
    Jacobsen L, Niggemann B, Dreborg S, Ferdousi HA, Halken S, Host A, et al. Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT study. Allergy. 2007;62(8):943–8.PubMedCrossRefGoogle Scholar
  115. 115.
    Horn A, Zeuner H, Wolf H, Schnitker J, Wustenberg E, GRAZAX LQ-study group. Health-related quality of life during routine treatment with the SQ-standardised grass allergy immunotherapy tablet: a non-interventional observational study. Clin Drug Invest. 2016;36(6):453–62.CrossRefGoogle Scholar
  116. 116.
    Tahamiler R, Saritzali G, Canakcioglu S. Long-term efficacy of sublingual immunotherapy in patients with perennial rhinitis. Laryngoscope. 2007;117(6):965–9.PubMedCrossRefGoogle Scholar
  117. 117.
    Marogna M, Spadolini I, Massolo A, Canonica GW, Passalacqua G. Long-lasting effects of sublingual immunotherapy according to its duration: a 15-year prospective study. J Allergy Clin Immunol. 2010;126(5):969–75.PubMedCrossRefGoogle Scholar
  118. 118.
    Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011;127(1 Suppl):S1–55.PubMedPubMedCentralCrossRefGoogle Scholar
  119. 119.
    Calderon MA, Simons FE, Malling HJ, Lockey RF, Moingeon P, Demoly P. Sublingual allergen immunotherapy: mode of action and its relationship with the safety profile. Allergy. 2012;67(3):302–11.PubMedCrossRefGoogle Scholar
  120. 120.
    Calderon MA, Cox L, Casale TB, Moingeon P, Demoly P. Multiple-allergen and single-allergen immunotherapy strategies in polysensitized patients: looking at the published evidence. J Allergy Clin Immunol. 2012;129(4):929–34.PubMedCrossRefGoogle Scholar
  121. 121.
    Rondon C, Blanca-Lopez N, Aranda A, Herrera R, Rodriguez-Bada JL, Canto G, et al. Local allergic rhinitis: allergen tolerance and immunologic changes after preseasonal immunotherapy with grass pollen. J Allergy Clin Immunol. 2011;127(4):1069–71. Epub 2011/02/01PubMedCrossRefGoogle Scholar
  122. 122.
    Rondon C, Campo P, Salas M, Aranda A, Molina A, Gonzalez M, et al. Efficacy and safety of D. Pteronyssinus immunotherapy in local allergic rhinitis: a double-blind placebo-controlled clinical trial. Allergy. 2016;71(7):1057–61.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Carmen Rondón
    • 1
  • Ibon Eguiluz-Gracia
    • 1
  • Gador Bogas
    • 1
  • Esther Barrionuevo
    • 1
  • María Salas
    • 1
  • Maria J. Torres
    • 1
  • Paloma Campo
    • 1
  1. 1.Allergy Unity, IBIMA-Hospital Regional Universitario of Málaga-UMAARADyAL, MálagaSpain

Personalised recommendations

Cite chapter

Buy options