Skip to main content
SpringerLink
Log in

Local Allergic Rhinitis: A New Allergic Rhinitis Phenotype

  • Chapter
  • First Online:
Challenges in Rhinology

  • 579 Accesses

Abstract

Local allergic rhinitis (LAR) describes a condition in which a patient has clear symptoms suggestive of allergic rhinitis and has a nasal eosinophilic inflammation with local specific IgE to a specific allergen but is negative on testing for systemic atopy. A considerable number of cases with rhinitis, in which SPT is negative and sIgE is undetectable, do in fact produce a positive response to the nasal allergen challenge (NAC). This phenotypical manifestation of AR is known as LAR. LAR affects the entire age range from children to adults, across the world, and symptoms may range from mild to severe. Despite the negative effects of LAR on patients’ quality of life and the way symptoms may quickly deteriorate, it is generally underdiagnosed. LAR persists as a condition in its own right. It is not merely a precursor to systemic AR. There are many common elements between AR and LAR, such as positive NAC, the presence of features indicating a type 2 inflammatory response in the nose (e.g. sIgE in secretions from the nose) and an increased risk of becoming asthmatic. In this chapter, we reviewed LAR in all aspects.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rondón C, Campo P, Togias A, et al. Local allergic rhinitis: concept, pathophysiology, and management. J Allergy Clin Immunol. 2012;129:1460–7.

    Article  PubMed  CAS  Google Scholar 

  2. Huggins KG, Brostoff J. Local production of specific IgE antibodies in allergic-rhinitis patients with negative skin tests. Lancet. 1975;2(7926):148–50.

    Article  CAS  PubMed  Google Scholar 

  3. 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;33:1374–9. https://doi.org/10.1046/j.1365-2222.2003.01737.x.

    Article  CAS  PubMed  Google Scholar 

  4. Rondón C, Romero JJ, López S, Antúnez C, Martín-Casañez E, Torres MJ, Mayorga C, R-Pena R, Blanca M. Local IgE production and positive nasal provocation test in patients with persistent nonallergic rhinitis. J Allergy Clin Immunol. 2007;119(4):899–905. https://doi.org/10.1016/j.jaci.2007.01.006.

    Article  CAS  PubMed  Google Scholar 

  5. Rondón C, Campo P, Eguiluz-Gracia I, Plaza C, Bogas G, Galindo P, Mayorga C, Torres MJ. Local allergic rhinitis is an independent rhinitis phenotype: the results of a 10-year follow-up study. Allergy. 2018;73(2):470–8. https://doi.org/10.1111/all.13272. Epub 2017 Sept 15.

    Article  CAS  PubMed  Google Scholar 

  6. Campo P, Eguiluz-Gracia I, Bogas G, Salas M, Plaza Serón C, Pérez N, Mayorga C, Torres MJ, Shamji MH, Rondón C. Local allergic rhinitis: implications for management. Clin Exp Allergy. 2019;49(1):6–16. https://doi.org/10.1111/cea.13192. Epub 2018 Jul 5.

    Article  CAS  PubMed  Google Scholar 

  7. Eguiluz-Gracia I, Pérez-Sánchez N, Bogas G, Campo P, Rondón C. How to diagnose and treat local allergic rhinitis: a challenge for clinicians. J Clin Med. 2019;8(7):1062.

    Article  CAS  PubMed Central  Google Scholar 

  8. Rondón C, Campo P, Galindo L, Blanca-López N, Cassinello MS, Rodriguez-Bada JL, Torres MJ, Blanca M. Prevalence and clinical relevance of local allergic rhinitis. Allergy. 2012;67(10):1282–8. https://doi.org/10.1111/all.12002.

    Article  PubMed  Google Scholar 

  9. 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. https://doi.org/10.1016/j.anai.2014.12.013.

    Article  PubMed  Google Scholar 

  10. Hamizan AW, Rimmer J, Alvarado R, et al. Positive allergen reaction in allergic and nonallergic rhinitis: a systematic review. Int Forum Allergy Rhinol. 2017;7:868–77.

    Article  PubMed  Google Scholar 

  11. Pawankar R, Mori S, Ozu C, Kimura S. Overview on the pathomechanisms of allergic rhinitis. Asia Pac Allergy. 2011;1(3):157–67. https://doi.org/10.5415/apallergy.2011.1.3.157.

    Article  PubMed  PubMed Central  Google Scholar 

  12. López S, Rondón C, Torres MJ, Campo P, Canto G, Fernandez R, Garcia R, Martínez-Cañavate A, Blanca M. Immediate and dual response to nasal challenge with Dermatophagoides pteronyssinus. Clin Exp Allergy. 2010;40(7):1007–14. https://doi.org/10.1111/j.1365-2222.2010.03492.x.

    Article  PubMed  Google Scholar 

  13. Campo P, Salas M, Blanca-Lopez N, Rondón C. Local allergic rhinitis. Immunol Allergy Clin N Am. 2016;36:321–32.

    Article  Google Scholar 

  14. Rondón C, Bogas G, Barrionuevo E, Blanca M, Torres MJ, Campo P. Nonallergic rhinitis and lower airway disease. Allergy. 2017;72:24–34.

    Article  PubMed  Google Scholar 

  15. Rondón C, Blanca-Lopez N, Aranda A, et al. Local allergic rhinitis: allergen tolerance and immunologic changes after preseasonal immunotherapy with grass pollen. J Allergy Clin Immunol. 2011;127:1069–71.

    Article  PubMed  Google Scholar 

  16. Rondón C, Campo P, Salas M, et al. Efficacy and safety of D. Pteronyssinus immunotherapy in local allergic rhinitis: a double-blind placebo-controlled clinical trial. Allergy. 2016;71:1057–61.

    Article  PubMed  CAS  Google Scholar 

  17. Auge J, Vent J, Agache I, et al. EAACI Position paper on the standardization of nasal allergen challenges. Allergy. 2018;73:1597–608. https://doi.org/10.1111/all.13416. [Epub ahead of print].

    Article  CAS  PubMed  Google Scholar 

  18. Campo P, Rondón C, Gould HJ, Barrionuevo E, Gevaert P, Blanca M. Local IgE in non-allergic rhinitis. Clin Exp Allergy. 2015;45:872–81.

    Article  CAS  PubMed  Google Scholar 

  19. Rondón C, Campo P, Galindo L, et al. Prevalence and clinical relevance of local allergic rhinitis. Allergy. 2012;67:1282–8.

    Article  PubMed  Google Scholar 

  20. Dordal MT, Lluch-Bernal M, Sanchez MC, 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;21:1–12; quiz follow 12.

    CAS  Google Scholar 

  21. Rondón C, Campo P, Herrera R, et al. Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis. J Allergy Clin Immunol. 2011;128:1192–7.

    Article  PubMed  CAS  Google Scholar 

  22. Rondón C, Canto G, Blanca M. Local allergic rhinitis: a new entity, characterization and further studies. Curr Opin Allergy Clin Immunol. 2010;10:1–7.

    Article  PubMed  CAS  Google Scholar 

  23. Campo P, Villalba M, Barrionuevo E, et al. Immunologic responses to the major allergen of Olea europaea in local and systemic allergic rhinitis subjects. Clin Exp Allergy. 2015;45:1703–12.

    Article  CAS  PubMed  Google Scholar 

  24. Campo P, Rondon C, Gould HJ, Barrionuevo E, Gevaert P, Blanca M. Local IgE in non-allergic rhinitis. Clin Exp Allergy. 2015;45:872–81. https://doi.org/10.1111/cea.12476.

    Article  CAS  PubMed  Google Scholar 

  25. Rondon C, Eguiluz-Gracia I, Shamji MH, Layhadi JA, Salas M, Torres MJ, Campo P. IgE test in secretions of patients with respiratory allergy. Curr Allergy Asthma Rep. 2018;18:67. https://doi.org/10.1007/s11882-018-0821-7.

    Article  CAS  PubMed  Google Scholar 

  26. Rondon C, Romero JJ, Lopez S, Antunez C, Martin-Casanez E, Torres MJ, Mayorga C, R-Pena R, Blanca M. Local IgE production and positive nasal provocation test in patients with persistent nonallergic rhinitis. J Allergy Clin Immunol. 2007;119:899–905. https://doi.org/10.1016/j.jaci.2007.01.006.

    Article  CAS  PubMed  Google Scholar 

  27. Rondon C, Campo P, Togias A, Fokkens WJ, Durham SR, Powe DG, Mullol J, Blanca M. Local allergic rhinitis: concept, pathophysiology, and management. J Allergy Clin Immunol. 2012;129:1460–7. https://doi.org/10.1016/j.jaci.2012.02.032.

    Article  CAS  PubMed  Google Scholar 

  28. Lopez S, Rondon C, Torres MJ, Campo P, Canto G, Fernandez R, Garcia R, Martinez-Canavate A, Blanca M. Immediate and dual response to nasal challenge with Dermatophagoides pteronyssinus in local allergic rhinitis. Clin Exp Allergy. 2010;40:1007–14. https://doi.org/10.1111/j.1365-2222.2010.03492.x.

    Article  CAS  PubMed  Google Scholar 

  29. Gelardi M, Guglielmi AV, Iannuzzi L, Quaranta VN, Quaranta N, Landi M, Correale M, Sonnante A, Rossini M, Mariggio MA, et al. Local allergic rhinitis: entopy or spontaneous response? World Allergy Organ J. 2016;9:39. https://doi.org/10.1186/s40413-016-0126-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. De Schryver E, Devuyst L, Derycke L, Dullaers M, Van Zele T, Bachert C, Gevaert P. Local immunoglobulin E in the nasal mucosa: clinical implications. Allergy Asthma Immunol Res. 2015;7:321–31. https://doi.org/10.4168/aair.2015.7.4.321.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Lee KS, Yu J, Shim D, Choi H, Jang MY, Kim KR, Choi JH, Cho SH. Local immune responses in children and adults with allergic and nonallergic rhinitis. PLoS One. 2016;11:e0156979. https://doi.org/10.1371/journal.pone.0156979.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Duarte Ferreira R, Ornelas C, Silva S, Morgado R, Pereira D, Escaleira D, Moreira S, Valenca J, Pedro E, Branco Ferreira M, et al. Contribution of in vivo and in vitro testing for the diagnosis of local allergic rhinitis. J Invest Allergol Clin Immunol. 2019;29:46–8. https://doi.org/10.18176/jiaci.0321.

    Article  CAS  Google Scholar 

  33. Gomez E, Campo P, Rondon C, Barrionuevo E, Blanca-Lopez N, Torres MJ, Herrera R, Galindo L, Mayorga C, Blanca M. Role of the basophil activation test in the diagnosis of local allergic rhinitis. J Allergy Clin Immunol. 2013;132:975–6. https://doi.org/10.1016/j.jaci.2013.07.016.

    Article  PubMed  Google Scholar 

  34. Campo P, Villalba M, Barrionuevo E, Rondon C, Salas M, Galindo L, Rodriguez MJ, Lopez-Rodriguez JC, Prieto-Del Prado MA, Torres MJ, et al. Immunologic responses to the major allergen of Olea europaea in local and systemic allergic rhinitis subjects. Clin Exp Allergy. 2015;45:1703–12. https://doi.org/10.1111/cea.12600.

    Article  CAS  PubMed  Google Scholar 

  35. 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;32:1436–40.

    Article  CAS  PubMed  Google Scholar 

  36. 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;43:86–92.

    PubMed  Google Scholar 

  37. Rondón C, Dona I, Lopez S, et al. Seasonal idiopathic rhinitis with local inflammatory response and specific IgE in absence of systemic response. Allergy. 2008;63:1352–8.

    Article  PubMed  Google Scholar 

  38. Powe DG, Huskisson RS, Carney AS, Jenkins D, Jones NS. Evidence for an inflammatory pathophysiology in idiopathic rhinitis. Clin Exp Allergy. 2001;31:864–72.

    Article  CAS  PubMed  Google Scholar 

  39. Lopez S, Rondón C, Torres MJ, et al. Immediate and dual response to nasal challenge with Dermatophagoides pteronyssinus in local allergic rhinitis. Clin Exp Allergy. 2010;40:1007–14.

    Article  CAS  PubMed  Google Scholar 

  40. Rondón C, Fernandez J, Lopez S, 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:e1.

    Article  Google Scholar 

  41. Fuiano N, Fusilli S, Incorvaia C. A role for measurement of nasal IgE antibodies in diagnosis of alternaria-induced rhinitis in children. Allergol Immunopathol (Madr). 2012;40:71–4.

    Article  CAS  Google Scholar 

  42. Kurosaki T, Kometani K, Ise W. Memory B cells. Nat Rev Immunol. 2015;15:149–59.

    Article  CAS  PubMed  Google Scholar 

  43. 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 Top Microbiol Immunol. 2015;388:1–19.

    CAS  PubMed  Google Scholar 

  44. 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;20:425–30.

    CAS  PubMed  Google Scholar 

  45. Lee KS, Yu J, Shim D, et al. Local immune responses in children and adults with allergic and nonallergic rhinitis. PLoS One. 2016;11:e0156979.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  46. Blanca-Lopez N, Campo P, Salas M, et al. Seasonal local allergic rhinitis in areas with high concentrations of grass pollen. J Investig Allergol Clin Immunol. 2016;26:83–91.

    Article  CAS  PubMed  Google Scholar 

  47. Eguiluz-Gracia I, Fernandez-Santamaria R, Testera-Montes A, Ariza A, Campo P, Prieto A, et al. Coexistence of nasal reactivity to allergens with and without IgE sensitization in patients with allergic rhinitis. Allergy. 2020; https://doi.org/10.1111/all.14206. [Epub ahead of print].

  48. Simpson EL, Bieber T, Guttman-Yassky E, et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016;375:2335–48.

    Article  CAS  PubMed  Google Scholar 

  49. James LK, Shamji MH, Walker SM, et al. Long-term tolerance after allergen immunotherapy is accompanied by selective persistence of blocking antibodies. J Allergy Clin Immunol. 2011;127:e1–5.

    Article  Google Scholar 

  50. De Schryver E, Derycke L, Calus L, et al. The effect of systemic treatments on periostin expression reflects their interference with the eosinophilic inflammation in chronic rhinosinusitis with nasal polyps. Rhinology. 2017;55:152–60.

    Article  PubMed  Google Scholar 

  51. Baroody FM, Naclerio RM. Nasal-ocular reflexes and their role in the management of allergic rhinoconjunctivitis with intranasal steroids. World Allergy Organ J. 2011;4:S1–5.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Bousquet J, Van Cauwenberge P, Khaltaev N, Aria Workshop Group, World Health Organization. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108:S147–334.

    Article  CAS  PubMed  Google Scholar 

  53. Bousquet J, Khaltaev N, Cruz AA, 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.

    Article  PubMed  Google Scholar 

  54. Brozek JL, Bousquet J, Baena-Cagnani CE, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126:466–76.

    Article  PubMed  Google Scholar 

  55. Rondón C, Campo P, Zambonino MA, et al. Follow-up study in local allergic rhinitis shows a consistent entity not evolving to systemic allergic rhinitis. J Allergy Clin Immunol. 2014;133:1026–31.

    Article  PubMed  Google Scholar 

  56. Shamji HM, Durham SR. Mechanisms of allergen immunotherapy for inhaled allergens and predictive biomarkers. J Allergy Clin Immunol. 2017;140:1485–98.

    Article  CAS  PubMed  Google Scholar 

  57. Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet. 2011;378:2112–22.

    Article  PubMed  Google Scholar 

  58. 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.

    Article  PubMed  Google Scholar 

  59. 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;26:390–4.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Muraro A, Clark A, Beyer K, et al. The management of the allergic child at school: EAACI/GA2LEN Task Force on the allergic child at school. Allergy. 2010;65:681–9.

    Article  CAS  PubMed  Google Scholar 

  61. Dykewicz MS, Hamilos DL. Rhinitis and sinusitis. J Allergy Clin Immunol. 2010;125:S103–15.

    Article  PubMed  Google Scholar 

  62. 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.

    Article  PubMed  Google Scholar 

  63. 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.

    Article  CAS  PubMed  Google Scholar 

  64. Bozek A, Kolodziejczyk K, Jarzab J. Efficacy and safety of birch pollen immunotherapy for local allergic rhinitis. Ann Allergy Asthma Immunol. 2018;120(1):53–8.

    Article  CAS  PubMed  Google Scholar 

  65. Rondon C, Blanca-Lopez N, Campo P, Mayorga C, Jurado-Escobar R, Torres MJ, et al. Specific immunotherapy in local allergic rhinitis: a randomized, double-blind placebo-controlled trial with Phleum pratense subcutaneous allergen immunotherapy. Allergy. 2018;73(4):905–15.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Allergy, Tepecik Training and Research Hospital, İzmir, Turkey

    Emine Ece Özdoğru

  2. Department of Otorhinolaryngology, Medical Faculty, Kırıkkale University, Kırıkkale, Turkey

    Nuray Bayar Muluk

  3. Allergy Unit, Hospital Regional Universitario de Málaga, IBIMA, ARADYAL, Málaga, Spain

    Carmen Rondon

Authors
  1. Emine Ece Özdoğru
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nuray Bayar Muluk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carmen Rondon
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Otolaryngology, Eskisehir Osmangazi University, Eskisehir, Turkey

    Cemal Cingi

  2. Otolaryngology Department, Kırıkkale University, Faculty Medicine, Kirikkale, Turkey

    Nuray Bayar Muluk

  3. Royal National ENT Hospital, London, UK

    Glenis K Scadding

  4. Croatian Academy of Medical Sciences, Zagreb, Croatia

    Ranko Mladina

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Özdoğru, E.E., Bayar Muluk, N., Rondon, C. (2021). Local Allergic Rhinitis: A New Allergic Rhinitis Phenotype. In: Cingi, C., Bayar Muluk, N., Scadding, G.K., Mladina, R. (eds) Challenges in Rhinology. Springer, Cham. https://doi.org/10.1007/978-3-030-50899-9_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-50899-9_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-50898-2

  • Online ISBN: 978-3-030-50899-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation