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Local allergic rhinitis: Implications for management

机译：局部过敏性鼻炎：对管理的影响

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A significant proportion of rhinitis patients without systemic IgE-sensitisation tested by skin prick test and serum allergen-specific IgE (sIgE) display nasal reactivity upon nasal allergen provocation test (NAPT). This disease phenotype has been termed local allergic rhinitis (LAR). LAR is an underdiagnosed entity affecting children and adults from different parts of the world, with moderate-to-severe symptoms, impairment of quality of life and rapid progression to symptom worsening. LAR is a stable phenotype and not merely an initial state of AR. Allergic rhinitis and LAR share many clinical features including a positive NAPT response, markers of type 2 nasal inflammation including sIgE in nasal secretions and a significant rate of asthma development. LAR should be considered as a differential diagnosis in those subjects of any age with symptoms suggestive of AR but no evidence of systemic atopy. Although LAR pathophysiology is partially unknown, 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 rhinitis phenotypes, especially AR. The diagnosis currently relies on the positivity of NAPT to a single or multiple allergens. NAPT has high sensitivity, specificity and reproducibility, and it is considered the gold standard. BAT and the measurement of nasal sIgE can also contribute to LAR diagnosis. LAR patients benefit from the same therapeutic strategies than AR individuals, including the avoidance of allergen exposure and the pharmacotherapy. Moreover, several recent studies support the effectiveness and safety of allergen immunotherapy for LAR, which opens a window of treatment opportunity in these patients.
机译：没有通过皮肤刺试验和血清过敏原特异性IgE（SiGe）对鼻过敏原挑衅试验（NAPT）测试的鼻炎患者鼻炎患者没有全身IgE致敏的鼻炎患者。这种疾病表型已被称为局部过敏性鼻炎（LAR）。 LAR是一种影响来自世界不同地区的儿童和成人的下常的实体，具有中度至严重的症状，生活质量损害以及症状恶化的快速进展。 Lar是一种稳定的表型，而不仅仅是AR的初始状态。过敏性鼻炎和大量患有许多临床特征，包括阳性乳腺反应，2型鼻炎的标记，包括鼻分泌物中的SiGe和哮喘发育的显着速率。应被视为任何年龄的受试者的差异诊断，症状暗示AR，但没有系统性地的证据。虽然LAS病理生理学部分是未知的，但在一些患者中，SIGE可以直接在鼻分泌物中和/或通过嗜碱性激活试验（BAT）中的正反应间接地进行。可以与其他鼻炎表型，尤其是AR共存。目前依赖于NAPT对单一或多个过敏原的阳性。 NAPT具有很高的灵敏度，特异性和可重复性，并且被认为是黄金标准。蝙蝠和鼻SiGe的测量也可以有助于诊断。患者受益于比AR个人相同的治疗策略，包括避免过敏原暴露和药物治疗。此外，最近的几项研究支持过敏原免疫疗法的有效性和安全性，这在这些患者中打开了一个治疗机会的窗口。

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    Campo P.; Eguiluz-Gracia I.; Bogas G.; Salas M.; Plaza Seron C.; Perez N.; Mayorga C.; Torres M. J.; Shamji M. H.; Rondon C.;

  • 作者单位

    UMA Hosp Reg Univ Malaga IBIMA Allergy Unit Malaga Spain;

    UMA Hosp Reg Univ Malaga IBIMA Allergy Unit Malaga Spain;

    UMA Hosp Reg Univ Malaga IBIMA Allergy Unit Malaga Spain;

    UMA Hosp Reg Univ Malaga IBIMA Allergy Unit Malaga Spain;

    UMA Hosp Reg Univ Malaga Allergy Unit Res Lab Malaga Spain;

    UMA Hosp Reg Univ Malaga IBIMA Allergy Unit Malaga Spain;

    UMA Hosp Reg Univ Malaga Allergy Unit Res Lab Malaga Spain;

    UMA Hosp Reg Univ Malaga IBIMA Allergy Unit Malaga Spain;

    Imperial Coll London Immunomodulat &

    Tolerance Grp Allergy &

    Clin Immunol Inflammat Repair &

    Dev;

    UMA Hosp Reg Univ Malaga IBIMA Allergy Unit Malaga Spain;

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  • 正文语种 eng
  • 中图分类 医学免疫学;
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