La rinitis alérgica local es una entidad prevalente inducida por alérgenos inhalados estacionales y perennes / Local allergic rhinitis is a prevalent entity induced by seasonal and perennial inhalant allergens

La rinitis alérgica local (RAL) es un nuevo fenotipo de rinitis con producción nasal de anticuerpos IgE específicos en ausencia de atopia sistémica que puede afectar a sujetos previamente diagnosticados de rinitis no alérgica y rinitis idiopática. Esta nueva entidad se caracteriza por la existencia de síntomas clínicos sugestivos de rinitis alérgica, producción local de IgE específica y presencia de un patrón inflamatorio Th2 en la mucosa nasal durante la exposición natural, así como tras la prueba de provocación nasal con alérgenos con producción local de IgE específica, triptasa y proteína catiónica de eosinófilos (ECP). La existencia de esta nueva entidad hace necesaria la realización de un diagnóstico alergológico preciso en pacientes con síntomas sugestivos de rinitis alérgicas cuando el prick test y la determinación de IgE específica sérica sean negativos. La detección local de anticuerpos IgE específicos en las secreciones nasales durante la exposición natural a aeroalérgenos y la respuesta positiva a la prueba de provocación nasal con aeroalérgenos con producción local de triptasa, ECP e IgE específica han demostrado ser una aproximación adecuada para detectar pacientes con RAL.

evaluation of new classification of allergic rhinitis in patients referred to a clinic in the city of Shiraz

Allergic rhinitis is the most common cause of allergic diseases. The recent guidelines of Allergic Rhinitis and its Impact on Asthma [ARIA] group, classified it to intermittent [less than 4 days per week and for less than 4 weeks] and persistent [more than 4 days per week or lasting more than 4 weeks regardless of the number of days per week]. The present study evaluates the patients with ARIA classification. The patients referred to Motahhari Clinic [Shiraz, Iran] were evaluated. Age, sex, seasonal or perennial, intermittent or persistent type, duration, sneezer or blocker, diurnal change and presence of allergic conjunctivitis were recorded. The patients who had one or more symptoms of; impairment of sleep, daily activity or work in school or troublesome symptoms had moderate to severe disease and those who did not have these problems have mild disease. The information of 96 patients [46 male and 50 female] were analysed [mean age +/- SD: 24.45 +/- 10.37 years]. The mean duration of disease was 4.26 +/- 4.12 years, was more in female [P<0.05]. Seasonal allergic rhinitis was presentxin 49 [52%] patients; 30 male, 19 female [P=0.007], perennial in 15 [16%], 1 male, 14 female and mixed type in 29 [30%]; 11 male, 18 female. Mild intermittent rhinitis was diagnosed in only 2 [2%] patients, 1 male and 1 female, mild persistent rhinitis in 23 [24%]; male 11, female 12; moderate/severe intermittent rhinitis in 4 [4%]; 3 male, 1 female; and moderate/severe persistent rhinitis in 56 [58%]; 22 male, 34 female [P<0.05]. Fifty-seven percent were more sneezer and 36% were more blocker type, sneezers suffered more in days and others more at nights. Others were both sneezer and blocker. Sixty percent had allergic conjunctivitis too, 76% of them were moderate/severe persistent, and 85% were in seasonal or mixed groups. Eleven patients [12%], in persistent group, had history of asthma. Family history of allergic rhinitis and asthma was found in 53% and 25% of patients, respectively. According to new guidelines for classification of allergic rhinitis, most of the patients are moderate to severe types. The classification of allergic rhinitis to seasonal and perennial disease is not proportional to intermittent and persistent types of classification