Value of allergen nasal provocation test in assessment of the efficacy of house dust mites specific immunotherapy / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the value of nasal provocation test（NPT） in evaluating the efficacy of allergen immunotherapy（AIT） in patients with dust mite induced allergic rhinitis（AR）. Methods:A total of 83 patients with dust mite induced AR with/without asthma were included. Symptom score（SS）, daily medication score（DMS）, combined symptom and medication score（CSMS）, rhinoconjunctivitis quality of life questionnaire（RQLQ）, NPT and skin prick test（SPT） were assessed before and after 1 year AIT. Results:There were statistical differences in SS（P<0.000 1）, DMS（P<0.000 1）, CSMS（P<0.000 1）, and RQLQ（P<0.000 1） after 1 year of AIT compared with pre-treatment. The effective rate of CSMS was 73.49%, and the effective rate of NPT was 42.17%. CSMS was consistent with NPT in efficacy assessment（Kappa=0.437, P<0.001）; while in 54 patients with pre-treatment NPT concentrations other than the original concentration, CMSM and NPT showed better consistence（Kappa=0.895, P<0.001）. Among the 48 patients with ineffective NPT assessment in the first year, 25 patients completed the second-year follow-up, and 12 patients（48.00%） showed effective in NPT. However, 10 out of 12 patients（83.33%） with NPT concentration other than original solution pre-treatment showed effective NPT at the second year. Conclusion:NPT can be used as one of the indicators for efficacy evaluation for dust mite induced AR patients, especially for patients with positive NPT induced at lower concentrations before treatment.

Evaluation of subjective scale in allergen nasal provocation test / 临床耳鼻咽喉头颈外科杂志

Objective:To compare the clinical value of visual analogue scale （VAS）, Lebel scale and total nasal symptom scores （TNSS） in evaluating nasal allergen provocation test （NAPT）. Methods:A total of 151 patients suspected of allergic rhinitis admitted to the Department of Otolaryngology-Head and Neck Surgery of our hospital from April 2020 to September 2020 were included, of which 76 were positive for house dust mites and 75 were negative for allergens. Nasal airway resistance（NAR） was measured by active anterior nasal manometry. Nasal symptoms were evaluated by VAS, Lebel and TNSS. House dust mite allergen was used for NAPT by spray method. An increase≥40% in NAR was used as the gold standard for objective evaluation of NAPT. ROC curves of VAS, Lebel and TNSS were drawn to compare the evaluation effectiveness of different subjective evaluation methods, and the optimal critical point of each ROC curve was obtained. Results:With NAR increased by ≥40% as the gold standard, the area under ROC curve of VAS was 0.884, and the sensitivity and specificity were 97.75% and 80.65%, respectively. The area under ROC curve of Lebel was 0.773, and the sensitivity and specificity were 68.54% and 75.81%, respectively. The area under ROC curve of TNSS was 0.792, and the sensitivity and specificity were 68.54% and 79.03%, respectively. There was no significant difference between Lebel and TNSS（P>0.05）. The VAS differed significantly from Lebel and TNSS（P<0.05）. The Kappa values of VAS, Lebel, TNSS and NAR were 0.803, 0.432 and 0.459, respectively. Conclusion:The VAS, Lebel, TNSS subjective scale and NAR are consistent in evaluating the efficacy of NAPT, with the VAS assessment showing highest consistency with NAR. As objective assessment instruments are not widely used in China, subjective assessment method could be adopted to evaluate the efficacy of NAPT in clinical practice, and VAS scale is recommended as a priority.

Research progress and clinical application of allergen nasal provocation test / 临床耳鼻咽喉头颈外科杂志

The allergen nasal provocation testing（NPT）, in which allergens are applied directly to the nasal mucosa under standard and controlled conditions to provoke the main symptoms of allergic rhinitis（AR）, reproduces the response of the upper respiratory tract to natural exposure to allergens under controlled conditions and is the only test currently available to confirm nasal reactivity to allergens. It is invaluable in studying the mechanisms of AR and in assessing the response to novel anti-allergic treatments. The test may play an increasingly important role in clinical practice, especially in the identification of local AR, the diagnosis of occupational AR, the clarification of the composition of allergens, the assessment of the efficacy of AR treatment and the selection of candidates undergoing allergen immunotherapy. This article reviewed the application of NPT in the diagnosis of allergic and non-allergic rhinitis, and also introduces the indications, contraindications, advantages and limitations of NPT in evaluating nasal response.

Rinite alérgica persistente com elevada sensibilização a pólen de gramíneas: a medicina personalizada pode identificar os verdadeiros alérgicos a polens na imunoterapia / Persistent allergic rhinitis with high sensitization to grass pollen: personalized medicine can identify immunotherapy patients who are truly allergic to pollen

Este trabalho teve como objetivo avaliar pacientes com rinite alérgica persistente, sensibilizados a ácaros domésticos, associado à elevada sensibilização por pólen de gramíneas, sem sintomatologia estacional. Usou-se como método o diagnóstico molecular por componentes para selecionar os verdadeiramente alérgicos ao pólen de gramíneas. Foi realizado um estudo retrospectivo com análise de prontuários de pacientes em áreas de Caxias do Sul e municípios próximos no estado do RS, nos anos de 2016 e 2017, com as mesmas características climáticas. Foram selecionados 50 pacientes com alergia a ácaros, através de teste de punctura (pápula > 5 mm) associado ao pólen de gramíneas (pápula de > 7 mm) sem sintomatologia na primavera. Um total de 52% era do sexo feminino, a idade variou entre 4 e 56 anos, com uma média de 26,6 anos. Pesquisou-se a dosagem de IgE específica no soro para antígenos moleculares de pólen de gramíneas como estes: Phl p1, Phl p5, Cyn d1, em todos os pacientes. Houve 13 pacientes (26%) com diagnóstico, pelo menos, a um dos antígenos moleculares estudados. A amostra restringida apresentou 5 (10%) deles que possuíam Phl p5 > Phl p1, ou seja, eram verdadeiramente alérgicos à subfamília Poideae, enquanto 2 (4%) apresentaram Cyn d1 (subfamília Chloridoideae) > Phl p1. O estudo mostra que, em pacientes com rinite alérgica persistente, polissensibilizados a ácaros associados a pólen de gramíneas, sem sintomas estacionais característicos, os testes moleculares podem diagnosticar os verdadeiros alérgicos ao pólen.

This study aimed to evaluate patients with persistent allergic rhinitis who are sensitized to house mites and have high sensitization to grass pollen without seasonal symptoms. Molecular diagnosis was used to determine patients truly allergic to grass pollen. This retrospective study analyzed the medical records of patients from areas of Caxias do Sul and nearby municipalities (all with the same climatic characteristics) in the state of Rio Grande do Sul, Brazil between 2016 and 2017. Fifty patients allergic to dust mites were selected through a prick test (papule > 5 mm) and grass pollen (papule > 7 mm), but were asymptomatic in the spring. A total of 52% were female, and their ages ranged from 4 to 56 (mean 26.6) years. Specific serum IgE levels for grass pollen antigens, such as Phl p1, Phl p5, and Cyn d1, were investigated in all patients. Thirteen patients (26%) were diagnosed with at least one studied molecular antigen. The restricted sample included 5 (10%) patients with Phl p5 > Phl p1, ie, truly allergic to the Pooideae subfamily, while 2 (4%) had Cyn d1 (Chloridoideae subfamily) > Phl p1. The results indicate that among patients with persistent allergic rhinitis polysensitized to mites and grass pollen but without characteristic seasonal symptoms, molecular tests can diagnose those who are truly allergic to pollen.

Paradoxical Response to Cold Dry Air Provocation according to the Season in Allergic Rhinitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We investigated the seasonal variation of nonspecific hyperreactivity by performing the cold dry air (CDA) provocation test in both summer and winter in patients with rhinitis. SUBJECTS AND METHOD: We performed the CDA provocation test in 57 patients with allergic rhinitis (AR) or non-allergic rhinitis (NAR). Depending on the season and the type of rhinitis, we divided patients into four groups (Summer AR group, n=17; Winter AR group, n=15; Summer NAR group, n=18 and Winter NAR group, n=7) and compared the changes in nasal symptoms, total nasal volume (TNV), and minimal cross-sectional area (MCA) measured by acoustic rhinometry after CDA provocation in each group. RESULTS: When the CDA provocation was performed for AR patients in summer, nasal symptoms improved slightly, which was significantly different from those shown in winter (Summer AR vs. Winter AR, p=0.012). In addition, there was a significant difference in symptom change between AR and NAR patients in the summer (Summer AR vs. Summer NAR, p=0.033). There was no significant difference in TNV or MCA changes after CDA provocation depending on the type of rhinitis and season (p>0.05). CONCLUSION: When performing CDA provocation in AR patients in summer, the examiner should pay attention to the possible paradoxical response.

Provocation test with 5% glycerol has fast and fleeting effects on the nasal mucosa / Teste de provocação com glicerol 5%: efeito rápido e fugaz na mucosa nasal

The effects observed with nasal provocation testing using 5% glycerol were associated only with irritation/burning sensation within the first few minutes, reducing spontaneously and disappearing quickly. The use of 5% glycerol was found to have no influence on the prevalence of nasal obstruction, rhinorrhea, sneezing and nasal/ocular itching obtained through summing symptoms, as evaluated in different nasal provocation tests, after 15-20 minutes. Overall, dilution with 5% glycerol did not change the final score for symptoms during nasal provocation testing.

Os efeitos observados com glicerol a 5% na provocação nasal foram associados unicamente a irritação e sensação de prurido nos primeiros minutos, cedendo espontaneamente e desaparecendo rapidamente. O uso de glicerol a 5% não influenciou a prevalência de obstrução nasal, rinorreia, espirros e prurido nasal e ocular obtidos na soma dos sintomas, quando avaliado em diferentes testes de provocação nasal específica, após 15-20 minutos. Tomada em conjunto, essa diluição com glicerol a 5% não altera a pontuação final dos sintomas durante a provocação nasal.

Usefulness of House Dust Mite Nasal Provocation Test in Asthma

PURPOSE: We previously reported that the skin prick test was sensitive and the serum specific immunoglobulin E test was specific for predicting positive airway responses to house dust mites (HDMs) in patients with asthma. Because the nose and bronchus are one airway, the nasal provocation test would be more specific for predicting the bronchial responses to HDM than the skin test. METHODS: The allergy skin prick test and nasal and bronchial provocation tests using HDM (Dermatophagoides farinae) were performed in 41 young men (age, 19–28 years) who wanted military certification for asthma. The nasal responses to HDM was scored according to the severity of rhinorrhea, sneezing, and nose itching. RESULTS: The prevalence of a positive skin prick test to HDM did not significantly differ between patients with (n=24) and without (n=17) an early airway reaction (EAR; 79.2% vs 70.6%, P=0.534). However, the prevalence of a positive nasal test was significantly higher in the airway responders than in the others (37.5% vs 0%, P=0.005). The concordance of a positive response to the nasal test (κ=0.332, P=0.004) but not to the skin prick test (κ=0.091, P=0.529) was significant with an EAR. The diagnostic sensitivity of the nasal test (37.5%) was lower than that of the skin prick test (79.2%), but the specificity was higher (100% vs 29.4%). CONCLUSIONS: The skin prick test is more sensitive, whereas the nasal test is more specific and accurate, for predicting an EAR to HDM in patients with asthma.

Prevalence and Clinical Characteristics of Local Allergic Rhinitis to House Dust Mites

Local allergic rhinitis (LAR) is a localized nasal allergic response in the absence of systemic atopy. The aim of this study was to evaluate the prevalence and clinical characteristics of LAR in Korean rhinitis patients compared to allergic rhinitis (AR) and non-allergic rhinitis (NAR). A total of 304 rhinitis patients were enrolled from November 2014 to March 2016. A skin prick test, serum total and specific immunoglobulin E, and a nasal provocation test (NPT) with house dust mite (HDM) were performed on all patients. Subjects also documented changes in rhinitis symptoms before and after NPT. Seventy-four patients with nasal hyper-reactivity and 80 patients with subclinical allergy were excluded. AR was diagnosed in 69 (46.0%) patients, NAR in 75 (50.0%) patients, and LAR to HDM in 6 (4.0%) patients. The average medication score and disease duration of each group were 14.5 points and 77.6 months in AR, 12.1 point and 51.1 months in NAR, and 17.7 point and 106.0 months in LAR, respectively. There were no significant differences in the baseline nasal symptom score of the three groups. However, after NPT with HDM, the score of rhinitis, itching, and obstructive were 4.83±1.47 vs. 1.95±2.53, 3.00±2.10 vs. 1.45±2.06, and 5.50±1.38 vs. 2.57±2.84 in LAR and NAR, respectively (p<0.05). LAR patients had longer duration of disease and tended to be older and have higher medication score than other rhinitis patients.

Usefulness of Allerkin House Dust Mite Extract for Nasal Provocation Testing

OBJECTIVES: We evaluated the clinical usefulness of Allerkin (Lofarma) for nasal provocation testing (NPT) in patients with rhinitis symptoms, by examining changes in nasal symptoms and acoustic parameters after exposure to house dust mite (HDM) extract. METHODS: Twenty patients (16 males and 4 females, mean age: 29.6±14.6 years) were enrolled. We performed skin prick test (SPT) before and 15 and 30 minutes after intranasal challenge with Allerkin HDM extract, and we evaluated symptom changes (nasal obstruction, rhinorrhea, sneezing, and itching) using a visual analogue scale. We also evaluated changes in acoustic parameters such as total nasal volume (TNV) and minimal cross-sectional area (MCA) before and after challenge. RESULTS: Group A (the nonallergic group, n=8) showed negative results for all tested aeroallergens in SPT and nonprovocative results ( 29% decrease in TNV/MCA from the baseline value). Patients in group C showed significant aggravation of nasal obstruction compared to those in group A (P < 0.05). Thirty minutes after HDM challenge, patients in groups B and C showed significantly greater decreases in MCA compared to those in group A (P < 0.01). CONCLUSION: Allerkin HDM extract can be a useful provocative agent in NPT for diagnosing allergic rhinitis and local allergic rhinitis.

Clinical Practice Guideline for Physicians on Allergic Rhinitis / 대한내과학회지

Recently, the rhinitis work group of the Korean Academy of Asthma, Allergy and Clinical Immunology developed a practice guideline on allergic rhinitis. The group consisted of physicians, pediatricians, and otolaryngologists. Here, the guideline is adapted for clarity and for ease of use by physicians. To manage allergic rhinitis well, accurate diagnosis is most important. In patients with rhinitis symptoms, the first step is to perform a skin prick test to inhalant allergens, and/or to measure allergen-specific immunoglobulin E in serum. Next, allergic rhinitis should be diagnosed upon documenting the association between positive allergens and rhinitis symptoms, via patient history or allergen nasal provocation test. Allergic rhinitis should be differentiated from non-allergic rhinitis, because treatment modalities differ between the two. Allergic rhinitis should be effectively managed with allergen avoidance, pharmacotherapy, allergen immunotherapy, surgical treatment, and/or saline irrigation. Second-generation antihistamines or leukotriene modifiers may be used for mild-to-moderate forms, and intranasal steroids may be effective for moderate-to-severe forms. Allergic rhinitis is closely associated with asthma. Spirometry should be performed initially for asthma diagnosis, if asthma-like symptoms are present.

Efficacy of Nasal Cellulose Powder in the Symptomatic Treatment of Allergic Rhinitis: A Randomized, Double-Blind, Placebo-Controlled Trial

PURPOSE: Nasal Cellulose Powder (NCP), which can prevent from binding an allergen to nasal mucosa, may reduce allergic rhinitis (AR) symptoms in dust mite-sensitized children. This study was conducted to assess the efficacy of NCP in improving clinical symptoms of a nasal airflow limitation and the response of nasal inflammatory cells. METHODS: Children with dust mite-sensitized AR aged 6–18 years were recruited. After a 4-week run-in period, NCP or a placebo was administered, 1 puff per nostril 3 times daily for 4 weeks. The nasal provocation test (NPT) with Dermatophagoides pteronyssinus (Der p) was performed before and after treatment. The daily symptom scores (DSS), daily medication scores (DMS), the peak nasal inspiratory flows (PNIF), nasal airway resistance (NAR), as well as the maximum tolerated dose of NPT and eosinophil counts in nasal scraping, were evaluated. RESULTS: Sixty children (30 NCP and 30 placebos) were enrolled. Before treatment, there were no significant differences in age, dust mite control measures, DSS, DMS, PNIF, NAR, the maximum tolerated dose of NPT, or nasal eosinophil scores between children receiving NCP and placebos. After treatment, there were no significant differences between the NCP and placebo groups in the median (range) of the outcomes—DSS: 2.06 (0.18–3.77) vs. 1.79 (0.08–7.79), P=0.756; DMS: 1.60 (0–5.13) vs. 0.56 (0–4.84), P=0.239; PNIF (L/min): 110 (60–160) vs. 100 (50–180), P=0.870; NAR (Pa/cm³/s): 0.40 (0.20–0.97) vs. 0.39 (0.24–1.32), P=0.690; the maximum tolerated dose of NPT and the nasal eosinophil scores: 1 (0–4) vs. 1 (0–4), P=0.861. CONCLUSIONS: NCP treatment may not be more effective than placebo treatment in dust mite-sensitized AR children.

Evidences for Local Allergic Rhinitis

Local allergic rhinitis is defined as a localized allergic reaction of the nasal mucosa in the absence of systemic atopy. Its main pathophysiological mechanism can be summarized as: 1) increased specific immunoglobulin E in the nasal fluid, and 2) Th2 allergic mechanism localized in the nasal mucosa. In patients whose result of a skin prick test is totally negative for all antigens, practitioners could diagnose local allergic rhinitis using a nasal provocation test. Oral antihistamines and intranasal steroids can be an effective treatment. Subcutaneous immunotherapy can also be helpful. Further study is essential to further elucidate the detailed pathophysiologic mechanism and set up global standard diagnostic criteria.

Detection of Allergen Specific Antibodies From Nasal Secretion of Allergic Rhinitis Patients

PURPOSE: Allergic rhinitis (AR) is a common and increasing disease in which Dermatophagoides (D.) farinae is one of the most common causative allergens. The aims of this study were to confirm the presence of locally produced antibodies to D. farinae in nasal secretions between nasal provocation test (NPT)-positive and -negative groups of AR patients, to evaluate their relationships with the levels of inflammatory mediators, and to determine adaptive and innate immune responses in nasal mucosa. METHODS: Sixty AR patients sensitive to house dust mites confirmed by skin prick test or serum specific IgE to D. farinae underwent NPT for D. farinae. Nasal packs were placed in both nasal cavities of the patients for 5 minutes to obtain nasal secretions after NPT. The levels of total IgE, specific IgE to D. farinae, eosinophil cationic protein (ECP), and tryptase in nasal secretions were detected by using ImmunoCAP. The levels of specific IgE, IgA, and secretory IgA antibodies to D. farinae in nasal secretions were measured by using ELISA. The levels of IL-8, VEGF, IL-25, and IL-33 were also measured by using ELISA. RESULTS: High levels of total IgE, specific IgE, specific IgA, and secretory IgA to D. farinae, as well as inflammatory mediators, such as ECP, IL-8, VEGF and tryptase, were detected in nasal secretions, although the differences were not statistically significant between the NPT-positive and NPT-negative groups. Levels of all immunoglobulins measured in this study significantly correlated with ECP, IL-8, and VEGF (P0.05). IL-33 and IL-25 were also detected, and IL-25 level significantly correlated with IL-8 (r=0.625, P<0.001). CONCLUSIONS: These findings confirmed the presence of locally produced specific antibodies, including D. farinae-specific IgE and IgA, in nasal secretions collected from D. farinae-sensitive AR patients in both the NPT-positive and NPT-negative groups, and close correlations were noted between antibodies and nasal inflammatory mediators, including such as ECP, IL-8 and VEGF, indicating that locally produced antibodies may be involved in the nasal inflammation of AR.

Instrumentos objetivos tradicionais de avaliação respiratória em respiradores orais / Traditional instruments objectives of respiratory evaluation in mouth breathers

A obstrução nasal é uma das principais anormalidades que afetam a permeabilidade nasal (PN) e em consequência está associada à respiração oral. Considerando a importância das complicações respiratórias e sua relação com o mecanismo de obstrução nasal, ressalta-se a necessidade e importância desse tipo de avaliação na população pediátrica e adulta. Objetivo: apresentar uma atualização da literatura quanto aos instrumentos objetivos para avaliação da permeabilidade das vias aéreas superiores e sua aplicabilidade na avaliação respiratória de indivíduos RO. Síntese dos dados: a revisão bibliográfica foi realizada utilizando as palavras-chaves: mouth breathing, nasal obstruction, nasal patency evaluation e instrumentos objetivos tradicionais da permeabilidade das vias aéreas: rhinomanometry, sniff nasal inspiratory pressure nasal peak flow, acoustic rhinometry, rhinomanometry e nasal spirometry. Uma síntese dos trabalhos foi organizada apresentando os instrumentos objetivos mais tradicionais encontrados na literatura. Com base nos estudos selecionados, discutiu-se sobre a indicação destes recursos na avaliação da permeabilidade de vias aéreas superiores. Conclusões: a avaliação respiratória objetiva de RO pode ser realizada por diferentes instrumentos tradicionais, utilizados tanto na avaliação, diagnóstico e identificação de efeitos de intervenções de RO.

Clinical efficacy and safety of rush immunotherapy in patients with allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of rush immunotherapy (RIT) for patients with persistent allergic rhinitis (AR).</p><p><b>METHODS</b>In this study, a total number of thirty three (33) patients who suffered mite allergic rhinitis were included. These patients completed one year subcutaneous immunotherapy (SCIT). Using RIT, the patients underwent the incremental dose phase in a week instead of 15 weeks in a conventional treatment procedure. The symptom scores, visual analog scale (VAS), appropriate medication score, total blood serum IgE, dermatophagoides pteronyssinus specificity IgG4, mite allergy skin prick test (SPT), dermatophagoides farinae nasal provocation test (NPT) and the incidence of adverse reactions were used to evaluate the efficiency and safety of RIT.</p><p><b>RESULTS</b>After one year SCIT treatment, the symptom score and VAS scores were significantly decreased, the corresponding medication usage was significantly reduced (8.91 ± 1.84, 20.64 ± 6.99 vs. 4.97 ± 2.92, 11.94 ± 7.21, t value was 9.15, 7.11, both P < 0.001) and the cutaneous reactions to mite allergen were significantly decreased (P < 0.001) as well. However, dermatophagoides pteronyssinus-specific serum IgG4 increased significantly (Z = -4.517, P < 0.001). The concentration of dermatophagoides farinae nasal provocation test (NPT) was significantly increased. After the treatment, the number of patients who had positive reactions to high concentration nasal provocation test (NPT) increased (χ² = 1.93, P = 0.38). During the treatment, all the patients experienced local reactions, and specifically there were four patients got general reactions.</p><p><b>CONCLUSION</b>RIT is safe and effective. It shortened the incremental dose phase remarkably. NPT is a good indicator for diagnosing allergic rhinitis and evaluating the efficacy of the treatment.</p>

The Current Knowledge of Allergen Nasal Provocation Test

Nasal provocation test (NPT) is a procedure used to evaluate the hyper-responsiveness of nasal mucosa after exposure to a provocative allergen. We aimed to identify the clinical indication and contra-indication for the use of NPT, and to introduce the actual NPT laboratory protocol in our clinical practice. We also provide clinical information which could be useful in conducting NPT. Finally, we discuss the current limitations of NPT and present a plan to overcome these difficulties.

Diagnosis of Allergic Rhinitis / 대한내과학회지

Rhinitis is divided into allergic and non-allergic rhinitis. Non-allergic rhinitis includes inflammatory rhinitis, such as non-allergic rhinitis with eosinophilia syndrome (NARES) and infective rhinitis, and non-inflammatory rhinitis, such as vasomotor rhinitis and idiopathic rhinitis. Allergic rhinitis is diagnosed based on the presence of allergen-specific IgE and the documentation of relationship between the allergen and symptoms in patients with typical rhinitis symptoms, such as rhinorrhea, nasal obstruction, itchiness and/or sneezing. Local allergic rhinitis can be considered for differential diagnosis. Allergic rhinitis should be differentiated from non-allergic rhinitis by using skin prick test, serum specific IgE test, nasal cytology and/or allergen nasal provocation test. Allergic rhinitis should be differentiated from structural nasal diseases, such as septal deviation and nasal polyps. Rhinitis is frequently accompanied by paranasal sinusitis, which should be recognized in clinical practice. Management strategies differ between allergic and nonallergic rhinitis. In addition to pharmacotherapy, allergen avoidance and allergen-specific immunotherapy can be tried in patients with allergic rhinitis. Thus, the exact diagnosis is very important for the effective treatment in allergic rhinitis. The diagnostic tests for allergic rhinitis are reviewed.

Diagnosis of Allergic Rhinitis / 대한내과학회지

Rhinitis is divided into allergic and non-allergic rhinitis. Non-allergic rhinitis includes inflammatory rhinitis, such as non-allergic rhinitis with eosinophilia syndrome (NARES) and infective rhinitis, and non-inflammatory rhinitis, such as vasomotor rhinitis and idiopathic rhinitis. Allergic rhinitis is diagnosed based on the presence of allergen-specific IgE and the documentation of relationship between the allergen and symptoms in patients with typical rhinitis symptoms, such as rhinorrhea, nasal obstruction, itchiness and/or sneezing. Local allergic rhinitis can be considered for differential diagnosis. Allergic rhinitis should be differentiated from non-allergic rhinitis by using skin prick test, serum specific IgE test, nasal cytology and/or allergen nasal provocation test. Allergic rhinitis should be differentiated from structural nasal diseases, such as septal deviation and nasal polyps. Rhinitis is frequently accompanied by paranasal sinusitis, which should be recognized in clinical practice. Management strategies differ between allergic and nonallergic rhinitis. In addition to pharmacotherapy, allergen avoidance and allergen-specific immunotherapy can be tried in patients with allergic rhinitis. Thus, the exact diagnosis is very important for the effective treatment in allergic rhinitis. The diagnostic tests for allergic rhinitis are reviewed.

Recent update of local allergic rhinitis

Rhinitis is a common airway disease that can affect patient's quality of life and social activities. Rhinitis comprises heterogenous diseases and classified as allergic rhinitis (AR) or nonallergic rhinitis (NAR) based on the clinical history, skin prick test, and serum-specific IgE to aeroallergens. It is important to differentiate between AR and NAR, as management differs for each. However, classification of NAR is controversial and the specific mechanisms responsible for NAR remain unclear. Recently, the entopy of local allergic rhinitis (LAR) has been raised if positive response to nasal provocation test, and elevated specific IgE and inflammatory mediators such as tryptase and eosinophilic cationic peptide in the nasal lavage fluids are shown in patients with NAR. About 47-62.5% of patients previously diagnosed with NAR actually have LAR. LAR shares similar nasal symptoms with AR, such as itching, sneezing, rhinorrhea, and nasal obstruction. LAR shows a good response to nasal corticosteroids and oral antihistamines. However, its natural history and role of immunotherapy need to be elucidated.