post-title Localized Allergic Rhinitis 2012-07-24 13:37:28 yes no Posted by

Localized Allergic Rhinitis

By Midwest Allergy Physician Deborah Ortega-Carr, M.D. How can my tests be negative if I have severe symptoms during grass season? On occasion, a patient will present with seasonal nasal congestion and  sneezing but skin and intradermal  skin testing will be negative.  These patients are typically diagnosed with nonallergic rhinitis or irritant or vasomotor rhinnits.  […]

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By Midwest Allergy Physician
Deborah Ortega-Carr, M.D.

How can my tests be negative if I have severe symptoms during grass season?

On occasion, a patient will present with seasonal nasal congestion and  sneezing but skin and intradermal  skin testing will be negative.  These patients are typically diagnosed with nonallergic rhinitis or irritant or vasomotor rhinnits.  Doctors  often treat these patients with the same medications used to treat allergic rhinitis with mixed results.   Now  researchers believe that  47-62 %  of these patients may actually have  local allergic rhinitis.  Local allergic rhinitis may be due to localized production of localized serum specific IgE, the antibodies  responsible for most of the allergic rhinitis symptoms. These patients may respond to a nasal allergen provocation test, meaning that allergen is sprayed into the patients nose as a challenge, then measurements of the reaction are taken afterward.  Some researchers are able to used specialized tests to measure the sIgE in nasal secretions to identify allergens.  The most common allergens to date have been dust mite and olive tree pollen but mold and other common allergens are certainly of interest to researchers. Recent studies have also shown that 27% these patients will eventually have positive skin tests but many do not.  Given that local allergic rhinitis occurs in later in life in many individuals, researchers question whether these patients will continue to become more “allergic” as time goes on.

allergy columbus ohFinally, treatment options for these patients may be broadened to include environmental control and possibly immunotherapy.  Research into new forms of localized immunotherapy (allergens in your nose) may even be considered in the future.

Carmen Rondon MD,PHD, Paloma Campo, MD PHD, Alkis Togias MD PHD, Wytske Fokkens MD PHD, Stephan Durham MD PHD, Desmond Powe PHD, Joaquim Mollol MD PHD, Miguel Blanca MD PHD, J Allergy Clin Immunol  June 2012

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