Allergen Immunotherapy for Local Respiratory Allergy
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RHINOSINUSITIS (J MULLOL, SECTION EDITOR)
Allergen Immunotherapy for Local Respiratory Allergy I. Eguiluz-Gracia 1 & A. Ariza 2 & A. Testera-Montes 1 & C. Rondón 1 & P. Campo 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Reviesw Local respiratory allergy (LRA) is an eosinophilic phenotype of chronic airway disease. Three entities have been described within the LRA spectrum: local allergic rhinitis (LAR) and local allergic asthma (LAA) in non-atopic patients, and dual allergic rhinitis (DAR) in atopic patients (coexistence of LAR and allergic rhinitis). In this article, we aim to review the current evidence on the therapeutic options for LRA. Recent Findings No controlled study has assessed the effect of standard therapy (oral antihistamines, intranasal or inhaled corticosteroids, bronchodilators) in LRA subjects. Three randomized clinical trials and one observational study demonstrated that allergen immunotherapy (AIT) is able to control nasal and ocular symptoms, decrease the need for rescue medication, and improve quality of life in LAR individuals. Summary Nasal or inhaled steroids can be expected to improve eosinophilic inflammation in LRA patients but cannot change the natural course of the disease. Moreover, the long-term and disease-modifying effects of AIT in LRA subjects need to be investigated. Keywords Allergen immunotherapy . Dual allergic rhinitis . Endophenotypes . Local allergic asthma . Local allergic rhinitis . Local respiratory allergy
Introduction Chronic rhinitis is an inflammatory disease of the nasal mucosa affecting > 30% of the Western population [1•]. The condition is responsible for a significant burden on the health systems in terms of both direct and indirect costs [1•]. Moreover, chronic rhinitis is associated with other inflammatory diseases of the respiratory mucosa, further amplifying its impact [2]. Nevertheless, the condition has been historically trivialized, and only in recent years, it has gained significant attention from physicians and researchers. Chronic rhinitis has been classically divided into the allergic rhinitis (AR) and the non-allergic rhinitis (NAR) phenotypes [1•, 3]. AR patients are defined by the positivity of skin prick test (SPT) and/or serum allergen-specific (s)IgE [4]. This article is part of the Topical Collection on Rhinosinusitis
Conversely, the negativity of both classical markers of atopy identifies NAR individuals [5•]. Nevertheless, several evidences indicate the existence of a new allergic phenotype of rhinitis in non-atopic patients who display nasal-specific reactivity to aeroallergens. This phenotype has been termed local allergic rhinitis (LAR) [6], and the diagnosis requires the implementation of the nasal allergen challenge (NAC) in the clinical algorithms for rhinitis [7••]. To complicate further the field, recent evidence suggests that nasal reactivity to aeroallergens with and without positive SPT can coexist in the same patient [8••]. The endotype guides treatment options in rhinitis [1•]. A
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