Seasonal idiopathic rhinitis with local inflammatory response and specific IgE in absence of systemic response
Open accessAbstract
Background: Patients with idiopathic rhinitis (IR) are considered to be nonallergic because they have a negative skin prick test (SPT) and allergen specific‐IgE in serum. The concept of localized mucosal allergy in the absence of atopy has recently been proposed. The immunological mechanisms involved in seasonal IR have not been sufficiently studied. We examined nasal mucosa inflammation, the presence of nasal specific‐IgE and the response to nasal allergen provocation test (NAPT) in patients with seasonal IR who presented symptoms only in spring. Methods: We evaluated 32 patients with seasonal IR and 35 with persistent allergic rhinitis to pollen (PAR‐P) and compared these with healthy controls and persons with PAR to house dust mite during the pollen season, as well as by NAPT out‐of‐season with grass and Olea europea. We measured the nasal leukocyte–lymphocyte phenotype (CD45, CD33, CD16, CD3, CD4 and CD8), eosinophil‐cationic‐protein, and total and specific‐IgE to grass and olive pollen in serum and nasal lavage and performed NAPT. Results: In the IR group, 62.5% had a positive NAPT (IR‐PosNAPT), 20/32 to grass, with four of these having a positive NAPT to olive pollen as well. IR‐PosNAPT patients showed a similar nasal leukocyte–lymphocyte profile to the PAR‐P patients and different to controls. We detected nasal specific‐IgE in 35% of IR‐PosNAPT patients. Conclusions: These results support the hypothesis that a subgroup of patients with IR have seasonal symptoms with evidence of a nasal allergic immune reaction in the absence of a positive SPT or serum specific IgE.
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Flow cytometry studies in nasal secretions have confirmed that aeroallergen exposure induces a Th2 inflammatory response in the nasal mucosa of LAR patients with increased eosinophils, basophils, mast cells, CD3+, and CD4+ T cells.
“Flow cytometry studies in nasal secretions have confirmed that aeroallergen exposure induces a Th2 inflammatory response in the nasal mucosa of LAR patients with increased eosinophils, basophils, mast cells, CD3+, and CD4+ T cells.300,301”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [300]
The Discussion (page unavailable) reports flow-cytometry evidence of increased nasal eosinophils, basophil–mast cells and CD3+ T cells in patients with seasonal idiopathic rhinitis who responded to pollen challenge. It does not report a significant increase in CD4+ T cells; the Results passage says no differences were found in the other measured values. The paper describes inflammation during seasonal pollen exposure, but does not establish that exposure induced a specifically Th2 response. (LLM, conf=0.88)
Experimental — accuracy not yet measuredImmunologic studies have revealed a Th2 inflammatory response in the nasal mucosa of LAR patients, with positive response to NPT and local production of sIgE and inflammatory mediators.
“Immunologic studies have revealed the existence of a Th2 inflammatory response in the nasal mucosa of LAR patients,177,299-301 with positive response to NPT,291,300-302 and local production of sIgE177,290,299-301,303-305 and inflammatory mediators.304,306,307”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [300]
The Abstract and Discussion (pages not provided) report positive nasal allergen provocation in a subgroup of seasonal idiopathic-rhinitis patients, nasal specific IgE in some of those patients, and increased nasal inflammatory cells and eosinophil cationic protein. They do not establish that the response is specifically Th2, and detection of nasal specific IgE does not by itself demonstrate local production in every patient. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn LAR, presence of sIgE in nasal secretions has been confirmed after natural allergen exposure, NPT, and periods of non-exposure.
“In LAR, the presence of sIgE in nasal secretions has been confirmed after natural allergen exposure,300,301 NPT,300,301,303-305 and periods of non-exposure.300,301”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [300]
The Natural exposure to pollen (April–June) methods and Symptom score results report nasal sIgE in 7 of 32 patients with seasonal idiopathic rhinitis during pollen exposure. The Determinations made outside the pollen season section reports positive NAPT responses and says all patients with nasal sIgE had a positive NAPT. It does not report detecting sIgE in nasal secretions after NAPT or during non-exposure. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe respiratory airway mucosa is a site of IgE production during allergic inflammation, as demonstrated in AR and LAR, with somatic hypermutation and class switching occurring in the nasal mucosa.
“The respiratory airway mucosa is a site of IgE production during allergic inflammation, as has been demonstrated in patients with AR309-312 and LAR,299-301,303-307 with both somatic hypermutation and class switching occurring in the nasal mucosa.309,312-315”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [300]
Experimental — accuracy not yet measuredLocal allergic rhinitis can be classified as perennial or seasonal, and similar findings in the nasal mucosa have been reported in both populations.
“Like traditional AR patients, LAR can be classified as perennial or seasonal, and similar findings in the nasal mucosa have been reported in both of these populations.300,301,953”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [300]
Some patients have negative SPT or serum specific IgE despite a clinical history suggestive of allergic rhinitis and meeting ARIA clinical criteria.
“However, some patients have negative SPT or serum sIgE despite a clinical history suggestive of AR and meeting ARIA clinical criteria.101,300”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [300]
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- Authors
- Rondón, C., Doña, I., López, S., Campo, P., Romero, J. J., Torres, M. J., Mayorga, C., & Blanca, M.
- Corresponding author
- Blanca, M.
- Venue
- Allergy
- Publisher
- Wiley
- Published
- 2008-09-08
- Volume
- 63
- Issue
- 10
- Pages
- 1352-1358
- ISSN
- 0105-4538 (ISSN-L)
- 1398-9995
- OpenAlex
- W2008064166
- Cited by
- 166
- References
- 27
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 4 · 2023: 6 · 2022: 10 · 2021: 7 · 2020: 12 · 2019: 12 · 2018: 12 · 2017: 11 · 2016: 18 · 2015: 13 · 2014: 6 · 2013: 8 · 2012: 6
- FWCI
- 5.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Allergy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Keywords
- vasomotor rhinitis, seasonal rhinitis, nasal allergen provocation test, nasal mucosa inflammation, non-allergic rhinitis, allergic rhinitis, grass pollen, olive pollen, eosinophil cationic protein, skin prick test
- MeSH terms
- Adolescent, Adult, Aged, Allergens, Antibody Specificity, Female, Flow Cytometry, Poaceae, Rhinitis, Allergic, Seasonal, Humans, Immunoglobulin E, Male, Middle Aged, Nasal Mucosa, Nasal Provocation Tests, Pollen, Oleaceae
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