Local allergic rhinitis: Concept, pathophysiology, and management
Local allergic rhinitis: Concept, pathophysiology, and management
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DOI：
10.1016/j.jaci.2012.02.032
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发表时间：
2012-06-01
影响因子：
14.2
通讯作者：
Blanca, Miguel
中科院分区：
文献类型：
--
作者：
Rondon, Carmen;Campo, Paloma;Blanca, Miguel
局部变应性鼻炎（LAR）是一种在没有全身特应性的情况下发生的局部鼻腔过敏反应，其特征是局部产生特异性IgE （sIgE）抗体，自然暴露于空气过敏原时粘膜细胞浸润的T(H)2模式，以及鼻腔过敏原激发试验阳性反应，炎症介质（胰蛋白酶和嗜酸性粒细胞阳离子蛋白）释放。虽然患病率仍有待确定，但许多以前被诊断为非过敏性鼻炎或特发性鼻炎的患者现在被归类为LAR。罪魁祸首过敏原包括屋尘螨、草和橄榄花粉以及许多其他过敏原。对于LAR的诊断，无论是皮肤点刺试验还是血清sIgE抗体的测定都是无效的，需要进行鼻腔过敏原激发试验来确定罪魁祸首过敏原或过敏原。在一定比例的病例中，可检出局部sIgE，并伴有结膜炎、哮喘或两者兼有。LAR患者将来是否会发生系统性特应性反应是一个有争议的问题。需要进一步的研究来检查这种现象在不同地区的流行程度，改进诊断方法以更好地识别这些患者，并开发治疗方法，包括使用免疫疗法。[J] .中华过敏杂志，2012;29(1):1 -7。
Local allergic rhinitis (LAR) is a localized nasal allergic response in the absence of systemic atopy characterized by local production of specific IgE (sIgE) antibodies, a T(H)2 pattern of mucosal cell infiltration during natural exposure to aeroallergens, and a positive nasal allergen provocation test response with release of inflammatory mediators (tryptase and eosinophil cationic protein). Although the prevalence remains to be established, a number of patients previously given a diagnosis of nonallergic rhinitis or idiopathic rhinitis are now being classified as having LAR. Culprit allergens responsible include house dust mite, grass and olive pollens, and many others. For the diagnosis of LAR, neither skin prick testing nor determination of the presence of serum sIgE antibodies is useful, and a nasal allergen provocation test is needed to identify the culprit allergen or allergens. In a certain proportion of cases, local sIgE can be detected, and conjunctivitis, asthma, or both can be associated. Whether patients with LAR will have systemic atopy in the future is a matter of debate. Further studies are needed for examine the prevalence of this phenomenon in different areas, to improve the diagnostic methods to better identify these patients, and to develop therapeutic approaches, including the use of immunotherapy. (J Allergy Clin Immunol 2012;129:1460-7.)