Abstract：
Local allergic rhinitis (LAR) is defined by a clinical history suggestive of allergic rhinitis (AR), negativity of systemic IgE measurement and positive response to nasal allergen challenge (NAC). The term local respiratory allergy includes LAR, local allergic asthma (positive response in bronchial allergen challenge) and dual allergic rhinitis defined by the coexistence of AR and LAR. LAR worsens in severity and presence of comorbidities over time, and it is an independent entity from AR. Prevalence is higher in Mediterranean countries. LAR onset occurs during childhood in 36% of cases. Physiopathological features of LAR are: increased nasal eosinophilic inflammation, tryptase and eosinophil cationic protein, and presence of nasal specific IgE in secretions of 20-40% of subjects. A recent study demonstrated increase in sequential class switch recombination to IgE markers in mucosa of LAR with accumulation of IgE+ CD38+ plasmablasts. Moreover, there is increased expression in B cells of mucosal homing receptors CXCR3+ and CXCR4 in peripheral blood, with accumulation of Th9 and Th2 cells. NAC is the gold standard in the diagnosis of LAR. The measurement of specific IgE in nasal secretions basophil activation test or are still not suitable for diagnosis. There is ample evidence of the usefulness of allergen immunotherapy in the treatment in LAR after 4 DBPCRT in 152 patients. In conclusion, knowledge about LAR is continuously increasing, with detailed definition of physiopathological mechanisms and new phenotypes. More awareness of the disease should be promoted among different specialists, and NAC must be considered an essential diagnostic tool in any age group, including children.
摘要：
局部过敏性鼻炎（LAR）由提示过敏性鼻炎（AR）的临床病史定义。全身IgE测量阴性和对鼻过敏原攻击（NAC）的阳性反应。术语局部呼吸道过敏包括LAR，局部过敏性哮喘（支气管过敏原攻击中的阳性反应）和由AR和LAR共存定义的双重过敏性鼻炎。LAR随着时间的推移，合并症的严重程度和存在恶化，它是一个独立于AR的实体。地中海国家的患病率更高。36％的病例在儿童期发生LAR。LAR的病理生理特征是：鼻腔嗜酸性粒细胞性炎症增加，类胰蛋白酶和嗜酸性粒细胞阳离子蛋白，以及在20-40%的受试者的分泌物中存在鼻特异性IgE。最近的一项研究表明，随着IgECD38浆细胞的积累，LAR粘膜中IgE标志物的顺序类别转换重组增加。此外，外周血中粘膜归巢受体CXCR3+和CXCR4的B细胞表达增加，与Th9和Th2细胞的积累。NAC是诊断LAR的金标准。鼻腔分泌物嗜碱性粒细胞激活试验中特异性IgE的测定或仍不适于诊断。有充分的证据表明，在152例患者中4例DBPCRT后，变应原免疫疗法在LAR中的治疗中是有用的。总之,关于LAR的知识不断增加，详细定义了病理生理机制和新的表型。应该在不同的专家中提高对这种疾病的认识，NAC必须被视为任何年龄组的基本诊断工具，包括孩子。
