article · Ear Nose & Throat Journal
This clinical study evaluated diagnostic methods, allergen profiles and quality of life differences across endotypes of persistent allergic rhinitis, comparing forty-four affected patients against forty-four healthy controls. The investigation categorised patients into systemic allergic rhinitis and two subcategories of local allergic rhinitis based on nasal allergen provocation testing and local antibody levels. House dust mite antibodies were predominant, with serum-specific immunoglobulin E being significantly higher in systemic cases, whilst nasal-specific immunoglobulin E was concentrated in local allergic rhinitis. Nasal allergen provocation testing showed superior diagnostic accuracy, reaching 85.71 percent sensitivity and 88.89 percent specificity, outperforming nasal-specific antibody testing. Furthermore, patients with systemic allergic rhinitis experienced significantly greater impairment in their overall quality of life compared to those suffering from localised forms.
Local allergic rhinitis frequently evades standard allergy checks because standard skin and blood tests return negative results. Demonstrating that nasal provocation and local antibody tests can accurately distinguish systemic from localised forms allows clinicians to correctly identify underlying causes, leading to more targeted treatment plans for individuals suffering from persistent nasal symptoms.
This research informs clinical diagnostic protocols and specialised testing panels for ENT specialists, allergists and clinical laboratories. The methods evaluated, specifically nasal provocation and nasal-specific antibody tests, are applied and tested in a clinical cohort. Real-world adoption as standardised commercial assays or diagnostic kits remains at an intermediate stage, requiring broader validation and standardised sampling procedures for routine clinical use.
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Background The endotype of allergic rhinitis (AR) known as local allergic rhinitis (LAR) is distinguished by localized nasal allergic reactions despite negative skin and blood tests for systemic IgE. This work aims to evaluate the offending allergens, sensitivity of diagnostic tests, and quality of life differences in different endotypes of AR. Methods A clinical study was conducted on 44 patients complaining of AR symptoms and 44 healthy controls. Three endotypes of persistent Allergic rhinitis: Type (I): (AR), Type (II): (LAR) subdivide to group (a) (LAR) with positive nasal allergen provocation test (NAPT) with elevated nasal specific IgE and group (b) LAR with positive nasal allergen provocation test (NAPT) and non-elevated nasal specific IgE. All patients were subjected to C-reactive protein, blood IgE (total and specific) and nasal IgE (total and specific), nasal allergen provocation test (NAPT) and the Mini Rhino Conjunctivitis Quality of Life Questionnaire (MINI RQLQ). Results The serum-specific IgE levels of aeroallergens, the mean of Dermatophagoides pteronyssinus (D. pteronyssinus ) and Dermatophagoides farinae (D. farinae ) was significantly higher in Type (I) patients (17.75±17.71 IU/ml (11.16 ±12.55 IU/ml), (p=0.021, p=0.030) respectively. Regarding nasal-specific IgE levels of aeroallergens, a mean of D. pteronyssinus and D. farinae were significantly higher in the Type (II) (17.25 ±7.88), (12.75 ±4.92 IU/ml) respectively, (p<0.001). There were significant differences between A and B groups, nasal specific IgE regarding D. pteronyssinus and D. farinae (p<0.05). D. pteronyssinus and D. farinae was significantly higher among patients type II A compared to type II B. The sensitivity of NAPT and nasal specific IgE in AR (85.71%, 55.17%) respectivily. The specificity of NAPT and nasal specific IgE in type I (88.89%, 47.85%). The total score of miniRQLQ was significantly higher in type I (41.28), (p<0.001). Conclusion The NAPT is the most sensitive and specific test to differentiate between systemic and local form while nasal specific IgE can differentiate between the two endotypes of LAR.
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DOI: 10.1177/01455613261475716
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