Local allergic rhinitis: concept, clinical manifestations, and diagnostic approach.

Local allergic rhinitis is a newly described type of rhinitis involving nasal production of specific immunoglobulin (slg) E antibodies in the absence of atopy. It can affect patients previously diagnosed with non-allergic rhinitis. Evidence for this entity is supported by clinical symptoms, local production of slgE, a type 2 helperT cell inflammatory pattern in nasal secretions during natural exposure to aeroallergens, and a positive response to nasal allergen provocation with local nasal production of slgE to aeroallergens, tryptase, and eosinophil cationic protein (ECP). Based on these new findings, an advanced diagnostic approach is proposed in patients with symptoms suggestive of allergic rhinitis but negative results in skin prick test and serum slgE determination. Detection of local slgE in nasal secretions during natural exposure to aeorallergens and a positive nasal allergen provocation test with local production of tryptase, ECP, and slgE are useful for detecting patients with local allergic rhinitis.