LOCAL Allergic Rhinitis: Entopy or Spontaneous Response?

Rationale: The existence of a “local” allergic rhintis was proosed on the basis of the detection of nasal IgE in the absence of a systemic sensitization. Neverhteless, the significance of this phenomenon remains partially unclear. We assessed the presence of mucosal nasal IgE in patients with ascertained allergic rhinitis, nonallergic rhinitis with inflammation and in healthy controls. 

Methods: Conseutive patients with a well ascertained rhinologic diagnosis (clinical history, skin prick test, specific IgE assay, nasal endoscopy, nasal cytology) underwent an immunoenzymatic measurement of specific IgE to grass, cypress, parietaria and olive in nasal scrapings.

Results: Fifteen patients with allergic rhinitis, 12 with nonallergic cellular rhinitis and 14 healthy subjects were studied. The patients with allergic and nonallergic rhinitis had significantly more nasal symptoms versus the control subjects. A systemic sensitizatition (assessed by skin test and CAP RAST) was obviously more frequent in allergic rhinitis. Nasal IgE could be found equally present in the trhee groups (86,7%, 33,3%, and 50% positive, respectively), even more frequently in the controls than in nonallergic rhinitis patients. No difference among the single allergens was detected. Among the 26 nonallergic patients (cellular rhinitis+controls) nasal IgE were positive in 11.

Conclusions: According to the results, the presence of nasal IgE against allergens seems to be a non-specific phenomenon, since they are present also in non allergic rhinitis and in healthy subjects. It can be hypothesiszed that the mucosal IgE production is part of a spontaneous immune response.