Increased Local IgE Production in Allergic Rhinitis (AR) During Rhinovirus (RV) Infection

RATIONALE: RV infections are the leading cause of exacerbations of asthma in children and have been ascribed to the worsening of an allergic reaction to concomitantly expressed aeroallergens. Local production of IgE has been described as a pathogenic mechanism contributing to severity of allergic airway disease. We therefore assayed the presence of specific IgE in the nares relevant to exposure history in allergic rhinitis subjects with naturally-occurring and experimental RV infections.

METHODS: Interstitial secretions were collected via absorptive filter paper applied to the inferior turbinates for 5 minutes. Allergen-specific IgE was assayed via immunocap^®. To eliminate confounding influences of transudation or transcytosis, data were normalized to total IgE concentrations in the interstitial fluid and ratios compared between nasal and serum samples.

RESULTS: Initially, we studied 88 consecutive allergic patients presenting the ED of the Hospital Naçional de Niños in San José, Costa Rica with an asthma exacerbation. Amongst patients without RV, 7/34 (20.6%) demonstrated local nasal production of IgE to dermatophagoides pteronyssinus. In contrast, 23/24 (48.9%) of RV-infected asthma exacerbators demonstrated local nasal-specific IgE production. In our subsequent studies, we evaluated prospectively the development of local IgE production to seasonally relevant allergen after an experimental infection with HRV-16. In 8/12 subjects, increased local IgE production in the nares was observed.

CONCLUSIONS: Local IgE production is uncommon but demonstrable in allergic rhinitis subjects. The prevalence of local IgE production dramatically increases during a RV infection further supporting the concept that RV-induced asthma exacerbations are related to enhancement of a concomitant bystander allergic reaction.