Local IgE production and positive nasal provocation test in patients with persistent nonallergic rhinitis

• Published in: Journal of allergy and clinical immunology 2007-04, Vol.119 (4), p.899-905
• Main Authors: Rondón, Carmen, MD, Romero, José J., BS, López, Soledad, PhD, Antúnez, Cristina, PhD, Martín-Casañez, Enrique, MD, PhD, Torres, Maria J., MD, PhD, Mayorga, Cristobalina, PhD, R-Pena, Rebeca, MD, PhD, Blanca, Miguel, MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Allergies; Allergy and Immunology; Biological and medical sciences; Cells, Cultured; Disease; Family medical history; Female; Flow cytometry; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunoglobulin E - biosynthesis; Immunopathology; lymphocyte subtypes; Lymphocytes; Male; Medical sciences; Medical treatment; Middle Aged; nasal allergen provocation test; nasal lavage; Nasal Mucosa - immunology; Nasal Mucosa - pathology; Nasal Provocation Tests; nasal specific IgE; Nose; persistent allergic rhinitis; persistent nonallergic rhinitis; Proteins; Rhinitis - diagnosis; Rhinitis - immunology; Rhinitis - physiopathology
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2007.01.006

Background Allergic rhinitis is an IgE-mediated inflammatory disease of the nasal mucosa, which is usually diagnosed by typical symptoms, positive skin tests, and/or serum specific IgE antibodies to allergens. Despite suggestive symptoms of allergic rhinitis, some patients have a negative diagnostic test for atopy. Objective To evaluate in the nose the inflammatory response, specific IgE to Dermatophagoides pteronyssinus (DP), and the response to a nasal allergen provocation test with DP (NAPT-DP), in patients with persistent nonallergic rhinitis (PNAR) compared with patients with persistent allergic rhinitis (PAR) and healthy controls. Methods Fifty patients with PNAR, 30 with PAR to DP, and 30 healthy controls were studied by determining the nasal leukocyte-lymphocyte phenotype by flow cytometry (CD16, CD8, CD4, CD33, CD3, and CD45), nasal eosinophil cationic protein (ECP), albumin, total and specific IgE to DP, and NAPT-DP. Results The PNAR patients showed a similar leukocyte-lymphocyte phenotype in nasal lavage to the PAR patients and was different to the healthy controls. Within the PNAR group, 54% showed a positive NAPT-DP, with 22% of these having nasal specific IgE to DP. Conclusion These data support the hypothesis that in persistent nonallergic rhinitis some patients may have local inflammation, nasal IgE production, and a positive response to a nasal allergen provocation test despite no evidence of systemic atopy. Further research is needed to evaluate the influence of other perennial allergens and/or immunologic mechanisms. Clinical implications The local production of IgE antibodies without systemic detection is a condition that should be considered in patients with PNAR.