Rinitis alérgica

Allergic rhinitis is characterized by symptoms of sneezing, rhinorrhea, nasal obstruction, and pruritus caused by inhaled allergens and involving mucosal inflammation. Allergic rhinitis is a disease with high prevalence all over the world.

This review aimed at highlighting recent developments in the etiology and management of allergic rhinitis.

Exposure of atopic individuals to external environmental factors such as ambient air pollutants, aeroallergens and climate play a crucial role in the pathogenesis of allergic rhinitis. When the nasal mucosa is exposed to inciting allergens such as pollen and dust mites, innate and adaptive immune cells are involved in the pathophysiologic mechanism of allergic rhinitis, which induce specific immunoglobulin E (IgE) production, activation of eosinophils, and degranulation of mast cells and basophils, with the consequent clinical symptoms.

At a cellular and molecular mechanism, several studies reported the role of IL-17 in allergic rhinitis. Serum IL-17 levels are significantly associated with allergy severity during the pollen season and are considered a marker of allergy severity in allergic rhinitis patients.

Current treatment options include patient education, irritant and allergen avoidance measures, pharmacotherapy, allergen immunotherapy, nasal irrigation and other less common measures such as acupuncture and surgery. Recent studies have strengthened the evidence base for the treatment of all aspect of allergic rhinitis.

Allergic rhinitis impacts negatively the quality of life and occupational activities of patients.

A 10-year duration cross-sectional study evaluated the quality of life and work productivity of patients diagnosed with allergic occupational rhinitis. Quality of Life was assessed by the Mini-RQLQ (rhinitis quality of life questionnaire) and work impairment was assessed by the Work Productivity and Activity Impairment questionnaire.

This study included 414 participants from both genders and with a mean age of 38 years old. Most of them were workers from the textile and clothing industry. Absenteeism was not relevant, however participants experienced activity limitations and practical problems, reducing productivity and quality of life.

Nasal eosinophilia on nasal cytology was a good screening tool for diagnosing local allergic rhinitis (LAR) because of its high sensitivity and simplicity of the procedure. Unfortunately, the low specificity of nasal eosinophilia makes the nasal provocation test (NPT) necessary for confirmation of LAR.

Chinese investigators hypothesized that local serum specific immunoglobulin E (sIgE) can be used for the diagnosis of local allergic rhinitis instead of nasal allergen provocation test.

This prospective single center study included 73 chronic rhinitis patients with negative findings for serum IgE and positive findings for local eosinophils and 10 healthy patients were used as controls. All participants completed questionnaires to record demographic data, nasal symptom severity and physician-diagnosed comorbid asthma.

A visual analogue scale of 10 cm was used to record symptom severity and the allergic status was assessed by serum IgE. Nasal secretions were collected for analysis of local sIgE and eosinophils and nasal allergen provocation test was performed to confirm local allergic rhinitis.

Fourteen patients demonstrated positive local sIgE, with twelve of them having significantly higher local sIgE levels and positive nasal allergen provocation test compared to controls.

In conclusion, the measurement of local sIgE levels in nasal secretions is a reliable and effective diagnostic method for local allergic rhinitis as its sensitivity, specificity and diagnostic accuracy was over 90%.

Allergen specific immunoglobulin E (spIgE) in the nasal mucosa is a biomarker for local allergic rhinitis. Inferior turbinate tissue biopsy is a sensitive method to detect nasal spIgE but is invasive. Nasal brushing is a relatively noninvasive method to detect nasal spIgE that may be of comparable diagnostic utility.

Nasal brushing constituted an easy and relatively noninvasive method to sample nasal epithelium. This sampling technique was comparable with an inferior turbinate tissue biopsy and may be developed as a diagnostic tool for the diagnosis of local allergic rhinitis.