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Original Article


Seasonal Local Allergic Rhinitis in Areas With High Concentrations of Grass Pollen


Blanca-Lopez N1, Campo P2, Salas M2, García Rodríguez C3, Palomares F4, Blanca M2, Canto G1, Feo Brito F3, Rondon C2

1Allergy Service, Infanta Leonor Hospital, Madrid, Spain
2Allergy Unit, IBIMA, Regional University Hospital, UMA, Málaga, Spain
3Allergy Section, General Hospital, Ciudad Real, Spain
4Research Laboratory, IBIMA, Regional University Hospital, UMA, Malaga, Spain

J Investig Allergol Clin Immunol 2016; Vol. 26(2): 83-91
doi: 10.18176/jiaci.0018



Background: Local allergic rhinitis (LAR) is a phenotype of allergic rhinitis characterized by the presence of a localized immune response in the nasal mucosa of patients with negative skin prick test (SPT) results and undetectable serum specific IgE (sIgE). It unknown whether LAR is limited to areas with low or moderate aeroallergen exposure.

Objective: To explore the presence of LAR and the clinical and immunological characteristics of this entity in geographic areas with high grass pollen loads.

Methods: A cross-sectional observational study was carried out in 2 hospitals in central Spain (Madrid and Ciudad Real). Sixty-one patients with seasonal rhinitis and negative SPT results and undetectable serum sIgE were evaluated using a clinical questionnaire, determination of serum total IgE, and a nasal allergen provocation test (NAPT) with Phleum species. The response to NAPT was monitored using assessment of nasal symptoms, acoustic rhinometry, and determination of sIgE, tryptase, and eosinophil cationic protein in the nasal cavity.

Results: Seasonal LAR was detected in 37 patients (61%) using the techniques described above. Eleven percent of patients with LAR were adolescents or children, and 14% reported onset of rhinitis in childhood. Most patients reported persistent-moderate seasonal nasal symptoms, and 41% reported worsening of the disease during the last 2 years. Conjunctivitis was the most common comorbidity, affecting 95% of cases.

Conclusions: LAR to grass pollen is relevant in patients with seasonal symptoms indicative of allergic rhinitis but with a negative skin test result who live in areas with high allergenic pollen loads. This entity should be included the differential diagnosis of rhinitis.

Key words: Grass pollen. Local allergic rhinitis. Local specific IgE. Nasal allergen provocation test.