Local Allergic Rhinitis の現状と課題

抄録

　Allergic rhinitis (AR) is a type I allergic disease of the nasal mucosa in response to inhaled aeroallergens and exhibits clinical symptoms such as watery rhinorrhea, nasal congestion, itching, and sneezing. Serum antigen-specific IgE (sIgE) measurements and a skin test (ST) against aeroallergens have been routinely employed to diagnose AR. Individuals exhibiting AR symptoms without a positive ST nor serum sIgE have been diagnosed as non-AR cases (NAR). However, the concept of local AR (LAR) has been advocated as a clinical entity mainly and initially in Europe. LAR is characterized by AR symptoms in the absence of systemic atopy assessed by ST or serum sIgE. The diagnosis of LAR should be rationally based on the detection of sIgE synthesis in nasal secretion or mucosa, and is now practically by a nasal allergen provocation test (NAPT). LAR is a stable phenotype and not an initial stage of conventional AR, it, however, shows moderate to severe nasal symptoms, remarkable impairment of QOL (quality of life) and rapid progression to symptomatic worsening. It should also be noted that LAR is often complicated with other atopic diseases such as atopic asthma and/or conventional AR. LAR complicated with AR is named dual Allergic Rhinitis (DAR). While no attention has been payed to LAR in Japan for long time, we reported the study about LAR cases in Japan this year, for the first time in Japan, based on our clinical and experimental investigation. According to our study, it is concluded that LAR is supposed to exist with the sensitization by house dust mite or Japanese cider pollen. This article is a review about LAR for clinical use containing its history, concept, diagnostic criteria and therapeutic choices in reference to recent publications updated including our published study.