Histological Investigation and Pathological Hypothesis of Local Allergic Rhinitis (LAR) to Mite, by Commercial Disc Diagnosis

Abstract

(Introduction) Even if the results of medical interview and rhinoscopic findings are suspicious for allergic rhinitis, all serum antibody titers and skin tests may be negative. In Europe and the United States, such cases are described as Local Allergic Rhinitis (LAR). We investigated the possibility of mite-LAR using a nasal provocation test with a commercially available HD disc, that can be performed in daily practice. Since cedar discs are not commercially available, we only examined the response to mite. The histopathological features of LAR in the nasal mucosa were compared with those of allergic and non-allergic rhinitis to aid in the investigation of the pathogenesis of LAR.

(Subjects, Methods) Twenty-one patients with symptoms of rhinitis who underwent surgical treatment at our department were included in the study. Endpoints included: (1) preoperative measurement of mite-specific IgE antibody titer in peripheral blood, (2) preoperative nasal provocation test (HD disc), (3) measurement of mite-specific IgE antibody titer in the mucosa of the inferior turbinate, and (4) HE staining and immunostaining with anti-CD40 antibody in specimens of the mucosa of the inferior turbinate.

(Results and discussion) 13 of the 21 cases were negative for mite-specific IgE antibody titer in peripheral blood, and 5 of the 13 cases were considered to have mite-LAR. In all groups, CD40-positive cell clusters were observed in the inferior turbinate mucosa. We describe the pathogenetic hypothesis of LAR and indicate that the establishment and standardization of a nasal provocation test is of great importance in the diagnosis of allergic rhinitis.