Dual systemic allergic rhinitis and local allergic rhinitis

Abstract

RATIONALE: In this study we investigated if seasonal systemic allergic rhinitis (SAR) induced by pollens and local allergic rhinitis (LAR) induced by perennial allergens may occur in the same patient. METHODS: Twenty-nine patients with seasonal SAR and positive SPT to grass and/or olive pollen with well-defined symptoms during pollen season in addition to nasal symptoms throughout the year were evaluated. Clinical questionnaires, skin tests, serum specific IgE, nasal levels of tryptase and eosinophil cationic protein, and nasal allergen provocation test (NAPT) with grass, olive, D. pteronyssinus (DP), and Alternaria alternata (AA) were performed. RESULTS: The coexistence of dual SAR-LAR was confirmed in 23 patients by NAPT (82.1%) with positive response to AA in 9 patients (22%), to DP in 19 (46.3%), and to both AA and DP in 13 (31.7%). A total concordance between SPT and NAPT results was obtained. The SPT and NAPT with seasonal pollens were positive to grass in 11 patients (26.8%), to olive in 20 (48.8%), and to both grass and olive in 11 (26.8%). No significant differences between seasonal and perennial allergens threshold concentrations were observed. The 56.5% of patients reported a seasonal onset of nasal symptom followed by perennial symptoms in the next years. The 30.4% a perennial onset of symptoms with a clear spring worsening, and the 13% could not remember the onset of the disease. CONCLUSIONS: These results demonstrate the coexistence of perennial LAR in patients with seasonal SAR who developing symptoms throughout the year has negative SPT should be explored.