DOI: 10.1177/01455613261475716 ISSN: 0145-5613

Endotypes of Persistent Allergic Rhinitis: Offending Allergens, Sensitivity of Diagnostic Tests and Quality of Life Differences

Ahmed Ragab, Tarek Abdelrahman, Shimaa Essam Afifi Hemid, Iman Ahmedy, Anwar Abdelatty Ibrahim
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Background

The endotype of allergic rhinitis (AR) known as local allergic rhinitis (LAR) is distinguished by localized nasal allergic reactions despite negative skin and blood tests for systemic IgE. This work aims to evaluate the offending allergens, sensitivity of diagnostic tests, and quality of life differences in different endotypes of AR.

Methods

A clinical study was conducted on 44 patients complaining of AR symptoms and 44 healthy controls. Three endotypes of persistent Allergic rhinitis: Type (I): (AR), Type (II): (LAR) subdivide to group (a) (LAR) with positive nasal allergen provocation test (NAPT) with elevated nasal specific IgE and group (b) LAR with positive nasal allergen provocation test (NAPT) and non-elevated nasal specific IgE. All patients were subjected to C-reactive protein, blood IgE (total and specific) and nasal IgE (total and specific), nasal allergen provocation test (NAPT) and the Mini Rhino Conjunctivitis Quality of Life Questionnaire (MINI RQLQ).

Results

The serum-specific IgE levels of aeroallergens, the mean of Dermatophagoides pteronyssinus (D. pteronyssinus ) and Dermatophagoides farinae (D. farinae ) was significantly higher in Type (I) patients (17.75±17.71 IU/ml (11.16 ±12.55 IU/ml), (p=0.021, p=0.030) respectively. Regarding nasal-specific IgE levels of aeroallergens, a mean of D. pteronyssinus and D. farinae were significantly higher in the Type (II) (17.25 ±7.88), (12.75 ±4.92 IU/ml) respectively, (p<0.001). There were significant differences between A and B groups, nasal specific IgE regarding D. pteronyssinus and D. farinae (p<0.05). D. pteronyssinus and D. farinae was significantly higher among patients type II A compared to type II B. The sensitivity of NAPT and nasal specific IgE in AR (85.71%, 55.17%) respectivily. The specificity of NAPT and nasal specific IgE in type I (88.89%, 47.85%). The total score of miniRQLQ was significantly higher in type I (41.28), (p<0.001).

Conclusion

The NAPT is the most sensitive and specific test to differentiate between systemic and local form while nasal specific IgE can differentiate between the two endotypes of LAR.

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