Diagnostic challenges in local allergic rhinitis

Abstract

Introduction. Local allergic rhinitis (LAR) is a distinct type of rhinitis characterized by perennial or seasonal symptoms in the absence of systemic atopy. Its prevalence is notably higher in Mediterranean countries, with 36% of cases beginning in childhood. Objective of the study. To perform a literature review on the topic of LAR, its clinical manifestations, diagnostic issues and treatment. Material and methods. A literature search was performed, using key words “local allergic rhinitis, diagnostic challenges treatment and clinical manifestations. We used PubMed database and selected articles Published in 2012-2024. During the search the system identified 246 articles. After selection of most relevant ones published in English, we analyzed those how are published in last 6 years. Results. Many studies have suggested that a significant number of people with LAR begin to experience nasal symptoms in childhood. LAR has the same clinical manifestations as non-local allergic rhinitis such as rhinorrhea, sneezing and nasal itching. The evidence of LAR has been increasing, particularly among pediatric and Asian demographics. These patients indeed present with a suggestive clinical background of allergic rhinitis despite negative skin prick tests and negative serum IgE tests for suspected allergens. Currently, the diagnosis can be confirmed through a positive reaction to the nasal allergen challenge (NAC), which is considered the gold standard for diagnosis. Also, we can use basophil activation test (BAT), and nasal cytology as a diagnostic test for the disease. The Treatment for LAR is comparable to that for AR, with demonstrated effectiveness and safety in allergen avoidance, medication, and allergen immunotherapy. Conclusions. This review strives to provide a comprehensive overview of the current understanding of LAR while identifying gaps in disease diagnosis and treatment that require attention.