Page 62 - Portuguese Journal - SPORL - Vol 61. Nº1
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SPT. Most of these patients receive a diagnosis and December 2021. The following keywords
of idiopathic rhinitis or non-allergic rhinitis were used: “allergic rhinitis”, “local allergic
with eosinophilia syndrome (NARES) . rhinitis”, “rhinitis diagnostic methods”, “rhinitis
2-5
Recent evidence indicates that the classic therapeutic approaches”.
approach to rhinitis is incomplete because The review was restricted to studies published
many patients diagnosed with NAR may be in English. The eligible articles were selected
classified as having a local allergic rhinitis in three stages, based on a sequential review
(LAR) phenotype . of the title, abstract, and full-text publication.
2-6
The first evidence of a localized allergic The publications included review articles,
response in the nasal mucosa, with local meta-analyses, systematic reviews, practice
production of IgE antibodies in patients protocols, and cross-sectional and cohort
with NAR, was reported in 1975 by Huggins studies. Studies with one or more of the
and Brostoff . In 2001/2002, an Australian following characteristics were excluded:
9
group also reported an increase in the local studies with non-standardized methods,
2
production of IgE antibodies in the nasal duplicate and overlapping studies, and studies
mucosa of patients with AR and NAR. This published in languages other than English.
phenomenon was described as “entopy”, After the application of the inclusion criteria,
or an allergic response restricted to the 19 articles were used to establish our protocol.
nasal mucosa in the absence of a systemic
allergic response . These findings led to the Results
1-2
identification of a distinct phenotype, LAR, 1. Definition and classification of rhinitis:
which was initially considered NAR (with The etiologic classification of non-infectious
negative SPT) . rhinitis divides it into AR and NAR. The
1-6
LAR is a localized nasal allergic response in the exact prevalence of NAR is unknown, as
absence of systemic atopy. It is characterized by it corresponds to a heterogeneous group
the local production of specific IgE antibodies of diseases with nasal manifestations that
and a pattern of T 2 inflammatory response are associated with a specific triggering
H
during exposure to aeroallergens, as well as a factor (“trigger”) in some cases. However, its
positive response to nasal allergen provocation cause is unknown in most cases and NAR is
tests (NAPT) with the release of inflammatory categorized as idiopathic or vasomotor rhinitis.
mediators in the nasal secretions (tryptase NARES is deemed a distinct nosological
and eosinophil cationic protein) . entity, in which a subgroup of patients with
8
According to the literature, the prevalence NAR has eosinophilia in the nasal mucosa,
of LAR is higher in southern European with a good response to topical treatment
countries (Portugal, Spain, Italy, and Greece), with nasal corticosteroids . In recent years,
9
accounting for 50% to 75% of the rhinitis several authors have shown that a significant
cases initially diagnosed as NAR. However, it percentage of patients with a negative SPT
remains an underdiagnosed clinical entity . and negative serum specific IgE, who would
3-6
The estimated prevalence of LAR in Asian be classified as having NAR, present with
countries is not higher than 20% 9-10 . nasal symptoms after NAPT . More recent
3-4
studies have suggested that in these patients,
Materials and Methods production of specific IgE occurs locally in the
This was a systematic review of the literature nasal mucosa; therefore, a new phenotypic
published on LAR, with an emphasis on entity has been proposed – LAR, which has led
diagnostic and therapeutic approaches, to to a new etiologic classification of rhinitis 3-6,11
establish a protocol. The search was conducted (Table 1).
in the online database PubMed and included
articles published between January 2000
62 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
