Page 69 - Portuguese Journal - SPORL - Vol 61. Nº1

nasal itching). In the Position Paper by Augé The implementation of the NAPT in the
et al. it was suggested that the ideal scale
19
to evaluate the symptoms of AR should
consider the following symptoms: rhinorrhea,
nasal congestion, sneezing, nasal itching,
and ocular symptoms. Although there is no
study on the effect of allergen elimination
or medical treatment in patients with LAR,
they exhibit a good response to treatment
with topical nasal corticosteroids and topical
or oral antihistamines, such as in AR . Unlike
16
NAR, this good response to pharmacological
treatment may be explained by the similarities
in the nasal inflammatory pattern of patients
with local and allergic symptomatology.
In recent years, it has been suggested that
IT has a role in LAR. The use of IT in LAR was
supported by one observational study and
four double-blind clinical trials, controlled by
placebo 21-24 . These studies have shown that
IT allows control of nasal, conjunctival, and
bronchial symptoms and possibly reduces
rescue medication use in patients with LAR
sensitized to grass pollens, birch pollen, and
house dust mites. Moreover, IT improves
the quality of life and nasal and bronchial
tolerance to the allergen in patients with
LAR. IT is a safe treatment, with only a few
mild and moderate reactions having been
observed during its administration, both
with the allergen and placebo solutions . It
14
has not yet been possible to determine the
long-term effects of IT in patients with LAR or
its ability to modify the natural course of the
disease. However, in cases of LAR refractory
to preventive measures and/or corticosteroids
and oral or nasal antihistamines, IT may be
administered to reduce symptoms, reduce
the need for rescue medication, and improve
the quality of life .
16
Conclusion
LAR is a phenotype that differs from the
described classical rhinitis and remains an
underdiagnosed condition that affects a
significant proportion of patients classified as
having NAR (negative SPT and serum specific
IgE).
diagnostic algorithms of rhinitis is essential
for the early recognition of LAR and adequate
treatment prescription. Unlike NAR, LAR
responds well to medical treatment with
nasal corticosteroids and/or oral or topical
antihistamines.
In moderate to severe cases of LAR refractory
to medical treatment, subcutaneous IT with a
specific allergen is a safe treatment and has
good results, including control of symptoms,
reduced need for rescue medication, and
improved quality of life.
Conflicts of Interest
The authors declare that there is no conflict
of interests regarding the publication of this
paper.
Data Confidentiality
The authors declare having followed the
protocols in use at their working center
regarding patients’ data publication.
Protection of humans and animals
The authors declare that the procedures
were followed according to the regulations
established by the Clinical Research and Ethics
Committee and to the 2013 Helsinki Declaration
of the World Medical Association.
Funding Sources
This work did not receive any contribution,
funding or scholarship.
Availability of scientific data
There are no datasets available, publicly related
to this work.
Bibliographic references
1 - Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens
WJ, Togias A. et al. Allergic Rhinitis and its Impact on
Asthma (ARIA) 2008 update (in collaboration with the
World Health Organization, GA(2)LEN and AllerGen).
Allergy. 2008 Apr;63 Suppl 86:8-160. doi: 10.1111/j.1398-
9995.2007.01620.x.
2 - Powe DG, Jagger C, Kleinjan A, Carney AS, Jenkins
D, Jones NS. ‘Entopy’: localized mucosal allergic disease
in the absence of systemic responses for atopy. Clin
Exp Allergy. 2003 Oct;33(10):1374-9. doi: 10.1046/j.1365-
2222.2003.01737.x. Clin Exp Allergy 2003;33:1374-9.
Volume 61 . Nº1 . March 2023 69