Mechanisms, Diagnosis and Relevance for Occupational Rhinitis
Mechanisms, Diagnosis and Relevance for Occupational Rhinitis
Purpose of review Local allergic rhinitis (LAR) is a new form of allergic rhinitis that has caused a growing interest. The possibility of an occupational equivalent (occupational rhinitis) has not been yet explored. The purpose of this review is to summarize the most relevant and recent scientific evidence on LAR and occupational rhinitis.
Recent findings LAR is a prevalent entity well differentiated from allergic rhinitis, affecting patients from different countries, ethnic groups and ages. Occupational rhinitis appears earlier and more frequently than occupational asthma, especially for high molecular weight substances. Diagnosis of LAR is based on nasal allergen provocation test and/or detection of nasal specific IgE, and other techniques such as basophil activation test may support the diagnosis. Skin prick tests and immunological determinations are of limited use for diagnosis of occupational rhinitis caused by low molecular weight agents. Performance of nasal allergen provocation test for confirming diagnosis of occupational rhinitis is strongly recommended. Uncommon allergens should also be investigated.
Summary The possibility of a local occupational rhinitis should be considered in workers with a clear history of occupational rhinitis and negative immunological test, especially in the case of high molecular weight allergens
Rhinitis is a complex syndrome with multiple causal factors or causes that can coexist in the same patient. A detailed characterization of pathophysiological mechanisms (endotype) and clinical manifestations (phenotype) of rhinitis is essential in order to achieve good management of the disease, which includes an appropriate diagnostic approach and treatment.
Local allergic rhinitis (LAR) is a novel phenotype of allergic rhinitis, in which patients develop an inflammatory response to allergens confined to the nasal mucosa in the absence of other systemic markers of specific IgE (sIgE) antibodies. LAR patients have a positive response after nasal exposure to allergens and a Th2 inflammation in the nose, as has been demonstrated with dust mites, Alternaria and pollens. The definition and characterization of LAR has allowed the identification of allergens as triggers of the nasal symptoms in these patients, in which specific treatments such as allergen avoidance or immunotherapy can be then applied.
Occupational rhinitis refers to those patients who develop rhinitis symptoms specific to the work environment. Occupational rhinitis appears more frequently than occupational asthma, and on most occasions, it precedes the bronchial symptoms, especially for high molecular weight (HMW) substances. The disease is often underestimated and underdiagnosed.
To date, the possibility of an occupational LAR has not yet been thoroughly investigated. In the present article, the most relevant and novel aspects of both types of rhinitis will be reviewed, emphasizing those diagnostic aspects of LAR that could be applied in the investigation of occupational rhinitis with negative immunological test and clear occupational history.
Abstract and Introduction
Abstract
Purpose of review Local allergic rhinitis (LAR) is a new form of allergic rhinitis that has caused a growing interest. The possibility of an occupational equivalent (occupational rhinitis) has not been yet explored. The purpose of this review is to summarize the most relevant and recent scientific evidence on LAR and occupational rhinitis.
Recent findings LAR is a prevalent entity well differentiated from allergic rhinitis, affecting patients from different countries, ethnic groups and ages. Occupational rhinitis appears earlier and more frequently than occupational asthma, especially for high molecular weight substances. Diagnosis of LAR is based on nasal allergen provocation test and/or detection of nasal specific IgE, and other techniques such as basophil activation test may support the diagnosis. Skin prick tests and immunological determinations are of limited use for diagnosis of occupational rhinitis caused by low molecular weight agents. Performance of nasal allergen provocation test for confirming diagnosis of occupational rhinitis is strongly recommended. Uncommon allergens should also be investigated.
Summary The possibility of a local occupational rhinitis should be considered in workers with a clear history of occupational rhinitis and negative immunological test, especially in the case of high molecular weight allergens
Introduction
Rhinitis is a complex syndrome with multiple causal factors or causes that can coexist in the same patient. A detailed characterization of pathophysiological mechanisms (endotype) and clinical manifestations (phenotype) of rhinitis is essential in order to achieve good management of the disease, which includes an appropriate diagnostic approach and treatment.
Local allergic rhinitis (LAR) is a novel phenotype of allergic rhinitis, in which patients develop an inflammatory response to allergens confined to the nasal mucosa in the absence of other systemic markers of specific IgE (sIgE) antibodies. LAR patients have a positive response after nasal exposure to allergens and a Th2 inflammation in the nose, as has been demonstrated with dust mites, Alternaria and pollens. The definition and characterization of LAR has allowed the identification of allergens as triggers of the nasal symptoms in these patients, in which specific treatments such as allergen avoidance or immunotherapy can be then applied.
Occupational rhinitis refers to those patients who develop rhinitis symptoms specific to the work environment. Occupational rhinitis appears more frequently than occupational asthma, and on most occasions, it precedes the bronchial symptoms, especially for high molecular weight (HMW) substances. The disease is often underestimated and underdiagnosed.
To date, the possibility of an occupational LAR has not yet been thoroughly investigated. In the present article, the most relevant and novel aspects of both types of rhinitis will be reviewed, emphasizing those diagnostic aspects of LAR that could be applied in the investigation of occupational rhinitis with negative immunological test and clear occupational history.
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