Medical algorithm: Diagnosis and treatment of local allergic rhinitis

Local allergic rhinitis (LAR) is a recently identified phenotype of chronic rhinitis. The disease is characterized by the negativity of skin prick test and serum specific (s)IgE for all relevant aeroallergens in a patient with chronic nasal symptoms suggestive of allergy, and who tests positive in the nasal allergen challenge (NAC) (1). The NAC or the natural exposure to the allergen induce an early peak of tryptase and a later and progressive increase of eosinophil mediators in the nasal secretions of LAR individuals (1).The disease is believed to arise from the mucosal synthesis of sIgE (S1, S2), although this aspect has not been undoubtedly demonstrated.