title: Seasonal Local Allergic Rhinitis in Areas With High Concentrations of Grass Pollen.
abstract: BACKGROUND
  Local allergic rhinitis (LAR) is a phenotype of allergic rhinitis characterized by the presence of a localized immune response in the nasal mucosa of patients with negative skin prick test (SPT) results and undetectable serum specific IgE (sIgE). It unknown whether LAR is limited to areas with low or moderate aeroallergen exposure.
  
  
  OBJECTIVE
  To explore the presence of LAR and the clinical and immunological characteristics of this entity in geographic areas with high grass pollen loads.
  
  
  METHODS
  A cross-sectional observational study was carried out in 2 hospitals in central Spain (Madrid and Ciudad Real). Sixty-one patients with seasonal rhinitis and negative SPT results and undetectable serum sIgE were evaluated using a clinical questionnaire, determination of serum total IgE, and a nasal allergen provocation test (NAPT) with Phleum species. The response to NAPT was monitored using assessment of nasal symptoms, acoustic rhinometry, and determination of sIgE, tryptase, and eosinophil cationic protein in the nasal cavity.
  
  
  RESULTS
  Seasonal LAR was detected in 37 patients (61%) using the techniques described above. Eleven percent of patients with LAR were adolescents or children, and 14% reported onset of rhinitis in childhood. Most patients reported persistent-moderate seasonal nasal symptoms, and 41% reported worsening of the disease during the last 2 years. Conjunctivitis was the most common comorbidity, affecting 95% of cases.
  
  
  CONCLUSIONS
  LAR to grass pollen is relevant in patients with seasonal symptoms indicative of allergic rhinitis but with a negative skin test result who live in areas with high allergenic pollen loads. This entity should be included the differential diagnosis of rhinitis.
authors.affiliation: Allergy Service, Infanta Leonor Hospital, Madrid, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Blanca-Lopez
authors.affiliation: Allergy Unit, IBIMA, Regional University Hospital, UMA, Málaga, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Campo
authors.affiliation: Allergy Unit, IBIMA, Regional University Hospital, UMA, Málaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Salas
authors.affiliation: Allergy Section, General Hospital, Ciudad Real, Spain.
authors.forename: C
authors.initials: C
authors.lastname: García Rodríguez
authors.affiliation: Research Laboratory, IBIMA, Regional University Hospital, UMA, Malaga, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Palomares
authors.affiliation: Allergy Unit, IBIMA, Regional University Hospital, UMA, Málaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Blanca
authors.affiliation: Allergy Service, Infanta Leonor Hospital, Madrid, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Canto
authors.affiliation: Allergy Section, General Hospital, Ciudad Real, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Feo Brito
authors.affiliation: Allergy Unit, IBIMA, Regional University Hospital, UMA, Málaga, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Rondon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology*; D002648:Child; D003231:Conjunctivitis / Q000097:blood / Q000150:complications / Q000276:immunology* / Q000473:pathology; D003430:Cross-Sectional Studies; D047150:Eosinophil Cationic Protein / Q000235:genetics / Q000276:immunology; D005260:Female; D015870:Gene Expression; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000276:immunology* / Q000473:pathology; D009299:Nasal Provocation Tests; D031784:Phleum / Q000737:chemistry / Q000276:immunology; D011058:Pollen / Q000276:immunology*; D006255:Rhinitis, Allergic, Seasonal / Q000097:blood / Q000150:complications / Q000276:immunology* / Q000473:pathology; D012621:Seasons; D012882:Skin Tests; D011795:Surveys and Questionnaires; D053802:Tryptases / Q000235:genetics / Q000276:immunology
chemical_list: D000485:Allergens; D007073:Immunoglobulin E; D047150:Eosinophil Cationic Protein; D053802:Tryptases
keywords: Grass pollen; Local allergic rhinitis; Local specific IgE; Nasal allergen provocation test