title: Local allergic rhinitis in children: Novel diagnostic features and potential biomarkers.
abstract: BACKGROUND
  Local allergic rhinitis (LAR) is a phenotype of rhinitis that has been poorly studied in children. It is characterized by the same symptoms of allergic rhinitis but with the absence of markers of systemic atopy.
  
  
  OBJECTIVE
  To identify children affected by LAR and to analyze the pathogenesis of this disease. We chose to focus our attention on interleukin (IL) and thymic stromal lymphopoietin (TSLP).
  
  
  METHODS
  We enrolled 20 children affected by nonallergic rhinitis (negative skin-prick test results and serum specific immunoglobulin E [sIgE] values). Each patient underwent a nasal allergen provocation test (NAPT) with dust mite and grass pollen. Before and after NAPT, nasal lavage was performed to detect sIgE, IL-5, and TSLP; anterior active rhinomanometry was used to evaluate changes in nasal obstruction.
  
  
  RESULTS
  Two patients were positive to a nonspecific NAPT and, thus, were excluded from the study. Of the remaining 18 children, 12 (66.7%) had positive results to at least one NAPT. Among these 12 patients, nasal sIgE levels for Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Lolium perenne increased significantly after NAPT (D. pteronyssinus, p < 0.005; D. farinae, p < 0.05; L. perenne, p < 0.05). Nasal IL-5 levels showed a significant increase after NAPT (p ≤ 0.006), and this increase was significantly higher in children who had positive NAPT results than in those patients with negative NAPT results (p ≤ 0.03). Among the 12 children who had a positive NAPT result, nasal TSLP was detected in 4 patients (33.3%) and its levels showed a relevant increase after NAPT, even though the difference did not reach statistical significance (p ≤ 0.061).
  
  
  CONCLUSIONS
  Observed results raise the importance of better refining the diagnostic protocol for LAR in children. Nasal TSLP and IL-5 levels offer new insights concerning localized allergic inflammation, although the role of nasal sIgE has still to be clarified.
authors.affiliation: Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Zicari
authors.forename: Francesca
authors.initials: F
authors.lastname: Occasi
authors.forename: Marco
authors.initials: M
authors.lastname: Di Fraia
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Mainiero
authors.forename: Alessandra
authors.initials: A
authors.lastname: Porzia
authors.forename: Ricciarda
authors.initials: R
authors.lastname: Galandrini
authors.forename: Anna
authors.initials: A
authors.lastname: Giuffrida
authors.forename: Daniela
authors.initials: D
authors.lastname: Bosco
authors.forename: Serena
authors.initials: S
authors.lastname: Bertin
authors.forename: Marzia
authors.initials: M
authors.lastname: Duse
mesh_terms: D000818:Animals; D039741:Antigens, Dermatophagoides / Q000276:immunology; D015415:Biomarkers / Q000378:metabolism*; D002648:Child; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000378:metabolism; D015848:Interleukin-5 / Q000378:metabolism*; D008129:Lolium; D008297:Male; D009297:Nasal Mucosa / Q000276:immunology*; D009299:Nasal Provocation Tests; D011058:Pollen / Q000276:immunology; D039981:Pyroglyphidae; D065631:Rhinitis, Allergic / Q000175:diagnosis*; D012882:Skin Tests; D000094632:Thymic Stromal Lymphopoietin
chemical_list: D039741:Antigens, Dermatophagoides; D015415:Biomarkers; D016207:Cytokines; D015848:Interleukin-5; D007073:Immunoglobulin E; D000094632:Thymic Stromal Lymphopoietin