D2.32 - Assessment of local nasal IgE in patients with suspected dual allergic rhinitis before and after nasal allergen provocation – presentation of 6 cases

The coexistence of perennial rhinitis symptoms, nasal allergen-specific reactivity to both perennial and seasonal allergens, and positive skin prick testing results only for seasonal allergens are the descriptive features of dual allergic rhinitis (DAR) patients. We present a description of six cases of patients with perennial rhinitis symptoms without IgE sensitization to perennial allergens and with coexistent presence of IgE specific to seasonal airborne allergens.

A total of 6 suspected DAR subjects (5 males and 1 female) with a median age of 37.5 have been included in our case study. The sensitizations to seasonal allergens were confirmed: birch (2 subjects), timothy grass (2 subjects), and mugwort (2 subjects). Total nasal symptom score and visual analog scale (TNSS/VAS) and anterior rhinoscopy were used for subjective and objective symptoms’ assessment, respectively. Specific IgE to house dust mites’ allergens (D. pteronyssinus and D. farinae) and total IgE levels were measured in nasal lavage fluid (NLF) before and after the nasal provocation test (NPT) with HDM allergens.

A positive NPT was noted by the increase of TNSS/VAS scores and/or the presence of symptoms such as swelling, redness, and nasal discharge assessed through anterior rhinoscopy. NPT was positive among all subjects. Higher median TNSS and VAS scores were noted post-NPT. Regarding nasal secretions assessment: sIgE to D. pteronyssinus was higher post-NPT (median = 0.11 kU/L) compared to pre-NPT (median = 0.095 kU/L), while for sIgE to D. farinae, the levels were similar. Additionally, the median total IgE was higher post-NPT (median = 5.48 kU/L) compared to pre-NPT (median = 5.13 kU/L).

Measuring sIgE levels in nasal secretions may be a promising tool in diagnosing suspected DAR subjects. However, a combination of objective and subjective assessment with the measurement of sIgE in nasal secretions is still required for a more comprehensive patient assessment. Ultimately, larger studies aimed at assessment of inflammatory proteins in nasal mucosa could provide a more conclusive evaluation of this underdiagnosed group of patients.