Positive allergen reaction in allergic and nonallergic rhinitis: a systematic review

Aneeza W Hamizan; Janet Rimmer; Raquel Alvarado; William A Sewell; Larry Kalish; Raymond Sacks; Richard J Harvey

doi:10.1002/alr.21988

Positive allergen reaction in allergic and nonallergic rhinitis: a systematic review

Int Forum Allergy Rhinol. 2017 Sep;7(9):868-877. doi: 10.1002/alr.21988. Epub 2017 Jul 20.

Authors

Aneeza W Hamizan^{1

2}, Janet Rimmer^{3

4}, Raquel Alvarado¹, William A Sewell^{5

6}, Larry Kalish^{7

8}, Raymond Sacks^{8

9}, Richard J Harvey^{1

9}

Affiliations

¹ Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.
² Department of Otolaryngology and Head and Neck Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
³ St Vincent's Clinic, St Vincent's Hospital, Sydney, Australia.
⁴ The Woolcock Institute, Sydney University, Sydney, Australia.
⁵ St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
⁶ Garvan Institute, Sydney, Australia.
⁷ Sydney Medical School, University of Sydney, Sydney, Australia.
⁸ Department of Otolaryngology-Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia.
⁹ Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.

PMID: 28727909
DOI: 10.1002/alr.21988

Abstract

Background: The diagnosis of allergic rhinitis (AR) is based on cutaneous and serological assessment to determine immunoglobulin E (IgE)-mediated disease. However, discrepancies between these tests and nasal provocation exist. Patients diagnosed as non-allergic rhinitis (NAR) but with positive nasal allergen provocation test (NAPT) may represent a local allergic condition or entopy, still suitable to allergy interventions. The objective of this study was to determine the frequency of nasal reactivity toward allergens among AR and NAR patients, and to describe the diagnostic characteristics of NAPT methodologies.

Methods: EMBASE (1947-) and Medline (1946-) were searched until December 8, 2015. A search strategy was used to identify studies on AR or NAR patients subjected to diagnostic local nasal provocation. All studies providing original NAPT data among the AR or NAR population were included. Meta-analysis of proportion data was presented as a weighted probability % (95% confidence interval [CI]).

Results: The search yielded 4504 studies and 46 were included. The probability of nasal allergen reactivity for the AR population was 86.3% (95% CI, 84.4 to 88.1) and in NAR was 24.7% (95% CI, 22.3 to 27.2). Reactivity was high with pollen for both AR 97.1% (95% CI, 94.2 to 99.2) and NAR 47.5% (95% CI, 34.8 to 60.4), and lowest with dust for both AR 79.1% (95% CI, 76.4 to 81.6) and NAR 12.2% (95% CI, 9.9 to 14.7). NAPT yielded high positivity when defined by subjective end-points: AR 91.0% (95% CI, 86.6 to 94.8) and NAR 30.2% (95% CI, 22.9 to 37.9); and lower with objective end-points: AR 80.8% (95% CI, 76.8 to 84.5) and NAR 14.1% (95% CI, 11.2 to 17.2).

Conclusion: Local allergen reactivity is demonstrated in 26.5% of patients previously considered non-allergic. Similarly, AR, when defined by skin-prick test (SPT) or serum specific IgE (sIgE), may lead to 13.7% of patients with inaccurate allergen sensitization or non-allergic etiologies.

Keywords: aeroallergens; allergen inhalation challenge; allergic rhinitis; entopy; local allergic rhinitis; rhinitis.

Publication types

Review
Systematic Review

MeSH terms

Allergens / immunology*
Humans
Nasal Provocation Tests
Rhinitis / diagnosis*
Rhinitis / immunology*

Substances

Allergens