This article reviews advances in the diagnosis and management of allergic rhinitis. Recent advances in the diagnosis of allergic rhinitis include testing of local immunoglobulin E (IgE), urinary test to diagnose aspirin hypersensitivity and optical rhinometry to assess degree of nasal congestion. Nasal mucosal IgE levels could be obtained from mucosal brush biopsy and this could aid in the diagnosis of allergic rhinitis. Currently, serum IgE levels are obtained and there is a subgroup of patients who have allergic rhinitis but a normal serum IgE level and skin prick test. The limitation of this test, however, is that the level of IgE found in a normal patient has not been well defined at the moment. Urinary leukotriene E4 (LTE4) could be used to diagnose patients with aspirin hypersensitivity as patients who undergo nasal provocation with lysine aspirin were found to have high levels of LTE4. The sensitivity and specificity of this technique has been described at 81% and 79% and could be a useful technique to identify patients who may have disease that is difficult to control and a candidate for aspirin desensitisation. Optical rhinometry measures nasal patency using optical spectroscopy measuring near-infrared light absorption in the tissue. This method could then be used to assess nasal patency following exposure to different agents hence assisting in distinguishing between allergic and non-allergic rhinitis. As for management of allergic rhinitis, the authors discussed the use of recombinant allergens in immunotherapy, monoclonal antibody treatment and intranasal capsaicin. Using recombinant allergens for immunotherapy allows tailoring of immunotherapy to the patient’s sensitisation profile and avoids any contamination with other allergens that may be present if the allergen is prepared naturally. The authors also discussed the potential role of using monoclonal antibodies such as Omalizumab especially for patients with severe asthma and concurrent difficult to control rhinitic symptoms. Intranasal capsaicin was discussed as a potential treatment for non-allergic rhinitis as well. However, despite promising results being reported, more evidence is needed as the results were from small studies. 

Future horizons in allergy.
Marino M, Luong A.
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Wai Sum Cho

Queens Medical Centre, Nottingham, UK.

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