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

Aneeza Khairiyah Wan Hamizan, Janet Rimmer, Raquel Alvarado, William A. Sewell, Larry Kalish, Raymond Sacks, Richard J. Harvey

Research output: Contribution to journalArticle

13 Citations (Scopus)

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.

Original languageEnglish
JournalInternational Forum of Allergy and Rhinology
DOIs
Publication statusAccepted/In press - 2017

Fingerprint

Allergens
Rhinitis
Nasal Provocation Tests
Confidence Intervals
Nose
Immunoglobulin E
Allergic Rhinitis
Pollen
Skin Tests
Dust
Population
Meta-Analysis
Hypersensitivity
Skin

Keywords

  • Aeroallergens
  • Allergen inhalation challenge
  • Allergic rhinitis
  • Entopy
  • Local allergic rhinitis
  • Rhinitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

Cite this

Positive allergen reaction in allergic and nonallergic rhinitis : A systematic review. / Wan Hamizan, Aneeza Khairiyah; Rimmer, Janet; Alvarado, Raquel; Sewell, William A.; Kalish, Larry; Sacks, Raymond; Harvey, Richard J.

In: International Forum of Allergy and Rhinology, 2017.

Research output: Contribution to journalArticle

Wan Hamizan, Aneeza Khairiyah ; Rimmer, Janet ; Alvarado, Raquel ; Sewell, William A. ; Kalish, Larry ; Sacks, Raymond ; Harvey, Richard J. / Positive allergen reaction in allergic and nonallergic rhinitis : A systematic review. In: International Forum of Allergy and Rhinology. 2017.
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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",
author = "{Wan Hamizan}, {Aneeza Khairiyah} and Janet Rimmer and Raquel Alvarado and Sewell, {William A.} and Larry Kalish and Raymond Sacks and Harvey, {Richard J.}",
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T2 - A systematic review

AU - Wan Hamizan, Aneeza Khairiyah

AU - Rimmer, Janet

AU - Alvarado, Raquel

AU - Sewell, William A.

AU - Kalish, Larry

AU - Sacks, Raymond

AU - Harvey, Richard J.

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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.

KW - Aeroallergens

KW - Allergen inhalation challenge

KW - Allergic rhinitis

KW - Entopy

KW - Local allergic rhinitis

KW - Rhinitis

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