Localized Allergic Rhinitis is defined by the occurrence, in patients with symptoms clearly suggesting allergic rhinitis but with negative results to common allergy testing, of allergen specific antibodies in the nasal mucosa. Which begs the question:

 

Can you have allergies with negative allergy testing?

Have you ever sniffed a flower and had your nose stuff up and eyes run? You probably think you have allergies to that flower and you are probably right. But, modern testing may not show that you have allergies to that flower with skin or blood testing. Likewise, if every time you are exposed to dust or pets you become congested with watery eyes and sneezing, you probably are sure that you have allergies. Again, you go to your doctor or allergist and they perform skin and blood allergy testing and the results come back that you “have no allergies”. Is this always right?

Local Allergic RhinitisApparently not. Recently, the phenomena of “Localized Allergy Response” or “Localized Allergic Rhinitis” has become more reported.  Examples include:

-An actor with severe congestion and runny nose in the Spring and Fall. 

-A 2-year-old with allergies to cats on only the right side of the body.

-A couple who both have congestion and sneezing when they clean their home.

All of these patients have negative skin and blood tests for allergens. But, they all have increased antibodies to allergens in the areas that they are having symptoms. The 2-year-old has sensitization of the right side of the body and the others have nasal allergy sensitization. It is unknown how this occurs but localized testing has shown it to be so.

 

How does a Localized Allergic Response happen?

Evidence shows that stimulation by an allergen such as dust, pollen or mold in a specific area of the body may increase the production of localized serum specific IgE (immunoglobulin E). These allergy immunoglobulins are your immune system’s way of overreacting to a perceived assault. The antibodies travel to cells nearby, causing the cells to release inflammatory factors that cause your swelling, itching, runny nose and congestion.

 

Types of Localized Allergic Responses:

  1. Perennial allergies– These are caused by allergens that are present all year long. These include dust mites, pet dander and insects.
  2. Seasonal allergies-These are transient and only occur at certain times of the year. Springtime is most likely from trees and grasses. Summer brings weeds, more grasses, pollens and mold spores. Fall ragweed may be severe but mold from piles of decaying leaves can worsen allergies. Winter brings molds but you are inside most of the time and exposed to the above mentioned perennial allergens.

 

What should I do?

If you have allergy symptoms and negative testing, you can treat your symptoms the same way as if you have proven allergies.

  1. Avoidance is the first line of defense including using high efficiency particulate air (HEPA) filters, washing bedding and pillows, and keeping windows shut on high pollen days and times of the year.
  2. Antihistamines including cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin), and diphenhydramine (Benadryl) can help prevent the itching, swelling and runny nose caused by allergies.
  3. Nasal steroids like fluticasone (Flonase) or budesonide (Rhinocort) especially when used daily can relieve congestion, sneezing and runny nose.
  4. Saline nasal sprays and irrigation can wash away pollen and dust in your nasal passages. 
  5. Azelastine (Astelin) is a topical nasal spray antihistamine that can decrease your nasal symptoms.
  6. Montelukast (Singulair) is effective for decreasing congestion.
  7. Decongestants like pseudoephedrine (Sudafed) can decrease congestion but will not improve the clear nasal discharge you may experience.
  8. Allergy eye-drops such as Visine-A can help with the redness and irritation of your eyes.
  9. Allergy desensitization may play a roll although it may be difficult to determine what you are allergic to which makes coming up with the appropriate allergens to give you difficult.

 

There is hope with Localized Allergy Response!

Many patients with negative allergy tests may have localized allergy responses. If fact, one study showed that around half of people who think they have allergies to a substance, may have localized increased immunoglobulin E and a localized allergy response. The skin and blood testing of these patients will tend to become positive later in life indicating that their allergy response will eventually affect their whole system. This is very good news for allergy sufferers because there is hope for relief even when an allergist may have told you that everything is ‘normal’. 

For more allergy tips go to: https://www.nycfacemd.com/allergy-proof-your-home/ 

If you aren’t sure whether you have a localized allergic rhinitis or a sinus infection, schedule and appointment with sinus specialist Dr Garrett Bennett.