Recent update of local allergic rhinitis

Rhinitis is a common airway disease that can affect patient's quality of life and social activities. Rhinitis comprises heterogenous diseases and classified as allergic rhinitis (AR) or nonallergic rhinitis (NAR) based on the clinical history, skin prick test, and serum-specific IgE to aeroallergens. It is important to differentiate between AR and NAR, as management differs for each. However, classification of NAR is controversial and the specific mechanisms responsible for NAR remain unclear. Recently, the entopy of local allergic rhinitis (LAR) has been raised if positive response to nasal provocation test, and elevated specific IgE and inflammatory mediators such as tryptase and eosinophilic cationic peptide in the nasal lavage fluids are shown in patients with NAR. About 47-62.5% of patients previously diagnosed with NAR actually have LAR. LAR shares similar nasal symptoms with AR, such as itching, sneezing, rhinorrhea, and nasal obstruction. LAR shows a good response to nasal corticosteroids and oral antihistamines. However, its natural history and role of immunotherapy need to be elucidated.