Bronchial asthma triggered by house dust mites in patients with local allergic rhinitis

• DOI: 10.1111/all.13775
• Publication Date: 2019-03-19T21:33:27Z
• Authors: Paloma Campo; Ibon Eguiluz‐Gracia; María Carmen Plaz...; María Salas; María José Rodríguez; Natalia Pérez‐Sán...; Miguel González; Ana Molina; Cristobalina Mayorga; María José Torres; Carmen Rondón
• Keywords: Adult; Male; 0303 health sciences; Pyroglyphidae; Allergens; Middle Aged; Rhinitis, Allergic; Asthma; Bronchial Provocation Tests; 3. Good health; Eosinophils; Young Adult; 03 medical and health sciences; Animals; Humans; Female; Antigens, Dermatophagoides; Bronchial Hyperreactivity; Skin Tests

AbstractBackgroundOver 30% of local allergic rhinitis (LAR) patients self‐report bronchial symptoms suggestive of asthma, but the relationship between the allergen exposure and the bronchial symptoms has not been studied.ObjectiveTo investigate whether a bronchial counterpart of LAR exists.MethodsPatients were classified by clinical history, skin prick test/serum specific IgE (sIgE), and nasal allergen provocation test (NAPT) into the LAR, allergic rhinitis (AR), and nonallergic rhinitis (NAR) phenotypes. Twenty‐eight LAR, 18 AR, and 19 NAR patients self‐reporting bronchial symptoms suggestive of asthma and 8 healthy controls (HC) were subjected to a methacholine test (MT) before (Visit 1) and 24 hours after (Visit 3) a bronchial provocation test with Dermatophagoides pteronyssinus (BPT‐DP) (Visit 2). Induced sputum and peripheral blood obtained after each MT were analyzed for immune cell populations, tryptase, ECP, and sIgE.ResultsA positive MT was found in 50% of LAR, 83.3% of AR, 57.89% of NAR, and 0% of HC individuals (P = 0.022 AR vs LAR) at V1. BPT‐DP was positive in 8 LAR and 15 AR patients (28% vs 83.3%, P < 0.001), with no positive responses in NAR and HC. All BPT‐DP+ patients experienced a significant decrease of PC20 at V3 vs V1 (P = 0.016 LAR, P ≤ 0.001 AR). BPT‐DP+ patients also showed a significant increase of eosinophils, monocytes, and ECP in induced sputum at V3 compared with V1.ConclusionThe results suggest the existence of a new asthma phenotype (local allergic asthma) defined by absence of systemic atopy and positivity to BPT with allergen.