Local allergic rhinitis, a new endotype of allergic rhinitis discerned by researchers of the Spanish Allergy School, is now in the focus of interest of international allergological community. A special feature of local allergic rhinitis, which, being similar to conventional signs of allergic rhinitis, is, however, characterized by absence of systemic atopy manifestations, e.g., an increased total serum IgE content and positive allergic skin tests. In order to assess the level of tolerance breakdown to allergens in local and classical allergic rhinitis, we have studyed concentrations of IL-4, IL-22, and IFNγ in three biological fluids, blood, nasal secretions, and skin exudate. The whole study cohort consisted of 82 patients aged 18 to 60 years with established allergic rhinitis. The diagnosis was based on counseling by allergologist/immunologist, including clinical case history and possible inheritance of atopy as well as videorhinoscopy performed by an ENT specialist. The procedure of videorhinoscopy allowed to specify allergic origin of rhinitis and exclude the patients with non-allergic forms of the disease, but it did not enable us to differentiate between the endotypes of classic and local allergic rhinitis. Subsequently, all patients have been divided into two subgroups based on the criteria of systemic atopy: (1) with a high content of serum total IgE and positive skin allergy tests (n = 41) and (2) with a significantly lower concentration of IgE and negative allergy tests (n = 41). It was concluded that the patients with classic allergic rhinitis prevailed in the 1st subgroup, whereas local rhinitis predominated in the 2nd group. The study of IL-4, IL-22 and IFNγ concentrations in the three biological fluids allowed us to presume that the 1st subgroup was characterized by increased content of IL-4 and IL-22 in blood and skin exudate in comparison with controls, and the 2nd subgroup showed a decrease in IFNγ to control values. The cytokine concentrations in nasal secretions were not representative for the subgroups studied. The result has been interpreted as the absence of tolerance breakdown to causal allergens in the patients with local allergic rhinitis at the systemic level. The obtained data could be used in development of a diagnostic biomarker system for this specific endotype of allergic rhinitis, thus avoiding potential diagnostic errors which occurred in the past, when this endotype was classified as non-allergic form of the disease, thus administering non-adequate treatment, e.g., allergen-specific immunotherapy, which could be prescribed in these cases.

Aim. The aim of the study was to differentiate the endotypes in allergic rhinitis by key allergy markers in a mixed group of patients.Material and Methods. The study comprised a total of 48 patients, men and women, aged 18-60 years suffering from three endotypes of allergic rhinitis including the classic, local, and dual allergic rhinitis. The standard diagnostics of allergic rhinitis included taking a history of allergies, family history of allergic disease, video rhinoscopy, serum total IgE level assessment, allergy skin tests to house dust mite and pollen allergens, and study of eosinophilic inflammation parameters (eosinophil cationic protein, interleukin-5 (IL5), and eosinophil counts in blood and nasal secretion).Results. Based on total IgE level, the general group of patients was divided to two subgroups: subgroup 1 comprised patients with high IgE level (n = 22); subgroup 2 comprised patients with low IgE level (n = 26). Most of patients in these groups had contradictory results of allergy skin tests i.e. positive allergy skin test results in case of high IgE level (group 1) and vice versa. Cluster analysis-based exminations of general group allowed to categorize three subgroups of patients: patients with classic allergic rhinitis (n = 22), local allergic rhinitis (n = 22), and dual allergic rhinitis (n = 4). Besides, an increased rate of anxiety disorder was found in patients with local allergic rhinitis (p < 0.001).Conclusion. The obtained data showed promise for a new research trend in studying allergic rhinitis endotypes, namely: investigation of neuroimmune relationships in allergic tolerance disruption in the presence of this pathology.