It’s difficult to find good material on the internet related to the practice of #allergy. Here is one such blog site: http://blogs.medscape.com/garystadtmauer. This blog originates from New York and the practice website is http://www.cityallergy.com. I will periodically post comments & articles from Dr. Stadtmauer’s blog and I’ve included one below about the coexistence of systemic allergy (that’s a positive skin or blood test) and LOCAL allergic rhinitis which has all the signs & symptoms of allergy, but guess what–skin & blood testing is all negative. Very frustrating for #patients to experience allergy symptoms, but go in to their local allergist and find nothing. I wish treatment would be more satisfactory, but as you can imagine, it’s unknown what allergens to mix up for your allergy recipe if all testing is negative.
Systemic Allergic Rhinitis and Local Allergic Rhinitis Often May Coexist: AAAAI Poster Highlight
Gary Stadtmauer, MD, Allergy & Clinical Immunology, 07:25PM Feb 22, 2015
Poster #456 entitled: Coexistence of Dual Systemic Allergic Rhinitis and Local Allergic Rhinitis was presented by Carmen Rondon, MD PhD at this years AAAAI session. In the study they assessed whether seasonal systemic allergic rhinitis (SAR) perennial local allergic rhinitis (LAR) may occur in the same patient. They studied 29 patients positive SPT to grass and/or olive pollen with pollen season symptoms and also rhinitis symptoms throughout the year but skin test negative to perennial allergens. Nasal allergen provocation test was postive in 23/29 patients to either Alternaria, dust mite (DP) or both. Most patients were nonsmokers. Nasal challenge was conducted with a micropipette afer saline control. Sequential challenge was done with DP at 0.04, 0.4 and 4 mcg/ml and 0.0025, 0.025 and 0.25 mcg/ml of Alternaria. Bilateral nares were challenged and 15 minutes was alotted between doses. They also performed nasal challenge to the pollens. This was obviously a time consuming process but the payoff is that in their experience patients with perennial local allergic rhinitis not responsive to maximal pharmacotherapy might respond to allergy immunotherapy. In private practice would you take the time to do nasal allergen provocation? I might on a slow day or for a patient who is really suffering. I would also perform a nasal endoscopy to ensure the patients perennial symptoms are not due to nasal polyps or chronic rhinosinusitis.