Another development in AR classification over the past decade has been local allergic rhinitis (LAR). This describes AR where standard nasal/conjunctival symptoms are present, but the usual confirmatory diagnostic procedures of a skin prick test or standard blood tests for systemic IgE antibodies are negative.4,5

Instead, LAR diagnosis relies on the direct challenge of an allergen to nasal tissue or by detecting IgE in nasal secretions. With only nasal/conjunctival cells showing an immune response, LAR is occasionally called ‘entopy’, distinguishing it from ‘atopy’ where cells throughout the body will respond to the common allergens.

Much of the original research into LAR was conducted in Spain where it has been shown that LAR could account for a quarter of AR. Two thirds of adults present with ‘standard’ systemic atopic AR while the remainder (11 per cent) have non-allergic AR.

Studies suggest that LAR may worsen in about a quarter of patients over five years (including developing asthma for some). However, LAR does not appear to be a precursor to systemic AR or atopy.

Another AR development is the adoption of the term ‘severe chronic upper airways disease’ (SCUAD).This is being used to describe severe uncontrolled allergic rhinitis of whatever cause, and something that affects one in five AR patients.4

It is important to distinguish between people who have AR symptoms because of serious disease and those who have symptoms because they are not being treated correctly or have poor adherence to treatment, says the British Society for Allergy & Clinical Immunology (BSACI). As a relatively new diagnosis, there is still much more to be understood about the pathophysiology and influence of genes versus the observable characteristics of SCUAD.