Local allergic rhinitis to storage mites

In a subgroup of patients with symptoms of allergic rhinitis (AR), no systemic sensitization can be detected in skin-tests or serum. These patients are regarded to have so-called "local allergic rhinitis" (LAR) with IgE-production exclusively at the site of the nasal mucosa. Patients without any positive allergological test results but seasonal (intermittent) or perennial (persistent) allergic symptoms were often misdiagnosed as "nonallergic rhinitis" (NAR) in the past. However, there is evidence for a specific IgE-production in the nasal mucosa in these patients without systemic sensitization. The diagnosis of LAR is confirmed by clinical symptoms, detection of specific IgE production in the nasal mucosa and/or nasal provocation test. So far, LAR has been described to be due to type-I-allergic reactions to pollen of birch, grasses and oleum, cat and dog dander, Alternaria alternata and Dermatophagoides pteronyssinus and D. farinae. We report on 9 cases of LAR to one or more of the storage mites Acarus siro, Lepidoglyphus destructor, Tyrophagus putrescentiae and/or Glycyphagus domesticus with symptoms of persistent allergic rhinitis that have been diagnosed by positive allergenspecific nasal challenge tests and specific IgE determinations in nasal secretions. According to an actual literature research, this is the first published report on LAR caused by storage mites.