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

Abstract Background Over 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. Objective To investigate whether a bronchial counterpart of LAR exists. Methods Patients 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. Results A 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 PC 20 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. Conclusion The results suggest the existence of a new asthma phenotype (local allergic asthma) defined by absence of systemic atopy and positivity to BPT with allergen.