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Review
. 2022 Apr 7:9:874114.
doi: 10.3389/fmed.2022.874114. eCollection 2022.

Allergic Rhinitis: A Clinical and Pathophysiological Overview

Siti Muhamad Nur Husna  1 , Hern-Tze Tina Tan  1 , Norasnieda Md Shukri  2   3 , Noor Suryani Mohd Ashari  1 , Kah Keng Wong  1
Affiliations
Review

Allergic Rhinitis: A Clinical and Pathophysiological Overview

Siti Muhamad Nur Husna et al. Front Med (Lausanne). .

Abstract

Allergic rhinitis (AR) represents a global health concern where it affects approximately 400 million people worldwide. The prevalence of AR has increased over the years along with increased urbanization and environmental pollutants thought to be some of the leading causes of the disease. Understanding the pathophysiology of AR is crucial in the development of novel therapies to treat this incurable disease that often comorbids with other airway diseases. Hence in this mini review, we summarize the well-established yet vital aspects of AR. These include the epidemiology, clinical and laboratory diagnostic criteria, AR in pediatrics, pathophysiology of AR, Th2 responses in the disease, as well as pharmacological and immunomodulating therapies for AR patients.

Keywords: Th2 responses; allergic rhinitis; diagnostic criteria; epidemiology; immunotherapy; pathophysiology.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Positive SPT of HDM allergen Dermatophagoides pteronyssinus (D. pteronyssinus; wheal size 9 mm), Dermatophagoides farinae (D. farinae; wheal size 11 mm) and Blomia tropicalis (B. tropicalis; wheal size 10 mm) tested on an AR patient at ORL-HNS clinic, Hospital Universiti Sains Malaysia.
FIGURE 2
FIGURE 2
Schematic presentation of pathophysiology of AR (12, 59, 64, 66). See texts for details.
FIGURE 3
FIGURE 3
In normal physiological state (left panel), intact epithelial barrier prevents allergens infiltration and hence homeostasis of immune components and functions are maintained. In AR such as HDM-sensitized AR (right panel), proteases released by HDMs disrupt tight junctions leading to disrupted epithelial barrier that allows infiltration of allergens. This triggers a cascade of IgE overproduction by B cells, cleaved CD40 on the surface of DCs disrupts the production of thiols by DCs causing decreased Th1 proliferation and collectively with increased IL-6 secretion leads to biased Th2 proliferation. Th2 cells produce the hallmark AR cytokines IL-4 and IL-13. HDM proteases also cleave the pulmonary surfactants SP-A and SP-D, causing decreased lung clearance of allergens. CLDN, Claudin; DC, Dendritic cell; HDM, House dust mite; IL-4, Interleukin 4; IL-12, Interleukin 12; IL-13, Interleukin 13; IL-25, Interleukin 25; IL-33; Interleukin 33; IFNγ, Interferon gamma; OCLN, Occludin; SP-A, Surface protein A; SP-D, Surface protein D; Th1, T helper type 1; Th2, T helper type 2; Treg, Regulatory T cell; TSLP, Thymic stromal lymphopoietin.
See this image and copyright information in PMC

References

    1. Pawankar R. Allergic diseases and asthma: a global public health concern and a call to action. World Allergy Organ J. (2014) 7:12. 10.1186/1939-4551-7-12 - DOI - PMC - PubMed
    1. Licari A, Manti S, Ciprandi G. What are the effects of rhinitis on patients with asthma? Expert Rev Respir Med. (2019) 13:503–5. 10.1080/17476348.2019.1604227 - DOI - PubMed
    1. Steelant B, Farre R, Wawrzyniak P, Belmans J, Dekimpe E, Vanheel H, et al. Impaired barrier function in patients with house dust mite-induced allergic rhinitis is accompanied by decreased occludin and zonula occludens-1 expression. J Allergy Clin Immunol. (2016) 137:1043–53.e5. 10.1016/j.jaci.2015.10.050 - DOI - PubMed
    1. Steelant B, Seys SF, Boeckxstaens G, Akdis CA, Ceuppens JL, Hellings PW. Restoring airway epithelial barrier dysfunction: a new therapeutic challenge in allergic airway disease. Rhinology. (2016) 54:195–205. 10.4193/Rhin15.376 - DOI - PubMed
    1. Steelant B, Seys SF, Van Gerven L, Van Woensel M, Farre R, Wawrzyniak P, et al. Histamine and T helper cytokine-driven epithelial barrier dysfunction in allergic rhinitis. J Allergy Clin Immunol. (2018) 141:951–63.e8. 10.1016/j.jaci.2017.08.039 - DOI - PubMed