International Rhinologic Society Rhinology 0300-0729 57 4 2019 8 1 31374113 Long-term antibiotics for Chronic Rhinosinusitis: changing views 241 241 EN W.J. Fokkens Department of Otorhinolaryngology, Amsterdam University Medical Centres, Location AMC Amsterdam, Amsterdam, The Netherlands 1935 10.4193/Rhin19.404

International Rhinologic Society Rhinology 0300-0729 57 4 2019 8 1 30907391 Does severe bleeding in HHT patients respond to intravenous bevacizumab? Review of the literature and case series 242 251 EN T. Rosenberg Department of ORL-Head and Neck Surgery, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark A.D. Fialla Department of Medical Gastroenterology and Hepatology, Odense University Hospital, Denmark J. Kjeldsen Department of Clinical Research, University of Southern Denmark; Department of Medical Gastroenterology and Hepatology, Odense University Hospital, Denmark A.D. Kjeldsen Department of ORL-Head and Neck Surgery, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark 1881 10.4193/Rhin18.289 Background: Hereditary Haemorrhagic Telangiectasia (HHT) is an autosomal dominant genetic disorder, with a wide variety of clinical manifestations due to the presence of multiple arteriovenous manifestations. Severe bleeding from the gastrointestinal (GI) tract and/or epistaxis presents a significant problem in a subgroup of patients and systemic bevacizumab, an angiogenesis inhibitor, has been suggested to benefit these patients. Objective: To perform a review of the literature concerning the efficacy of systemic bevacizumab in treatment of bleeding from the nose or GI tract in patients with HHT, including patients from our own HHT-center. Methods: A literature review was performed using the guideline "Preferred Reporting Items for systematic Reviews and MetaAnalysis statement" (PRISMA). Results: After careful selection, we finally analysed the results of eight case series and 33 case reports. Among 195 patients 171 (88%) had reduced bleeding after bevacizumab. Conclusions: Based on the literature review and data from our own case series, systemic bevacizumab is very promising as treatment for HHT patients with severe epistaxis and/or GI-bleeding. However, care should be taken using bevacizumab, a potent angiogenesis inhibitor; long-term side effects have not been studied in this population. A randomized controlled study is warranted to support the results in HHT patients.

International Rhinologic Society Rhinology 0300-0729 57 4 2019 8 1 30928998 Risk of mortality and cardiovascular events following macrolide prescription in chronic rhinosinusitis patients: a cohort study using linked primary care electronic health records 252 260 EN E. Williamson Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK; HDR UK, London, UK S. Denaxas HDR UK, London, UK; Institute of Health Informatics, UCL, London, UK S. Morris Department of Applied Health Research, University College London, London, UK C.S. Clarke Research Department of Primary Care and Population Health, University College London, London, UK M. Thomas Primary Care and Population Science, University of Southampton, UK H. Evans HDR UK, London, UK; Institute of Health Informatics, UCL, London, UK; Ear Institute, UCL, London, UK K. Direk Institute of Health Informatics, UCL, London, UK A. Gonzalez-Izquierdo Institute of Health Informatics, UCL, London, UK P. Little Primary Care and Population Science, University of Southampton, UK V. Lund Ear Institute, UCL, London, UK H. Blackshaw Ear Institute, UCL, London, UK A. Schilder Ear Institute, UCL, London, UK C. Philpott Norwich Medical School, University of East Anglia, Norwich, UK; ENT Department, James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK C. Hopkins ENT Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK J. Carpenter Department of Medical Statistics, London School of Hygiene On behalf of the MACRO programme team 1882 10.4193/Rhin18.237 BACKGROUND: Macrolide antibiotics have demonstrated important anti-inflammatory and immunomodulatory properties in chronic rhinosinusitis (CRS) patients. However, reports of increased risks of cardiovascular events have led to safety concerns. We investigated the risk of all-cause and cardiac death, and cardiovascular outcomes, associated with macrolide use. METHODOLOGY: Observational cohort (1997-2016) using linked data from the Clinical Practice Research Datalink, Hospital Episodes Statistics, and the Office for National Statistics. Patients aged 16-80 years with CRS prescribed a macrolide antibiotic or penicillin were included, comparing prescriptions for macrolide antibiotics to penicillin. Outcomes were all-cause mortality, cardiac death, myocardial infarction, stroke, diagnosis of peripheral vascular disease, and cardiac arrhythmia. RESULTS: Analysis included 320,798 prescriptions received by 66,331 patients. There were 3,251 deaths, 815 due to cardiovascular causes, 925 incident myocardial infarctions, 859 strokes, 637 diagnoses of peripheral vascular disease, and 1,436 cardiac arrhythmias. A non-statistically significant trend towards increased risk of myocardial infarction during the first 30 days following macrolide prescription was observed. No statistically significant short- or long-term risks were observed for macrolide prescription. No significant risks were identified for clarithromycin in particular. CONCLUSIONS: Although not statistically significant, our best estimates suggest an increased short-term risk of myocardial infarction in patients with CRS following macrolide prescription, supporting previous observational evidence. However, confounding by indication remains a possible explanation for this apparent increased risk. We found no evidence of longer term increased risks.

International Rhinologic Society Rhinology 0300-0729 57 4 2019 8 1 30801072 A retrospective study of changes of histopathology of nasal polyps in adult Chinese in central China 261 267 EN W.-X. Jiang Department of Otolaryngology - Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Department of Otolaryngology - Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Ho P.-P. Cao Department of Otolaryngology - Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China Z.-Y. Li Department of Otolaryngology - Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China G.-T. Zhai Department of Otolaryngology - Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China B. Liao Department of Otolaryngology - Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China X. Lu Department of Otolaryngology - Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China Z. Liu Department of Otolaryngology - Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China 1877 10.4193/Rhin18.070 BACKGROUND: The factors contributing to the eosinophilic inflammation in chronic rhinosinusitis with nasal polyps (CRSwNP) remain elusive. This study was designed to investigate the inflammatory patterns and tissue remodeling of CRSwNP in patients from central China at two time points over 14 years apart and the influence of age. METHODS: One hundred and eight CRSwNP patients enrolled in 2000 and 2001 (group A), and 134 CRSwNP patients enrolled in 2014 and 2015 (group B) were retrospectively studied. Hematoxylin-eosin stained tissue sections were used to study characteristics of inflammation and tissue remodeling. Immunohistochemistry was used to further evaluate the cells positive for eosinophil cationic protein (ECP), IL-5, IgE, tryptase or myeloperoxidase (MPO). Time- and age-related difference was analyzed. RESULTS: The number of eosinophils and proportion of eosinophilic CRSwNP were increased, whereas the numbers of total inflammatory cells and lymphocytes were decreased in group B as compared with group A. Group B had severer epithelial squamous metaplasia and basement membrane thickening, and a lower number of mucosal glands than group A. Higher numbers of ECP plus, IL-5 plus and IgE plus cells were detected in group B than those in group A. The elderly (60 yrs or older) and non-elderly (less than 60 yrs) had a comparable number of eosinophils and ratio of eosinophilic CRSwNP. CONCLUSION: Eosinophilic inflammation has been significantly augmented over time, which is associated with increased Th2 response and IgE production, and accompanied by exaggerated epithelium remodeling in CRSwNP patients from central China. Age has no significant influence on eosinophilic inflammation.

International Rhinologic Society Rhinology 0300-0729 57 4 2019 8 1 30887967 Azelastine nasal spray inhibiting sympathetic function on human nasal mucosa in patients with allergy rhinitis 268 272 EN L.-H. Cheng Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center J.-C. Lee Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center P.-C. Wu Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan, Republic of China Y.-Y. Lin Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center Y.-H. Chu Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center H.-W. Wang Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center; Graduate Institute of Clinical Medicine and Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital 1880 10.4193/Rhin18.274 BACKGROUND: Azelastine hydrochloride (azelastine) nasal spray is a histamine receptor-1 (H1) antagonist often used in treating allergic rhinitis to relieve its symptoms. However, the effects of azelastine to influence decongestion on human nasal mucosa in patients with allergic rhinitis are not yet fully explored and merit further exploration. The effects of azelastine on the vasocontractile responses generated by smooth muscles in the vascular structures of human nasal mucosa were investigated directly in vitro. METHODS: We examined the effectiveness of azelastine on isolated human nasal mucosa by testing: 1) the effect on mucosa resting tension; 2) the effect on mucosal contraction caused by 10-6 M methoxamine as a sympathetic mimetic; 3) the effect of the drugs on electrically induced mucosal contractions. RESULTS: The results indicated that addition of methoxamine to the incubation medium caused the nasal mucosa to contract in a dose-dependent manner. Addition of azelastine at doses of 10â€"6 M or above elicited a significant dilation response to 10â€"6 M methoxamine-induced mucosal contraction. Azelastine could inhibit electrical field stimulation-induced spike mucosal contraction. Moreover, increase in concentration of azelastine had minimal effect on basal tension of nasal mucosa. CONCLUSIONS: The technique in our study is simple and reproducible. Azelastine could inhibit both EFS and methoxamine-induced nasal mucosal contractions in vitro. This study highlights that although azelastine nasal spray is often used in treating allergic rhinitis to improve symptoms, nasal obstruction may be not relieved immediately due to the anti-sympathetic effect of azelastine.

International Rhinologic Society Rhinology 0300-0729 57 4 2019 8 1 30938377 Complications and number of follow-up visits after using septal stapler in septoplasty 273 278 EN S. Sainio Department of Otorhinolaryngology, University of Helsinki, Helsinki, Finland K. Blomgren Department of Otorhinolaryngology, University of Helsinki, Helsinki, Finland; Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland M. Lundberg Department of Otorhinolaryngology, University of Helsinki, Helsinki, Finland; Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland 1886 10.4193/Rhin18.142 BACKGROUND: Septoplasties have traditionally been closed with transseptal sutures, silicone splints, or packing with nasal tamponade. In 2015, our clinic began to employ a septal stapler. The stapler adheres the mucosa to the septal cartilage with bioresorbable staples, replacing both sutures and silicone splints and limiting the use of nasal tamponade for bleeding cases. The complications of stapler versus other methods have not been reported on previously. Thus, the aim of this study was to investigate whether the use of stapler in septoplasties makes a difference in complication rates, operation time, or number of follow-up visits when compared to the traditional closure or filling methods. METHODOLOGY: Patient records from 101 septoplasties in which the stapler had been used, and a reference group of 356 septoplasties in which the stapler had not been used, were retrospectively reviewed and analysed. RESULTS: No significant difference was seen in the complication rate between the stapler and the control group. Overall follow-up visits were fewer in the stapler group when compared to the control group, however there was no significant difference in the number of unplanned follow-up visits between the groups. CONCLUSIONS: By using the stapler in septoplasty, the number of postoperative follow-up visits might be reduced. Neither complication rate, nor operation time differed when using the stapler as compared to the traditional methods of closure.

International Rhinologic Society Rhinology 0300-0729 57 4 2019 8 1 30938376 Control of allergic rhinitis with MP-AzeFlu: a noninterventional study of a Swedish cohort 279 286 EN P. Stjarne Department of Clinical Sciences, Intervention and Technology, Division of Otorhinolaryngology, Karolinska Instituet, Stockholm, Sweden V. Strand Astma och Allergimottagningen, Stockholm, Sweden K. Theman Astma och Allergimottagningen, Goteborg, Sweden A. Ehnhage Department of Clinical Sciences, Intervention and Technology, Division of Otorhinolaryngology, Karolinska Instituet, Stockholm, Sweden 1885 10.4193/Rhin18.028 BACKGROUND: The European Union has prioritised allergic rhinitis (AR) control. A visual analogue scale (VAS) has been endorsed as the AR control language and embedded into the most recent MACVIA-ARIA guideline. This study assessed the effectiveness and safety of MP-AzeFlu using a VAS in a real-life study in Sweden. METHODS: 431 patients aged 12 years or over with ARIA-defined moderate to severe AR were included in this multicentre, prospective, non-interventional study and prescribed MP-AzeFlu. Patients assessed symptom severity using a VAS from 0 (not at all bothersome) to 100 mm (very bothersome) on Days 0, 1, 3 and 7, and after approximately 14 days in the morning before using MP-AzeFlu. Patients’ perceived level of disease control was assessed on Day 3. The proportion of patients who achieved a defined VAS score cutoff for well- and partly controlled AR was also calculated. RESULTS: MP-AzeFlu reduced mean (SD) VAS score from 67.9 (16.1) mm at baseline to 32.1 (22.8) mm on the last day. Results were consistent irrespective of severity, phenotype, patient age class or previous treatment. By Day 3, 84.0% of patients reported well- or partly controlled symptoms. Overall, 17.7%, 32.2%, 53.8% and 64.2% of patients achieved a 38 mm or greater �well-controlled� VAS score cutoff on Day 1, 3 and 7 and last day, respectively. CONCLUSIONS: MP-AzeFlu provided rapid, effective and sustained symptom control in patients with AR from Sweden in a realworld setting, aligning with EU and MACVIA-ARIA initiatives and supporting the effectiveness of MP-AzeFlu for AR treatment in real life.

International Rhinologic Society Rhinology 0300-0729 57 4 2019 8 1 31129684 Comparison of outcomes of triamcinolone versus normal saline soaked polyvinyl alcohol pack following bilateral endoscopic sinus surgery 287 292 EN B.R. Gyawali Department of ENT-HNS, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal B. Pradhan Department of ENT-HNS, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal N. Thapa Department of ENT-HNS, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal 1893 10.4193/Rhin19.004 BACKGROUND: Steroids have been proven to be beneficial in improving post-operative outcomes following sinus surgery. The ideal mode of delivery is to increase local concentration in the sinuses with minimal systemic side effects. In this study, we used triamcinolone soaked polyvinyl alcohol packs immediately following sinus surgery, and assessed the effects on post-operative outcomes. METHODOLOGY: This was a prospective, interventional, and comparative study. Following endoscopic sinus surgery, a polyvinyl alcohol pack was placed in both nasal cavities and 4 ml triamcinolone was infiltrated in one side and 4 ml of normal saline was infiltrated in the other. The pack was removed on the second post-operative day and nasal cavities and paranasal sinuses were evaluated using a flexible endoscope in the third post-operative week using Lund-Kennedy and Peri-operative sinus endoscopic scores. RESULTS: There was a reduction in the average Lund-Kennedy score and Peri-operative sinus endoscopy score in the treatment site compared to the control site which was statistically significant. There was a greater reduction in crusting, oedema and scarring in the treatment site compared to the control site. However, only the reduction in oedema was statistically significant. CONCLUSIONS: Triamcinolone soaked polyvinyl alcohol pack following endoscopic sinus surgery improves post-operative outcomes.

International Rhinologic Society Rhinology 0300-0729 57 4 2019 8 1 30984921 Frontal sinus ablation (Riedel-Mosher’s procedure): indications and role in the endonasal endoscopic era 293 302 EN G. Pietrobon Division of Otorhinolaryngology and Head and Neck Surgery, European Institute of Oncology, Milan, Italy M. Bignami Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery and Forensic Dissection Research centre (HNS and FDRc) A. Preti Department of Otorhinolaryngology, University of Milan and IRCCS Multimedica, Ospedale San Giuseppe, Milan, Italy A. Pistochini Division of Otorhinolaryngology, Department of Specialized Surgeries, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy F. Bandi Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy S. Gallo Division of Otorhinolaryngology, Department of Specialized Surgeries, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy H. Bahranifard Department of Otorhinolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran D. Locatelli Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy A. Karligkiotis Division of Otorhinolaryngology, Department of Specialized Surgeries, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy P. Castelnuovo Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery and Forensic Dissection Research centre (HNS and FDRc), 1889 10.4193/Rhin18.197 BACKGROUND: The aim of this article is to describe the Riedel-Mosher’s surgical technique and identify its current role in the endoscopic endonasal era based on the experience of a tertiary care medical centre. It also provides a brief excursus on materials available for frontal reconstruction. METHODS: A retrospective review of patients submitted to Riedel-Mosher’s procedure from 2005 to 2018 at a single tertiary care centre was carried out. Details of the surgical technique along with data on frontal reconstruction timing and materials used were collected. RESULTS: A total of 21 patients (16 males and 5 females) underwent the Riedel-Mosher’s procedure. The age of the patients ranged from 15 to 84 years. The underlying pathology was represented mainly by chronic osteitis of the frontal bone (17 cases), followed by benign tumours (3 cases) and malignancy (1 case). Perioperative complications occurred in 3 patients. Cranioplasty was carried out only on 16 cases and delayed by an average time of 10 months. Materials for reconstruction included titanium, ceramic, plastic and free flap . CONCLUSIONS: Nowadays, Riedel-Mosher’s procedure is still indicated in selected cases of benign and malignant pathologies of the frontal sinus and/or frontal bone. Surgical expertise is key to approach the frontal sinus safely. Its reconstruction requires proper planning and a wide variety of materials to perform it is now available.

International Rhinologic Society Rhinology 0300-0729 57 4 2019 8 1 31120456 Exploring the association between ingestion of foods with higher potential salicylate content and symptom exacerbation in chronic rhinosinusitis. Data from the National Chronic Rhinosinusitis Epidemiology Study 303 312 EN C.M. Philpott Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, United Kingdom; James Paget University Hospital NHS Foundation Trust, Gorleston, United Kingdom R. Smith Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, United Kingdom; James Paget University Hospital NHS Foundation Trust, Gorleston, United Kingdom C.R. Davies-Husband Royal Sussex County Hospital, Surrey, United Kingdom S. Erskine Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, United Kingdom A. Clark Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, United Kingdom A. Welch Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, United Kingdom C. Hopkins Guys and St Thomas Hospital, London, United Kingdom S. Carrie Freeman Hospital, Newcastle, United Kingdom J. Ray Sheffield University Teaching Hospitals, Sheffield, United Kingdom V. Sunkaraneni Royal Surrey County Hospital, Guildford, United Kingdom N. Kara Darlington Memorial Hospital, United Kingdom N. Kumar Wrightington, Wigan and Leigh NHS Foundation Trust, United Kingdom A. Robertson Southern General Hospital, Glasgow, United Kingdom S. Anari Birmingham Heartlands Hospital, Birmingham, United Kingdom R. Almeyda Royal Berkshire Hospital, Reading, United Kingdom A. Wilson Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, United Kingdom 1891 10.4193/Rhin19.027 INTRODUCTION: Pharmacological salicylates are known to trigger respiratory exacerbations in patients with Non-Steroidal Exacerbated Respiratory Disease (N-ERD), a specific phenotype of Chronic Rhinosinusitis (CRS) and asthma. The impact of dietary sources of salicylates across subgroups of CRS is not well understood. The hypothesis is that in patients with nasal polyps present, there is likely to be a higher incidence of symptom exacerbation due to dietary salicylates regardless of any known response to pharmacological salicylate. METHODS: The Chronic Rhinosinusitis Epidemiology Study (CRES) was a questionnaire-based case-control study which sought to characterise the UK CRS population in terms of sociological, economic and medical factors. Using specific questions to examine participant responses relating to symptom exacerbation from food groups thought to be high in salicylate content, this analysis of the CRES database sought to compare an estimate of the prevalence of dietary sensitivity due to food with higher potential salicylate content across patients with CRS with (CRSwNPs) and without nasal polyposis (CRSsNPs) and with allergic fungal rhinosinusitis (AFRS). RESULTS: The CRSwNPs group were significantly more likely than controls to report symptom exacerbation due to ingestion of food groups with higher potential dietary salicylate content. The same trend was observed amongst CRSsNPs participants to a lesser degree. Reported response to the individual specific food groups wine, nuts, spicy foods, fruit and vegetables demonstrated that a statistically significant proportion of CRSwNPs and AFRS participants reported sensitivity to wine. CONCLUSIONS: This analysis suggests that there is an association between symptom exacerbation in response to food products with higher potential salicylate content, specifically wine, in CRS patients both with and without nasal polyposis when compared to controls, but especially in the CRSwNPs and AFRS phenotypes. Further studies are needed to detail if this relationship represents a causal relationship to dietary salicylate. The data present the possibility that a wider group of CRS patients may elicit salicylate sensitivity than those with known N-ERD.

International Rhinologic Society Rhinology 0300-0729 57 4 2019 8 1 31129685 Specific immunoglobulin E in nasal secretions for the diagnosis of local allergic rhinitis 313 320 EN Y. Meng Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China Y. Wang Beijing Key Laboratory of nasal diseases, Beijing Institute of Otolaryngology, Beijing 100005, China H. Lou Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China K. Wang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China N. Meng Beijing Key Laboratory of nasal diseases, Beijing Institute of Otolaryngology, Beijing 100005, China L. Zhang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China; Beijing Key Laboratory of nasal diseases, Beijing Institute of Otolaryngology, Beijing 100005, China; Department of Allergy, B C. Wang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China 1894 10.4193/Rhin18.292 BACKGROUND: The diagnostic value of serum specific Immunoglobulin E (sIgE) and nasal allergen provocation test (NAPT) has been well investigated in local allergic rhinitis (LAR). We hypothesized that nasal local sIgE could be used for the diagnosis of LAR instead of NAPT. METHODS: This was a prospective single center study. Overall, 212 chronic rhinitis patients were screened, of whom 73 were recruited based on negative findings for serum IgE and positive findings for local eosinophils. Ten healthy subjects were also recruited as controls. All participants completed questionnaires at recruitment to record their demographic data, nasal symptom severity, and physician-diagnosed comorbid asthma. Symptom severity was recorded using a visual analogue scale (VAS) of 10 cm and allergic status was assessed by serum sIgE. Nasal secretions were collected for analysis of local sIgE and eosinophils, and NAPT was performed for confirmation of LAR. RESULTS: Overall, 14 patients demonstrated positive local sIgE results. Twelve of these patients had significantly higher local sIgE levels compared to controls, and also demonstrated positive NAPT results. The VAS scores, nasal airway resistance measured by active rhinomanometry, and the levels of local sIgE, ECP, histamine and leukotriene C4 were significantly increased from baseline values following NAPT. Sensitivity, specificity, and diagnostic accuracy of local sIgE for diagnosis of LAR were 91.7% respectively. CONCLUSIONS: The measurement of local sIgE levels in nasal secretion is a reliable and effective diagnostic method for LAR.