Division of Allergy & Immunology

New Local Rhinitis Initiative

Testing for Allergies Localized to the Nose

Nearly 50 percent of people in the United States suffer from allergies; a significant number report having nasal allergies or sinus problems. But for some patients with symptoms of allergic rhinitis – runny nose, nasal congestion – skin tests and blood work turn up negative for allergies.

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Denisa Ferastraoaru, MD

Dr. Denisa Ferastraoaru, Assistant Professor of Medicine (Allergy & Immunology) and an attending physician at Montefiore and Jacobi Medical Center, is heading up an initiative to diagnose local allergic rhinitis – a localized nasal allergic response in the absence of systemic atopy characterized by local symptoms (such as nasal congestion, itchy nose and eyes, sneezing) when exposed to the culprit environmental allergen(s).

That’s because the allergy may be localized in the nose.

In these cases, Dr. Ferastraoaru, who is also co-director of the Severe Sinusitis Clinic, identifies the allergy by performing “nasal challenges” with different enviornmental allergens. This is part of a study approved by the Institutional Review Board of Albert Einstein College of Medicine.

“Even with negative skin testing and bloodwork, some patients will get symptoms when exposed to certain environmental allergens,” said Dr. Ferarastrarou, a former Allergy & Immunology fellow at Montefiore and one of only a few allergists in New York City who offers testing for local allergic rhinitis.

Before conducting the nasal challenge, Dr. Ferastraoaru collects nasal secretions to establish a baseline of cell count and cell type.  Three different concentrations of the tested allergen are placed in the patient’s nose every 15 minutes.  The nasal challenge is positive if the patient experiences symptoms such as nasal congestion, sneezing or itching. After the challenge, the nasal secretions are collected again and the cell count and the type of the cells are compared with baseline.

“A positive nasal challenge proves that the patient is symptomatic to the tested allergen, despite negative skin testing and normal serum specific IgE in the blood,” Dr. Ferastraoaru explained.

She is currently testing patients with year-round (perennial) allergic rhinitis symptoms. The nasal challenges to dust mite, cockroach and mouse epithelia extracts are done every three or four weeks for each enrolled patient; patients must be off all medications, to avoid skewing the outcome. 

Seeking Clinical Trial Participants

Currently, Dr. Ferastraoaru and her team are enrolling patients in a clinical trial to determine the prevalence of local allergic rhinitis in the Bronx and which are the allergens involved.  

To participate in the trial, patients must have symptoms of chronic rhinitis, with negative skin test and blood work. The researchers are also seeking a control group with no nasal symptoms and negative skin tests. 

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