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Wise et al.

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The prevalence of “food-induced rhinitis” seems to be under 1%. 157 While rhinitis may frequently be observed as part of systemic IgE-mediated food allergy reaction, it is rarely the only presenting symptom. In a double-blind, placebo-controlled food challenge study of 480 children, 185 children (39%) experienced ocular and upper respiratory symptoms, but only 5% had symptoms confined to the upper respiratory tract alone. 158 Patients with pollen-food allergy syndrome (PFAS), also referred to as oral allergy syndrome (OAS), often experience oropharyngeal itching, tingling, and/or mild swelling of the lips, tongue, palate, and throat, and less commonly AR symptoms, after ingestion of certain raw fruits and vegetables. The assessed prevalence of this disorder ranges from 5% to 17%, and it affects up to one-half of pollen-allergic patients. 159-161 It occurs in individuals who are sensitized to pollen aeroallergens through the respiratory tract, which then predisposes them to clinical symptoms of PFAS after ingestion of cross-reactive, heatlabile food proteins of plant origin. Because the antigens are heatlabile, patients are usually able to tolerate cooked forms of the causative fruits and vegetables. 162 (See section X.E. Associated conditions - Food allergy and pollen-food allergy syndrome (PFAS) for additional information on this topic.) Alcohol-induced rhinitis.: Nasal symptoms can also occur after alcohol consumption. 163,164 However, very little is known about the prevalence and presentation of alcohol induced nasal symptoms. Additionally, there is a paucity of information about the relationship between alcohol-induced nasal symptoms and other diseases, such as AR, nasal polyposis, asthma, and other chronic lower airway diseases. 165 Airway symptoms are predominantly initiated by inhaled components that contact the airway mucosal membrane. However, several forms of rhinitis and asthma may not operate through this mechanism. One such example is known as alcohol-induced asthma. In these patients, alcoholic beverages, particularly red and white wines, have been shown to trigger bronchial symptoms. 163,166,167 Alcohol-induced nasal symptoms are about twice as common in females as in males, 165 but the basis for this predilection is not well understood. 168-170 Nasal congestion is the predominant symptom, and red wine is the most common alcoholic beverage to elicit symptoms. Additionally, wine, particularly red, is also the most widely recognized trigger of alcohol-induced bronchial symptoms. 163 Finally, direct alcohol utilization has also been associated with a trend toward developing SPT positivity, 171 and with increased serum total IgE (tIgE) levels. 172 III.C.9. Non-allergic rhinitis with eosinophilia syndrome (NARES)— Non allergic rhinitis with eosinophilia syndrome (NARES) is a clinical disorder comprising symptoms consistent with PAR in which an absence of atopy has been demonstrated, and eosinophilia is found on nasal cytology. 173 The pathophysiology of NARES is not well understood, but a key component involves an eosinophilic, self-perpetuating inflammation, with nonspecific histamine release. It is the most common type of inflammatory NAR, and was first described in 1981 by Jacobs et al. 174

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Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.