In allergic rhinitis there is good epidemiological and basic scientific evidence that there is an inherited genetic component that is responsible (Moffat et al., 1994; Jones et al., 1998b). However, why do 15.5% of asymptomatic people who have a positive skin-prick test not develop any allergic symptoms (Droste et al., 1996) (Fig. 16.3), and not all those with a raised IgE have symptoms of rhinitis (Panzani et al., 1993) (Fig. 16.4)? In another study of skin-prick tests, 18% of children changed over a 2-year period (Droste et al., 1996). An understanding of the normal course of these processes may help us to influence our immune status and suppress the excessive response to some foreign antigens that leads to the symptoms of allergic rhinitis.
In summary, research on the pathogenesis of all the forms of rhinosinusitis and a better understanding of their etiology and inflammatory mechanisms should lead to advances in the treatment of our patients.
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