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Nasal histamine responses in nonallergic rhinitis with eosinophilic syndrome.

Zambetti G, Ciofalo A, Romeo R, Soldo P, Fusconi M, Greco A, Magliulo G, de Vincentiis M - Allergy Rhinol (Providence) (2015)

Bottom Line: This correlation improved when using the composite symptom score.Unlike controls, a significant correlation was observed between the increase in MCT and TNR.In NARES, nonspecific nasal hyperreactivity is the result of epithelial damage produced by eosinophilic inflammation, which causes MCT slow down, an increase in TNR, and nasal reactivity classes, with possible impact on classification, prognosis, and treatment control.

View Article: PubMed Central - PubMed

Affiliation: Rhinology and Immuno-Allergy Unit, Sense Organs Department, Otolaryngology Section, Rome "Umberto I" General Hospital, "La Sapienza" University, Rome, Italy.

ABSTRACT

Background: Nonallergic rhinitis with eosinophilic syndrome (NARES) is persistent, without atopy, but with ≥25% nasal eosinophilia. Hypereosinophilia seems to contribute to nasal mucosa dysfunction.

Objectives: This analytical case-control study aimed at assessing the presence and severity of nonspecific nasal hyperactivity and at finding out whether eosinophilia may be correlated with the respiratory and mucociliary clearance functions.

Materials: The symptom score was assessed in 38 patients and 15 controls whose nasal smear was also tested for eosinophils and mucociliary transport (MCT). Nonspecific nasal provocation tests (NSNPT) with histamine were also carried out, and total nasal resistance (TNR) was determined.

Results: The symptom score of NARES after NSNPT were not significantly different from the control group, and there was poor or no correlation among the single symptoms and the differences studied for every nasal reactivity class. This correlation improved when using the composite symptom score. The most severe eosinophilia was observed in high reactivity groups, and it was correlated with an increase in TNR. MCT worsened as eosinophilia and nasal reactivity increased. Unlike controls, a significant correlation was observed between the increase in MCT and TNR.

Conclusions: In NARES, nonspecific nasal hyperreactivity is the result of epithelial damage produced by eosinophilic inflammation, which causes MCT slow down, an increase in TNR, and nasal reactivity classes, with possible impact on classification, prognosis, and treatment control.

No MeSH data available.


Related in: MedlinePlus

Reactivity classes for the nasal obstruction symptom in patients with NARES after NSNPT with histamine. Data are presented as medians with 75% confidence intervals. The percentage of patients observed in each nasal reactivity classes is reported.
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Figure 2: Reactivity classes for the nasal obstruction symptom in patients with NARES after NSNPT with histamine. Data are presented as medians with 75% confidence intervals. The percentage of patients observed in each nasal reactivity classes is reported.

Mentions: The nasal response to NSNPT with histamine in the two groups, which was measured based on the symptom score, is shown in Fig. 1. The data are expressed as median values with 75% confidence intervals. The comparison of data referred to the symptom score obtained after and before the NSNPT with histamine has not allowed differentiation of the NARES from the control groups. Only the symptom of sneezing reached a reduced statistical significance (p = 0.02). In the NARES, the index of correlation between the score of single symptoms and the TNR, MCT, and the eosinophilia for each reactivity nasal class did not reach, or reached only for some symptoms, low levels of correlation, which, however, improved when using the composite symptom score (r, from 0.75 to 0.87) (Table 1). The median values with 75% confidence intervals for the nasal obstruction symptom score after NSNPT with histamine in the NARES group are shown in Fig. 2. Such values were compared with those of TNRs and then were matched with the nasal reactivity classes obtained after nasal provocation, thus showing that 39% of patient showed very high reactivity, 37% showed high reactivity, 21% showed medium reactivity, and 3% showed low reactivity. The differences among the nasal reactivity classes so obtained were significant, that is, p = 0.0001 between strong and consistent reactivity and p = 0.002 between consistent and moderate reactivity. As to the controls, 20% of them showed low reactivity and 80% did not show any reactivity after NSNPT.


Nasal histamine responses in nonallergic rhinitis with eosinophilic syndrome.

Zambetti G, Ciofalo A, Romeo R, Soldo P, Fusconi M, Greco A, Magliulo G, de Vincentiis M - Allergy Rhinol (Providence) (2015)

Reactivity classes for the nasal obstruction symptom in patients with NARES after NSNPT with histamine. Data are presented as medians with 75% confidence intervals. The percentage of patients observed in each nasal reactivity classes is reported.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541641&req=5

Figure 2: Reactivity classes for the nasal obstruction symptom in patients with NARES after NSNPT with histamine. Data are presented as medians with 75% confidence intervals. The percentage of patients observed in each nasal reactivity classes is reported.
Mentions: The nasal response to NSNPT with histamine in the two groups, which was measured based on the symptom score, is shown in Fig. 1. The data are expressed as median values with 75% confidence intervals. The comparison of data referred to the symptom score obtained after and before the NSNPT with histamine has not allowed differentiation of the NARES from the control groups. Only the symptom of sneezing reached a reduced statistical significance (p = 0.02). In the NARES, the index of correlation between the score of single symptoms and the TNR, MCT, and the eosinophilia for each reactivity nasal class did not reach, or reached only for some symptoms, low levels of correlation, which, however, improved when using the composite symptom score (r, from 0.75 to 0.87) (Table 1). The median values with 75% confidence intervals for the nasal obstruction symptom score after NSNPT with histamine in the NARES group are shown in Fig. 2. Such values were compared with those of TNRs and then were matched with the nasal reactivity classes obtained after nasal provocation, thus showing that 39% of patient showed very high reactivity, 37% showed high reactivity, 21% showed medium reactivity, and 3% showed low reactivity. The differences among the nasal reactivity classes so obtained were significant, that is, p = 0.0001 between strong and consistent reactivity and p = 0.002 between consistent and moderate reactivity. As to the controls, 20% of them showed low reactivity and 80% did not show any reactivity after NSNPT.

Bottom Line: This correlation improved when using the composite symptom score.Unlike controls, a significant correlation was observed between the increase in MCT and TNR.In NARES, nonspecific nasal hyperreactivity is the result of epithelial damage produced by eosinophilic inflammation, which causes MCT slow down, an increase in TNR, and nasal reactivity classes, with possible impact on classification, prognosis, and treatment control.

View Article: PubMed Central - PubMed

Affiliation: Rhinology and Immuno-Allergy Unit, Sense Organs Department, Otolaryngology Section, Rome "Umberto I" General Hospital, "La Sapienza" University, Rome, Italy.

ABSTRACT

Background: Nonallergic rhinitis with eosinophilic syndrome (NARES) is persistent, without atopy, but with ≥25% nasal eosinophilia. Hypereosinophilia seems to contribute to nasal mucosa dysfunction.

Objectives: This analytical case-control study aimed at assessing the presence and severity of nonspecific nasal hyperactivity and at finding out whether eosinophilia may be correlated with the respiratory and mucociliary clearance functions.

Materials: The symptom score was assessed in 38 patients and 15 controls whose nasal smear was also tested for eosinophils and mucociliary transport (MCT). Nonspecific nasal provocation tests (NSNPT) with histamine were also carried out, and total nasal resistance (TNR) was determined.

Results: The symptom score of NARES after NSNPT were not significantly different from the control group, and there was poor or no correlation among the single symptoms and the differences studied for every nasal reactivity class. This correlation improved when using the composite symptom score. The most severe eosinophilia was observed in high reactivity groups, and it was correlated with an increase in TNR. MCT worsened as eosinophilia and nasal reactivity increased. Unlike controls, a significant correlation was observed between the increase in MCT and TNR.

Conclusions: In NARES, nonspecific nasal hyperreactivity is the result of epithelial damage produced by eosinophilic inflammation, which causes MCT slow down, an increase in TNR, and nasal reactivity classes, with possible impact on classification, prognosis, and treatment control.

No MeSH data available.


Related in: MedlinePlus