Individualized Treatment of Allergic Rhinitis According to Nasal Cytology

Abstract

PurposeNasal cytology is important in the diagnosis and treatment of nasal inflammatory diseases. Treatment of allergic rhinitis (AR) according to nasal cytology has not been fully studied. We plan to explore the individualized treatment of AR according to nasal cytology.MethodsNasal cytology from 468 AR patients was examined for inflammatory cell quantity (grade 0-5) and the percentage of neutrophils and eosinophils. Results were subdivided into the following categories: AR(Eos), eosinophil ≥50% of the whole inflammatory cells; AR(Neu), neutrophils ≥90%; AR(Eos/Neu), 10%≤ eosinophil <50%; AR(Low), grade 0/1 inflammatory cell quantity. Nasal cytology-guided treatment was implemented: all AR(Eos) patients (n=22) and half of the AR(Neu) patients (AR[Neu1], n=22) were treated with mometasone furoate spray and oral loratadine. Another half of the AR(Neu) patients (AR[Neu2], n=22) were treated with oral clarithromycin. Visual analog scale (VAS), symptom scores, and nasal cytology were evaluated 2 weeks before and after treatment.ResultsThere were 224/468 (47.86%) AR(Eos), 67/468 (14.32%) AR(Neu), 112/468 (23.93%) AR(Eos/Neu), and 65/468 (13.89%) AR(Low) of the AR patients studied. There were no significant differences in clinical characteristics among these subgroups, except that the nasal blockage score was higher in AR(Eos) patients than in AR(Neu) patients (1.99 vs 1.50, P=0.02). Comparing AR(Eos) patients with AR(Neu1) patients 2 weeks after treatment, nasal symptoms and VAS were significantly lower in AR(Eos) patients, except for nasal blockage symptoms (P<0.05 of nasal itching and sneezing; P<0.01 for nasal secretion, total scores, and VAS). Comparing AR(Neu1) with AR(Neu2) patients, nasal symptoms, and VAS were significantly lower in AR(Neu2), except for nasal blockage and nasal itching symptoms (P<0.05 for nasal secretions, sneezing, total score, and VAS).ConclusionsNasal cytology may have important value in subtyping AR and optimizing AR treatment. Treating neutrophils is very important in AR patients with locally predominant neutrophils.

A Wide Spectrum of Autoimmune Manifestations and Other Symptoms Suggesting Immune Dysregulation in Patients With Cartilage-Hair Hypoplasia

“…In allergic rhinitis and asthma, eosinophils are recruited by pro-inflammatory cytokines and mediators and are the predominant cells in later phases of an allergic response ( 30 , 31 ). The role of neutrophils in allergic inflammation is debated, but some studies report increasing numbers in nasal cytology in patients with allergic rhinitis ( 32 – 34 ). While all five tested subjects reported recurrent or chronic symptoms of allergic rhinitis and nasal samples were collected during the peak pollen season, none had increased numbers of eosinophilic, neutrophilic or lymphocytic nasal cells.…”

The impact of allergen exposure and specific immunotherapy on circulating blood cells in allergic rhinitis

“…A recent study of nasal cytology in 468 AR patients described a neutrophils dominated (≥90%) inflammatory cell response in 14.32% and a mixed eosinophil/neutrophil (10% ≤ eosinophil < 50%) response in 23.93% of all cases. [ 88 ]. Compared to healthy controls higher neutrophil numbers are generally observed in nasal fluid of AR patients [ 49 ].…”

Different effects of allergic rhinitis on nasal mucosa remodeling in chronic rhinosinusitis with and without nasal polyps

“…Whereas, neutrophils exerts its role in remodeling by secreting remodeling mediators, such as MMPs and TGF-β in non-eosinophilic CRS [ 23 ]. AR is a Th2-skewed inflammation with high levels of IL-4, IL-13 and IL-5, and elevated inflammatory cells infiltration including EOS and neutrophils [ 24 ]. Studies suggested that AR could affect the pathogenesis of CRS and the effects could be different between distinct races.…”