Nasal Cytology as a Diagnostic Tool for Local Allergic Rhinitis

Abstract

Background Local allergic rhinitis (LAR) is characterized by chronic rhinitis with localized nasal allergic response to allergens in the absence of systemic immunoglobulin (IgE)-mediated disease assessed by skin prick test (SPT) or specific serum IgE level. Nasal provocation test (NPT) is the gold standard for the diagnosis of LAR. Nasal eosinophilia is a known inflammatory marker in allergic rhinitis. We hypothesized that nasal eosinophilia can be used as a screening tool for LAR. Objective To determine the applicability of nasal eosinophilia as a diagnostic tool for LAR. Methods Forty-eight perennial nonallergic rhinitis (NAR) patients with SPT negative were recruited. Nasal cytology analysis was performed. NPTs with 3 allergens (mixed mites, mixed cockroaches, and Bermuda grass) were performed to diagnose LAR. Nasal symptoms combined with nasal patency were used to determine the results of NPT. The sensitivity, specificity, positive predictive value, and negative predictive value of nasal eosinophilia as a diagnostic tool of LAR were calculated. Results LAR was diagnosed in 41.6% of the NAR patients. Nasal eosinophilia was found in 58% of the NAR patients. The sensitivity of nasal eosinophilia for diagnosing LAR was 80%, the specificity was 57.14%, the positive predictive value was 57.14%, and the negative predictive value was 80%. The most common allergen of LAR was mixed mites. Conclusion Nasal eosinophilia on nasal cytology was a good screening tool for diagnosing LAR because of its high sensitivity and simplicity of the procedure. Unfortunately, the low specificity of nasal eosinophilia makes the NPT necessary for confirmation of LAR.

Local Allergic Rhinitis: Lights and Shadows of a Mysterious Entity

“…Nasal cytology has highlighted a complex and heterogeneous landscape of NAR [4]. However, LAR does not seem to find a proper positioning in these classifications [60] because its pathogenetic aspect, consisting of local production of IgE and eosinophilia [61], tends to be confounded with an inflammatory feature, such as the one found in NAR with eosinophilia syndrome [60].…”

“…Phothijindakul et al [61] developed a diagnostic algorithm for the diagnosis of LAR in confirmed NAR patients. The algorithm proposes the use of nasal cytology as a pivotal discriminator before the utilization of NAC due to its simplicity and contained costs.…”

Skin Prick Test Versus Phadiatop as a Tool for Diagnosis of Allergic Rhinitis in Children

“…The mixed cockroach NPT was started with mixed American and German cockroach at the concentration of 1:5000 weight per volume (wt/v) and 1:1000 wt/v. 12 All the procedure for NPT was similar with Der p NPT.…”

Update in Rhinology and Allergy

“…Phothijindakul et al found nasal cytology examination for nasal eosinophilia to be a useful screening tool with high sensitivity for diagnosing local AR. 3 Hamizan et al found that patients who were older, lacked comorbid asthma, and did not have self-reported inhalant allergy triggers were more likely to be diagnosed with true non-AR. 4 Another article from Hwang et al examined bisphosphonate use and chronic osteitis as a unique pathogenic factor for CRS.…”