The epidemiologic relationship of clinical nasal allergy to eosinophils and to goblet cells in the nasal smear

Clinical Importance of Eosinophil Count in Nasal Fluid in Patients with Allergic and Non-Allergic Rhinitis

“…Therefore, it is applicable only in specialist centers (1)(2)(3)(5)(6). Although these approaches have been widely used in the limited research setting, they have been less widely applied as a means of objectively monitoring nasal disease in the clinical trial and/or in real-life clinical practice setting (14)(15)(16)(17).…”

“…However, few prospective studies evaluating the diagnostic utility of nasal cytology in allergic rhinitis have been performed (14)(15)(16)(17).…”

The Nasal Smear for Eosinophils

“…The groups were defined as follows: (1) seasonal allergic rhi¬ nitis: children who experienced at least one of the symptoms and one of the signs listed in Table 1 either seasonally or perennially with seasonal exacerbations, and who had one or more positive skin tests for trees, grasses, or ragweed consistent with the seasonal occurrence of symptoms; (2) pe¬ rennial rhinitis and negative skin tests: children who experienced chronically at least one of the symptoms and one of the signs listed in Table 1, but who had negative skin tests for allergens and no clinical signs of nasal infection or roentgenographic find¬ ings suggesting adenoidal obstruction of the nasopharyngeal airway (this combina¬ tion of findings is often considered indica¬ tive of vasomotor rhinitis); (3) nonallergic controls: children with none of the symp¬ toms or signs listed in Table 1 and with negative skin tests for allergens.…”

“…Slides were scanned microscopically across from left to right in the upper, middle, and lower thirds and read for (1) mucus and debris (gross, moderate, scant, or inadequate); (2) polymorphonuclear leu¬ kocytes (many, few, or none); (3) bacteria (many, few, or none); and (4) eosinophils (estimated as 0% to 3%, 4% to 25%, 26% to 50%, 51% to 75%, or 76% to 100%, depend- ing on the estimated ratio of eosinophils to total number of leukocytes). A slide was considered positive if the estimated per¬ centage of eosinophils was 4% or more.…”

“…He sub¬ divided the disease into three catego¬ ries: (1) allergy demonstrated; (2) allergy not demonstrated, nasal eosinophilia; and (3) allergy not dem¬ onstrated, no eosinophilia. He the¬ orized that patients in the second cate¬ gory might be sensitive to unidentified allergens or substances, whereas those in the third category might have nasal hyperactivity due to autonomie imbalance.…”