The Role of Nasal Cytology and Serum Atopic Biomarkers in Paediatric Rhinitis

Abstract

A Nasal Provocation Test allows the differentiation of allergic and non-allergic rhinitis, but it is difficult and expensive. Therefore, nasal cytology is taking hold as an alternative. We carried out a cross-sectional study, including 29 patients with persistent rhinitis according to ARIA definition and negative skin prick tests. Nasal symptoms were scored from 0 to 5 using a visual analogue scale, and patients underwent blood tests to investigate blood cell count (particularly eosinophilia and basophilia), to analyze serum total and specific IgE and eosinophil cationic protein (ECP), and to perform nasal cytology. We performed a univariate logistical analysis to evaluate the association between total serum IgE, serum eosinophilia, basophils, and ECP and the presence of eosinophils in the nasal mucosa, and a multivariate logistic model in order to weight the single variable on the presence of eosinophils to level of the nasal mucosa. A statistically significant association between serum total IgE levels and the severity of nasal eosinophilic inflammation was found (confidence interval C.I. 1.08–4.65, odds ratio OR 2.24, p value 0.03). For this reason, we imagine a therapeutic trial with nasal steroids and oral antihistamines in patients with suspected LAR and increased total IgE levels, reserving nasal cytology and NPT to non-responders to the first-line therapy.

The Impact of Eosinophil Cationic Protein on Nasal Epithelial Cells: An Investigation of Cellular Responses

“…[4] 2 Activation of the MAPKs pathway: ECP can also activate the mitochondrial-associated protein kinases (MAPKs) pathway, which promotes the expression and secretion of IL-8. [5] 3 Activation of the NLRP3 in ammasome: ECP can induce the activation of the NLRP3 in ammasome, thereby enhancing the expression and secretion of IL-8. [6] It should be noted that the above mechanisms are only some of the possible mechanisms by which ECP induces IL-8 production, and further research and validation are needed to fully understand the related mechanisms.…”

Skin, gut, and lung barrier: Physiological interface and target of intervention for preventing and treating allergic diseases

“…169 Nasal cytology can be used to support the differential diagnosis of rhinitis with and without inflammation and eosinophilia, and an association has been found between serum total IgE levels and the severity of nasal eosinophilia. 170 High nasal eosinophil levels also predict the clinical efficacy of subcutaneous immunotherapy. 171…”

“…Positive skin‐prick tests and/or serum specific IgE levels for seasonal and perennial aeroallergens are used to screen for AR, although confirmation of the diagnosis may require a nasal allergen challenge 169 . Nasal cytology can be used to support the differential diagnosis of rhinitis with and without inflammation and eosinophilia, and an association has been found between serum total IgE levels and the severity of nasal eosinophilia 170 . High nasal eosinophil levels also predict the clinical efficacy of subcutaneous immunotherapy 171 …”