Allergy Asthma Immunol Res.  2017 Sep;9(5):403-409. 10.4168/aair.2017.9.5.403.

Individualized Treatment of Allergic Rhinitis According to Nasal Cytology

Affiliations
  • 1Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. entwjkong@hust.edu.cn
  • 2Division of Allergy, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.

Abstract

PURPOSE
Nasal 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.
METHODS
Nasal 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.
RESULTS
There 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).
CONCLUSIONS
Nasal cytology may have important value in subtyping AR and optimizing AR treatment. Treating neutrophils is very important in AR patients with locally predominant neutrophils.

Keyword

Nasal cytology; neutrophils; allergic rhinitis

MeSH Terms

Clarithromycin
Diagnosis
Eosinophils
Humans
Loratadine
Mometasone Furoate
Nasal Obstruction
Neutrophils
Pruritus
Rhinitis, Allergic*
Sneezing
Visual Analog Scale
Clarithromycin
Loratadine
Mometasone Furoate

Figure

  • Fig. 1 The typical slides of different cell distributions in AR. (A) AR(Eos): eosinophils ≥50% of whole inflammatory cells. (B) AR(Eos/Neu): 10%≤ eosinophils <50% of whole inflammatory cells. (C) AR(Neu): eosinophils <10% of the whole inflammatory cells. (D) AR(Low): grade 0 or grade 1 inflammatory cell quantity. AR, allergic rhinitis.

  • Fig. 2 The flow diagram of treatment of AR according to nasal cytology. AR, allergic rhinitis.

  • Fig. 3 Changes in nasal symptoms in the AR(Eos), AR(Neu1), and AR(Neu2) groups before and after treatment. (A) VAS. (B) Nasal blockage. (C) Nasal itching. (D) Nasal secretion. (E) Sneezing. (F) Total scores. AR, allergic rhinitis; VAS, visual analog scale. *P<0.05; †P<0.01.

  • Fig. 4 Changes in nasal cytology in the AR(Eos), AR(Neu1), and AR(Neu2) groups before and after treatment. (A) Neutrophils. (B) Eosinophils. (C) Inflammatory cells grade. AR, allergic rhinitis. *P<0.05; †P<0.01.


Cited by  1 articles

The Relevance of Nasal Cytology in the Workup of House Dust Mite-Induced Allergic Rhinitis
Matteo Gelardi, Paola Puccinelli, Cristoforo Incorvaia, Giovanni Passalacqua, Giorgio Ciprandi,
Allergy Asthma Immunol Res. 2018;10(3):283-284.    doi: 10.4168/aair.2018.10.3.283.


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