Allergic and nonallergic rhinitis in children: The role of nasal cytology

Abstract

Background: Nasal cytology is a diagnostic tool currently used in rhinology to study either allergic and vasomotor rhinological disorders or infectious and inflammatory rhinitis. Until the development of this method, there was a significant diagnostic problem in patients with NAR (non-allergic rhinitis), now solved by nasal cytology examination. In particular, it provided an important contribute to the definition and understanding of the pathophysiologic mechanism of allergic and non-allergic rhinitis and to the identification of new pathological entities. The advantages of nasal cytology are different: the ease of performance, the non - invasiveness allowing repetition and the low cost. It is useful to follow the disease during medical treatment by periodic cytologic controls, showing, for example, a significant reduction of inflammatory cells or the disappearance of bacteria. It's a simple and safe technique, which can be performed in outpatient setting and it is particularly feasible for application in children. Method and results: We evaluated 100 children from 2 to 15 years old. Only 59/100 subjects were classified as affected by AR after skin prick test or RAST. According to ARIA guidelines, the 59 children with AR were divided in 56 with persistent AR and just three with an intermittent form. 26/56 children had mostly seasonal symptoms associated to the prevailing allergy to grass pollen, while 30/56 children were allergic to housedust mites and molds and showed perennial symptoms. 17/59 children were monosensitised to perennial allergens, 12/59 were sensitised to seasonal allergens and 2/59 children were allergic to Betula v. and Corylus a. The other 28/59 children were poliallergic patients. 10/59 children with AR were under sublingual- specific immunotherapy (SLIT). 9/59 children with AR had a significant number of neutrophilis and eosinophilis at the nasal citology, documenting the presence of 'minimal persistent inflammation'. 10/59 AR patients showed a positive swab for bacteria. Children with NAR were 32/100. After nasal cytology, 16/32 children were classified as patients affected by NARES, 1/32 as a child with NARESMA (non-allergic rhinitis with eosinophils and mast cell) and another 1/32 as NARMA (non-allergic rhinitis with mast cell). One child with X-linked agammaglobulinemia presented nasal eosinophilia. Conclusion: In conclusion, nasal citology allowed us to correctly classify children with NAR, and was also was able to better assess the condition of children with AR.