Clinical predictors of nasal secretory cell quantities in allergy clinic patients.

Abstract

Nasal cytograms are useful in evaluating patients with inflammatory disease of the nose and paranasal sinuses. When mucosal samples are taken with curette and brush devices, significant numbers of non-leukocytic cells can also be analyzed. To examine two specific morphologic variations in granule-containing epithelial cells in nasal samples obtained from allergy clinic patients and describe their clinical associations. These two cellular variants consisted of goblet cells, with coalesced granules usually displacing the nucleus, and discrete granular mucinous cells (DGMC), which show more discrete granules not displacing the nucleus. Patients from an adult allergy clinic were studied prospectively for nasal mucosal cytology, historical clinical data, nasal physical findings, serum IgE levels, and aeroallergen-specific IgE. Proportions and absolute numbers of goblet cells and DGMC in the nasal mucosal samples were related to other data using simple and multivariate analyses. Both goblet cells and DGMC showed absolute number increases in patients with observable nasal secretions. Discrete granular mucinous cell decreases were also observed in patients with IgE levels greater than or equal to 200 IU/mL and in asthmatic patients. In non-asthmatic patients with nasal eosinophilia, a significantly greater proportion of DGMC was observed compared with other patients (19.8 +/- 11.9% versus 8.5 +/- 5.9%, P = .007), while asthmatics with nasal eosinophilia had mean DGMC quantities closer to that observed in patients without nasal eosinophilia. Increases in goblet cell numbers were observed in patients with specific IgE to aeroallergens compared with other patients (46.5 +/- 46.7 versus 27.0 +/- 23.9, P = .014). Multivariate analysis confirmed that (1) the presence of aeroallergen-specific IgE and (2) the presence of nasal eosinophilia in the absence of asthma were differentially associated with increases in goblet cells and DGMC, respectively. Increases in nasal DGMC and goblet cells differentially relate to specific clinical patterns of nasal cellular inflammation and aeroallergen hypersensitivity. The nasal epithelial cell profile associated with nasal eosinophilia in asthmatics may differ from that observed in non-asthmatic nasal eosinophilia.