Abstract
BackgroundThe diagnosis and treatment of nonallergic rhinitis with eosinophilia syndrome (NARES) remain controversial. The aim of this study was to evaluate whether Cystatin SN together with symptoms can be used to diagnose NARES and to measure the efficiency of medical treatment. MethodsSeventy-five patients with chronic rhinitis (CR) and 18 control subjects were enrolled. Their clinical characteristics were reviewed and laboratory parameters were evaluated. The concentration of Cystatin SN in nasal secretions was determined using the enzyme-linked immunosorbent assay. The histological assessment of Cystatin SN in the nasal mucosa was conducted by hematoxylin and eosin staining. The logistic regression and receiver operating characteristic curves were used to assess the predictive value of parameters for NARES. ResultsNasal obstruction, sneezing, loss of smell, and total visual analogue scale (VAS) score were significantly different among the patients with CR. In particular, olfaction score was higher in patients with NARES than in those without NARES (AR, LAR, or IR). Similarly, the Cystatin SN level was significantly different between the control subjects and patients with CR. After treatment for 2 weeks, the Cystatin SN level and VAS score were significantly decreased in the NARES group. The accuracy of Cystatin SN together with local sIgE and loss of smell to diagnose NARES was up to 0.987 (sensitivity, 100%; specificity, 93.1%). ConclusionsCystatin SN with local sIgE and loss of smell may serve as one of the reliable and alternative biomarkers for the diagnosis of NARES and be used to evaluate disease severity and NARES treatment efficacy.
Highlights
Chronic rhinitis (CR) is defined as a symptomatic inflammation of the nasal mucosa, with morbidity as high as 30% of the total population.[1,2] CR is generally subcategorized into the following 2 phenotypes: allergic rhinitis (AR) and nonallergic rhinitis (NAR).[3,4] AR is a very common disorder worldwide and has been thoroughly studied.[5]
Consistent with the findings of a previous study,[6] the local eosinophils (LE) were positive for patients with AR, Nonallergic rhinitis with eosinophilia syndrome (NARES), and local allergic rhinitis (LAR), whereas it was negative for patients with idiopathic rhinitis (IR)
The local sIgE level was positive for patients with AR or LAR, whereas it was negative for patients with IR and NARES
Summary
Chronic rhinitis (CR) is defined as a symptomatic inflammation of the nasal mucosa, with morbidity as high as 30% of the total population.[1,2] CR is generally subcategorized into the following 2 phenotypes: allergic rhinitis (AR) and nonallergic rhinitis (NAR).[3,4] AR is a very common disorder worldwide and has been thoroughly studied.[5]. A study suggested that it could be a precursor of nasal polyps, asthma, and aspirinexacerbated respiratory disease.[11] the pathophysiology of NARES is yet to be fully understood, chronic, nonspecific liberation of histamine and chronic eosinophilic nasal inflammation have been suggested as the 2 common pathogenic factors of the disease.[10] By evaluating 20 patients with NARES, MoneretVautrin et al.,[12] revealed a three-stage development process of the disease: (1) migration of eosinophils from the vessels into nasal secretions; (2) retention of eosinophils in the mucosae, and this might be linked to activation by an unknown origin; and (3) development of nasal micropolyposis and polyposis. The aim of this study was to evaluate whether Cystatin SN together with symptoms can be used to diagnose NARES and to measure the efficiency of medical treatment
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