Abstract
BackgroundThe pathogenesis of non-allergic rhinitis (NAR) is still largely unknown. Furthermore, it is unclear whether there is a correlation between the effect of nasal glucocorticoids on nasal inflammation and on nasal symptoms and quality of life.MethodsIn this pilot study we recruited 12 healthy subjects and 24 patients with recently diagnosed persistent NAR [12 untreated and 12 under regular treatment with nasal fluticasone furoate (two sprays of 27.5 μg each in each nostril once daily, total daily dose = 110 μg) for at least 20 days]. Each subject filled a mini rhinoconjunctivitis quality of life questionnaire (mini RQLQ). Nasal scrapings were obtained from each subject and used to prepare slides for Diff-Quik and immunocytochemical staining for inflammatory and epithelial cells count, MUC5AC expression and the general pro-inflammatory transcription factor nuclear factor kB (NF-kB) activation.ResultsThe nasal score of the mini RQLQ, the number of nasal inflammatory cells (neutrophils, eosinophils) and the number of goblet cells are significantly higher in untreated patients with persistent NAR compared with control subjects and treated NAR patients. The percentage of MUC5AC+ nasal epithelial cells is significantly increased in untreated patients with persistent NAR compared with the control subjects (41.8 ± 6.4 vs 22.3 ± 4.8, respectively; p = 0.0403) without significant differences between control subjects and patients with persistent NAR on regular fluticasone furoate treatment (33.9 ± 5.0 %; p = 0.0604) nor between the 2 groups of persistent NAR subjects (p = 0.3260). The number of cytosolic and/or nuclear p65+ nasal epithelial and inflammatory cells was not significantly different between the three groups.ConclusionsPatients with persistent untreated NAR, compared with normal control subjects and patients with persistent NAR under regular treatment with nasal fluticasone furoate by at least 20 days, have more nasal symptoms, worst quality of life and an increased number of nasal inflammatory cells (neutrophils, eosinophils), goblet cells and MUC5AC+ nasal epithelial cells. This nasal inflammation seems unrelated to NF-kB activation.
Highlights
The pathogenesis of non-allergic rhinitis (NAR) is still largely unknown
Patients with persistent untreated NAR, compared with normal control subjects and patients with persistent NAR under regular treatment with nasal fluticasone furoate by at least 20 days, have more nasal symptoms, worst quality of life and an increased number of nasal inflammatory cells, goblet cells and mucin 5 AC (MUC5AC)+ nasal epithelial cells. This nasal inflammation seems unrelated to nuclear factor kB (NF-kB) activation
The total mini RQLQ score was significantly increased in the patients with untreated persistent NAR compared both to the control normal subjects and the patients with persistent NAR under regular treatment with fluticasone furoate (FF)
Summary
The pathogenesis of non-allergic rhinitis (NAR) is still largely unknown. It is unclear whether there is a correlation between the effect of nasal glucocorticoids on nasal inflammation and on nasal symptoms and quality of life. When allergy has not been proven by proper allergy examination (history, skin prick testing, measurement of serum specific IgE antibodies) [1]. This definition can be narrowed by allowing only chronic conditions to be included and, by excluding acute viral and acute bacterial infections [1]. The aim of this study was to investigate, using nasal cytology, inflammatory cell counts, the activation of the general pro-inflammatory transcription factor nuclear factor kB (NF-kB) and the expression of MUC5AC (the main secretory mucin expressed on the surface of the nasal epithelium), in patients with untreated persistent
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