Corso Bocciolini1, Emanuele Nappi2,3, Gianmarco Giunta2,3, Giovanni Paoletti2,3, Luca Malvezzi3, Giulia Monti4, Alberto Macchi4, Luca Amorosa1, Enrico Heffler5,6. 1. UOC of Otolaryngology, Maggiore Hospital, Bologna, Italy. 2. Humanitas University, Pieve Emanuele, MI, Italy. 3. IRCCS Humanitas Research Hospital, Rozzano, MI, Italy. 4. ENT Department, ASST Sette Laghi, Varese, Italy. 5. Humanitas University, Pieve Emanuele, MI, Italy. enrico.heffler@hunimed.eu. 6. IRCCS Humanitas Research Hospital, Rozzano, MI, Italy. enrico.heffler@hunimed.eu.
Abstract
PURPOSE: Non allergic rhinitis (NAR) comprises different clinical definitions and phenotypes, including non inflammatory non allergic (NINAR) and cellular inflammatory forms. Nasal cytology, usually performed by scraping the inferior turbinate, is a non invasive, cheap and point-of-care tool to distinguish among the different NAR phenotypes, but still a relevant proportion of patients evaluated by nasal cytology receive a non precise definition of NAR phenotype. We hypothesize that collecting nasal cytology samples from middle meatus could increase the diagnostic accuracy. METHODS: Consecutive patients with chronic rhinitis without evidence of allergic sensitization were assessed for nasal cytology by means of scraping both the inferior turbinate and the middle meatus (lateral-inferior wall of the middle turbinate). RESULTS: 107 consecutive patients with NAR were enrolled in the study. According to inferior turbinate cytology, 42.1% were defined as affected by NINAR, 2.8% by bacterial rhinitis, 10.3% by non allergic rhinitis with eosinophils (NARES), 15.0% non allergic rhinitis with neutrophils (NARNE), 19.6% non allergic rhinitis with mast-cells (NARMA) and 10.3% non allergic rhinitis with eosinophils and mast-cells (NARESMA). Middle meatus cytology was in accordance with inferior turbinate cytology in only 37.6% of cases. Eosinophils and mast-cells were detectable more frequently in middle meatus samples (49.5% vs 19.6%, p < 0.01, 59.8% vs 29.9%, p < 0.01, respectively). 93.3% of NINAR patients received an inflammatory NAR phenotype at middle meatus cytology: 26.7% NARES, 24.4% NARNE, 31.1% NARMA and 11.1% NARESMA. CONCLUSION: Middle meatus cytology is more reliable than inferior turbinate cytology in phenotyping patients with NAR. Our study strengthen that nasal cytology should be implemented in clinical practice collecting samples at the middle meatus level.
PURPOSE: Non allergic rhinitis (NAR) comprises different clinical definitions and phenotypes, including non inflammatory non allergic (NINAR) and cellular inflammatory forms. Nasal cytology, usually performed by scraping the inferior turbinate, is a non invasive, cheap and point-of-care tool to distinguish among the different NAR phenotypes, but still a relevant proportion of patients evaluated by nasal cytology receive a non precise definition of NAR phenotype. We hypothesize that collecting nasal cytology samples from middle meatus could increase the diagnostic accuracy. METHODS: Consecutive patients with chronic rhinitis without evidence of allergic sensitization were assessed for nasal cytology by means of scraping both the inferior turbinate and the middle meatus (lateral-inferior wall of the middle turbinate). RESULTS: 107 consecutive patients with NAR were enrolled in the study. According to inferior turbinate cytology, 42.1% were defined as affected by NINAR, 2.8% by bacterial rhinitis, 10.3% by non allergic rhinitis with eosinophils (NARES), 15.0% non allergic rhinitis with neutrophils (NARNE), 19.6% non allergic rhinitis with mast-cells (NARMA) and 10.3% non allergic rhinitis with eosinophils and mast-cells (NARESMA). Middle meatus cytology was in accordance with inferior turbinate cytology in only 37.6% of cases. Eosinophils and mast-cells were detectable more frequently in middle meatus samples (49.5% vs 19.6%, p < 0.01, 59.8% vs 29.9%, p < 0.01, respectively). 93.3% of NINAR patients received an inflammatory NAR phenotype at middle meatus cytology: 26.7% NARES, 24.4% NARNE, 31.1% NARMA and 11.1% NARESMA. CONCLUSION: Middle meatus cytology is more reliable than inferior turbinate cytology in phenotyping patients with NAR. Our study strengthen that nasal cytology should be implemented in clinical practice collecting samples at the middle meatus level.
Authors: Dana V Wallace; Mark S Dykewicz; David I Bernstein; Joann Blessing-Moore; Linda Cox; David A Khan; David M Lang; Richard A Nicklas; John Oppenheimer; Jay M Portnoy; Christopher C Randolph; Diane Schuller; Sheldon L Spector; Stephen A Tilles Journal: J Allergy Clin Immunol Date: 2008-08 Impact factor: 10.793
Authors: Olivier Vandenplas; Denis Vinnikov; Paul D Blanc; Ioana Agache; Claus Bachert; Michael Bewick; Lars-Olaf Cardell; Paul Cullinan; Pascal Demoly; Alexis Descatha; Joao Fonseca; Tari Haahtela; Peter W Hellings; Jacques Jamart; Juha Jantunen; Ömer Kalayci; David Price; Boleslaw Samolinski; Joaquin Sastre; Longxiu Tian; Antonio L Valero; Xinyi Zhang; Jean Bousquet Journal: J Allergy Clin Immunol Pract Date: 2017-10-07
Authors: P W Hellings; L Klimek; C Cingi; I Agache; C Akdis; C Bachert; J Bousquet; P Demoly; P Gevaert; V Hox; C Hupin; L Kalogjera; F Manole; R Mösges; J Mullol; N B Muluk; A Muraro; N Papadopoulos; R Pawankar; C Rondon; M Rundenko; S F Seys; E Toskala; L Van Gerven; L Zhang; N Zhang; W J Fokkens Journal: Allergy Date: 2017-06-02 Impact factor: 13.146
Authors: E Heffler; M Landi; C Caruso; S Fichera; F Gani; G Guida; M T Liuzzo; M P Pistorio; S Pizzimenti; A M Riccio; V Seccia; M Ferrando; L Malvezzi; G Passalacqua; M Gelardi Journal: Clin Exp Allergy Date: 2018-07-09 Impact factor: 5.018
Authors: J Bousquet; W Fokkens; P Burney; S R Durham; C Bachert; C A Akdis; G W Canonica; S-E Dahlen; T Zuberbier; T Bieber; S Bonini; P J Bousquet; J L Brozek; L-O Cardell; R Crameri; A Custovic; P Demoly; R G van Wijk; M Gjomarkaj; C Holland; P Howarth; M Humbert; S L Johnston; F Kauffmann; M L Kowalski; B Lambrecht; S Lehmann; B Leynaert; K Lodrup-Carlsen; J Mullol; B Niggemann; E Nizankowska-Mogilnicka; N Papadopoulos; G Passalacqua; H J Schünemann; H-U Simon; A Todo-Bom; E Toskala; R Valenta; M Wickman; J P Zock Journal: Allergy Date: 2008-07 Impact factor: 13.146