Canakcioglu Salih, Tahamiler Rauf, Saritzali Gkioukxel, Alimoglu Yalcin, Isildak Huseyin, Guvenc Melih Guven, Acar Gul Ozbilen, Inci Ender
Cerrahpasa Medical Faculty, Otolaryngology Department, University of Istanbul, Istanbul, Turkey.
Am J Otolaryngol. 2009 Sep-Oct;30(5):312-7. doi: 10.1016/j.amjoto.2008.06.015. Epub 2009 Mar 6.
No diagnostic test had been specifically developed to diagnose nonallergic rhinitis (NAR). Also a negative nasal smear for eosinophils does not rule out the diagnosis. There is a significant diagnostic problem in patients with NAR. How can we solve this problem?
Assessment of other cells than eosinophils present in the cytogram such as basophils, neutrophils, and goblet cells may help us to classify and management of diagnostic problem of rhinitis. We sought to characterize the cellular pattern of patients with allergic rhinitis (AR) and compare them with those of NAR.
According to the skin prick test positivity or negativity, individuals were divided into AR and NAR groups, respectively. Allergic rhinitis group was further divided into seasonal, perennial, and mixed subgroups. Nonallergic rhinitis group was also divided into the following 5 subgroups according to the nasal smear cytologic result: basophilic, neutrophilic, eosinophilic, mixed, and nonallergic noninfectious type. So the frequency rates of the subgroups were calculated and also smear cytologic results were compared.
Frequency of AR was approximately equal to NAR in subjects with chronic rhinitis. Neutrophilic, eosinophilic, mixed, and nonallergic noninfectious types were the common types of NAR. An evident nasal eosinophilia was found in AR and eosinophilic NAR, whereas a higher percentage of goblet cells were determined in nonallergic noninfectious rhinitis. There is no significant difference between cytologic results from NAR and AR patients.
In the patient with positive skin test result, the presence of nasal eosinophilia strongly supports the diagnosis of AR. No diagnostic test had been specifically developed to diagnose chronic NAR. Also, a negative nasal smear for eosinophils does not rule out the diagnosis. Assessment of other cells present in the cytogram such as basophils, neutrophils, and goblet cells may also provide valuable information for differential diagnosis and management of these conditions.
尚未专门开发用于诊断非过敏性鼻炎（NAR）的诊断测试。此外，嗜酸性粒细胞鼻涂片阴性并不能排除该诊断。NAR患者存在重大的诊断问题。我们如何解决这个问题？
评估细胞涂片图中除嗜酸性粒细胞外的其他细胞，如嗜碱性粒细胞、中性粒细胞和杯状细胞，可能有助于我们对鼻炎诊断问题进行分类和管理。我们试图描述过敏性鼻炎（AR）患者的细胞模式，并将其与NAR患者的细胞模式进行比较。
根据皮肤点刺试验阳性或阴性，个体分别分为AR组和NAR组。过敏性鼻炎组进一步分为季节性、常年性和混合性亚组。非过敏性鼻炎组也根据鼻涂片细胞学结果分为以下5个亚组：嗜碱性粒细胞性、中性粒细胞性、嗜酸性粒细胞性、混合性和非过敏性非感染性类型。计算亚组的频率，并比较涂片细胞学结果。
慢性鼻炎患者中AR的频率与NAR大致相等。中性粒细胞性、嗜酸性粒细胞性、混合性和非过敏性非感染性类型是NAR的常见类型。在AR和嗜酸性粒细胞性NAR中发现明显的鼻嗜酸性粒细胞增多，而在非过敏性非感染性鼻炎中杯状细胞的百分比更高。NAR和AR患者的细胞学结果之间没有显著差异。
在皮肤试验结果为阳性的患者中，鼻嗜酸性粒细胞增多强烈支持AR的诊断。尚未专门开发用于诊断慢性NAR的诊断测试。此外，嗜酸性粒细胞鼻涂片阴性并不能排除该诊断。评估细胞涂片图中存在的其他细胞，如嗜碱性粒细胞、中性粒细胞和杯状细胞，也可能为这些疾病的鉴别诊断和管理提供有价值的信息。
