Moneret-Vautrin D A, Wayoff M, Hsieh V, Maria Y, Jankowski R
Service de Médecine D, Immunologie et Allergologie, CHU de Brabois, Vandoeuvre-les-Nancy.
Ann Otolaryngol Chir Cervicofac. 1989;106(1):47-50.
The NARES is a new entity in rhinology. The incidence is more than 15% among all types of rhinitis. The clinical picture is a somewhat variable nasal hyper-reactivity, with frequent hyposmia. Three cases are recorded, which fit for classical criteria of diagnosis: negative allergic tests, more than 20% of local eosinophilia. The authors point out the absence of variation of eosinophilia after nasal challenge with an extract of house dust mite D. Ptéronyssinus. Nasal endoscopy and the computerized tomography show a propensity towards micropolyposis in 2 cases. A bronchial hyper-reactivity to carbamylcholine is detected twice. A cutaneous intolerance to aspirin is proved in one case. A state of adrenergic hyper-reactivity is established in the three patients. The authors suggest that NARES is precursor of the aspirin triad. A dysfunction of the autonomic nervous system, characterized by an adrenergic hyper-reactivity, leads to a neurogenic inflammation of the nasal mucosa. Eosinophils are attracted, and infiltrate the mucosa. Then the eosinophil-derived chemical mediators maintain a chronic inflammatory state. The best therapeutical means are discussed.
非变应性鼻炎伴嗜酸性粒细胞增多综合征（NARES）是鼻科学中的一个新病种。在所有类型的鼻炎中，其发病率超过15%。临床表现为鼻腔反应性有所变化，常伴有嗅觉减退。记录了3例符合经典诊断标准的病例：变应性试验阴性，局部嗜酸性粒细胞增多超过20%。作者指出，用屋尘螨提取物进行鼻激发试验后嗜酸性粒细胞无变化。鼻内镜检查和计算机断层扫描显示2例有微息肉样变倾向。两次检测到对氨甲酰胆碱的支气管高反应性。1例证实对阿司匹林皮肤不耐受。3例患者均存在肾上腺素能高反应状态。作者认为NARES是阿司匹林三联征的前驱疾病。以肾上腺素能高反应性为特征的自主神经系统功能障碍导致鼻黏膜神经源性炎症。嗜酸性粒细胞被吸引并浸润黏膜。然后，嗜酸性粒细胞衍生的化学介质维持慢性炎症状态。文中讨论了最佳治疗方法。
