Department of Otolaryngology, University Hospital of Foggia, Foggia, Italy.
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Acta Biomed. 2022 Aug 31;93(4):e2022249. doi: 10.23750/abm.v93i4.12200.
Allergic rhinitis (AR) and non-allergic rhinitis (NAR) belong to field of vasomotor rhinitis, characterized by nasal hyper-reactivity. Since AR and NAR are two separate nosological entities, these rhinopaties can coexist in the same patient in up to 15-20% of cases. Overlapped rhinitis (ORs) are associated with intense and persistent symptoms and are often misdiagnosed. Typically, when medical treatment fails, patients undergo turbinate surgery. We evaluated which rhinopaties are most at risk of undergoing turbinate surgery and established the percentage of ORs. Methods: The study included 120 patients undergoing turbinate surgery for turbinate hypertrophy. Anterior rhinoscopy, nasal endoscopy, nasal cytology, skin prick tests (SPT) and/or specific IgE serum assays (CAP-RAST) were performed preoperative on all patients.
Among patients with indication for turbinate surgery, 75% suffered from AR, whereas 25% of them had NAR. On closer analysis, only 7 (8%) of allergic patients presented a "pure" allergy. NAR with eosinophils and mast cells (NARESMA) represented the most common type of superimposed rhinitis (62.5%), while NAR with mast cells (NARMA) and with eosinophils (NARES) represented 25% and 12.5% of the superimposed forms, respectively.
Most of the patients undergoing turbinate surgery actually have complex forms of rhinitis. The non-allergic component of ORs often causes therapeutic failure. NARESMAs overlapping ARs are at most risk of undergoing turbinate surgery. Correctly framing a rhino-allergological patient is essential in order to guarantee the most adequate treatment. Hence the importance of introducing in clinical practice investigations, including allergy tests and nasal cytology.
变应性鼻炎（AR）和非变应性鼻炎（NAR）均属于血管运动性鼻炎范畴，其特征为鼻高反应性。由于 AR 和 NAR 是两种独立的疾病实体，这些鼻炎在同一患者中可共存，比例高达 15-20%。重叠性鼻炎（ORs）与强烈和持续的症状相关，并且经常被误诊。通常，当药物治疗失败时，患者会接受鼻甲手术。我们评估了哪些鼻炎最有可能接受鼻甲手术，并确定了 ORs 的比例。
该研究纳入了 120 例因鼻甲肥大而行鼻甲手术的患者。所有患者均接受了前鼻镜检查、鼻内镜检查、鼻细胞学检查、皮肤点刺试验（SPT）和/或特异性 IgE 血清检测（CAP-RAST）。
在有鼻甲手术指征的患者中，75%患有 AR，而其中 25%患有 NAR。进一步分析发现，仅有 7 例（8%）过敏患者表现为“纯”过敏。嗜酸性粒细胞和肥大细胞性非变应性鼻炎（NARESMA）是最常见的重叠性鼻炎类型（62.5%），而肥大细胞性非变应性鼻炎（NARMA）和嗜酸性粒细胞性非变应性鼻炎（NARES）分别占重叠性鼻炎的 25%和 12.5%。
大多数接受鼻甲手术的患者实际上患有复杂形式的鼻炎。ORs 的非变应性成分常常导致治疗失败。重叠 AR 的 NARESMAs 最有可能接受鼻甲手术。正确评估鼻过敏患者对于保证最适宜的治疗至关重要。因此，在临床实践中引入过敏测试和鼻细胞学检查非常重要。
