Leone C, Teodoro C, Pelucchi A, Mastropasqua B, Cavigioli G, Marazzini L, Foresi A
Servizio di Fisiopatologia Respiratoria, Modulo di Allergologia ed Immunopatologia Polmonare, Ospedale di Sesto San Giovanni, Italy.
J Allergy Clin Immunol. 1997 Dec;100(6 Pt 1):775-80. doi: 10.1016/s0091-6749(97)70273-2.
Nonallergic rhinitis with eosinophilia syndrome (NARES) is characterized by persistent nasal symptoms without allergy and by a marked eosinophil recruitment in the nasal cavities.
We studied whether patients with NARES had bronchial responsiveness to methacholine and airway inflammation and examined the relationship between these factors.
We selected a group of 39 patients referred to our allergy clinic for symptoms of perennial rhinitis. Atopic status was excluded by skin prick tests and RASTs. None of the patients had a history of respiratory symptoms. We preliminarily performed nasal lavage in all patients, and the diagnosis of NARES was made on the basis of the presence of at least 10% eosinophils in nasal lavage fluid. A methacholine challenge and sputum induction were also done on two different days.
Eosinophils in nasal lavage fluid ranged between 10% and 86%. Serum IgE levels were within normal range. Total circulating eosinophils ranged between 40 and 890/mm3. Methacholine PD20 values were measurable in only 18 patients (range, 0.32 to 22.56 micromol; group 1). In the remaining 21 patients, methacholine PD20 values were greater than 24 micromol (group 2). We found that differential cell counts in nasal lavage fluid in group 1 were not different from those in group 2. Methacholine PD20 values were not significantly related to any cell count in the nasal lavage fluid. Induced sputum was accomplished only in 22 patients. Eosinophils in induced sputum ranged between 0% and 56.5%. Numbers of total cells, macrophages, lymphocytes, neutrophils, and epithelial cells in the two subgroups were not different. The number of metachromatic cells tended to be higher in group 1 compared with group 2 (0.31% vs 0.05%), but the difference was not significant. The eosinophil count in the induced sputum was significantly higher in group 1 compared with group 2 (16.8% vs 3.1%; p < 0.05). In the entire population, methacholine PD20 values were significantly correlated with the number of eosinophils in sputum (r = -0.63; p < 0.001).
We showed that 46% of patients with NARES but without histories of respiratory symptoms had a measurable bronchial responsiveness. The presence of bronchial responsiveness was associated with an increased number of eosinophils in induced sputum but not with the inflammatory process in the nose.
嗜酸性粒细胞增多综合征性非变应性鼻炎（NARES）的特征是存在持续的鼻部症状但无变应性，且鼻腔中有明显的嗜酸性粒细胞募集。
我们研究了NARES患者是否对乙酰甲胆碱有支气管反应性及气道炎症，并检查了这些因素之间的关系。
我们选择了一组因常年性鼻炎症状转诊至我们过敏诊所的39例患者。通过皮肤点刺试验和放射变应原吸附试验排除特应性状态。所有患者均无呼吸道症状病史。我们首先对所有患者进行鼻腔灌洗，并根据鼻腔灌洗液中至少有10%嗜酸性粒细胞来诊断NARES。还在两个不同日期进行了乙酰甲胆碱激发试验和痰液诱导。
鼻腔灌洗液中的嗜酸性粒细胞比例在10%至86%之间。血清IgE水平在正常范围内。循环嗜酸性粒细胞总数在40至890/mm³之间。仅18例患者（范围为0.32至22.56 μmol；第1组）的乙酰甲胆碱PD20值可测量。其余21例患者的乙酰甲胆碱PD20值大于24 μmol（第2组）。我们发现第1组鼻腔灌洗液中的细胞分类计数与第2组无差异。乙酰甲胆碱PD20值与鼻腔灌洗液中的任何细胞计数均无显著相关性。仅22例患者完成了诱导痰液检查。诱导痰液中的嗜酸性粒细胞比例在0%至56.5%之间。两个亚组中的总细胞、巨噬细胞、淋巴细胞、中性粒细胞和上皮细胞数量无差异。与第2组相比，第1组中的异染细胞数量有更高的趋势（0.31%对0.05%），但差异不显著。与第2组相比，第1组诱导痰液中的嗜酸性粒细胞计数显著更高（16.8%对3.1%；p<0.05）。在整个研究人群中，乙酰甲胆碱PD20值与痰液中的嗜酸性粒细胞数量显著相关（r = -0.63；p<0.001）。
我们发现，46%无呼吸道症状病史的NARES患者有可测量的支气管反应性。支气管反应性的存在与诱导痰液中嗜酸性粒细胞数量增加有关，但与鼻部炎症过程无关。
