Bronchial responsiveness and airway inflammation in patients with nonallergic rhinitis with eosinophilia syndrome

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…It occurs in children and adults. Asthma appears to be uncommon but half of the patients show bronchial nonspecific hyperreactivity (202). It has been suggested that in some patients, NARES may represent an early stage of aspirin sensitivity (203).…”

Interpretation of the “positive” methacholine challenge

“…Studies consistently find a strong association between BHR and a history of either allergic or nonallergic rhinitis with prevalence rates sometimes in excess of 50% [Ramsdale et al, 1985;Prieto and Marin, 1990;Prieto et al, 1994;Leone et al, 1997;Okayama et al, 1998;Jang, 2002;Ciprandi et al, 2004a,b;Di Lorenzo et al, 2005]. BHR appears to increase with exposure to the offending allergen (i.e., during ''pollen season'') but is also present during the seasons when the individual is presumably not being exposed to the allergen [Ciprandi et al, 2004a,b;Di Lorenzo et al, 2005].…”

Nonallergic rhinitis with eosinophilia syndrome

“…Indeed, in about 50% of NARES patients without a history of respiratory symptoms, bronchial hyperresponsiveness is associated with an increase in the number of sputum eosinophils, but there is no correlation with the number of nasal eosinophils [13]. Some investigators have suggested that NARES is a variant of vasomotor rhinitis, and have referred to the condition as "perennial intrinsic rhinitis" [14].…”

“…In general, autonomic stimuli, such as exercise or changes in temperature, have a greater effect on patients with nonallergic rhinitis than on those with AR. In addition, the inflammatory process in NARES has been associated with increased bronchial hyperresponsiveness in a significant number of patients, despite a lack of respiratory symptoms [13]. This hyperresponsiveness is associated with an increased number of eosinophils in induced sputum, but there is no correlation with the number of eosinophils in nasal secretions [13].…”