Non-allergic rhinitis with eosinophilia syndrome is not associated with local production of specific IgE in nasal mucosa

Abstract

Non-allergic rhinitis with eosinophilia syndrome (NARES) is an eosinophilic inflammation of the nasal mucosa without evidence of an allergy or other nasal pathologies. Patients complain about perennial symptoms like nasal obstruction, rhinorrhea, itchiness and sneezing of the nose sometimes accompanied by hyposmia. The aim of the study was to better characterize NARES patients using immunoassay-biochip technology to examine serum and nasal secretion. Sera and nasal secretion of patients with NARES (perennial nasal symptoms, no evidence of acute or chronic rhinosinusitis with or without polyps, negative SX1-Screening test and/or negative skin prick test, eosinophilic cationic protein in nasal secretion >200 ng/ml) were tested by immunoassay-biochip technology (ImmunoCAP(®) ISAC, Phadia). 112 different allergen components from 51 allergen sources were tested on the chip. Furthermore, serum and nasal secretion were tested for specific IgE to Staphylococcus aureus enterotoxin TSST-1 by fluorescence-enzyme-immunoassay (UniCAP(®), Phadia). Unrecognized systemic sensitization could be ruled out by negative ISAC results in sera of all patients. Testing of nasal secretion for allergen-specific IgE by ISAC chip technology was negative as well in all cases. In one patient, a systemic sensitization to Staphylococcus aureus superantigen TSST-1 was detectable but no allergen-specific IgE to TSST-1 was measurable in nasal secretion of any patient. The results demonstrate that NARES is not associated with local allergy (entopy) nor with a local inflammation driven by Staphylococcus aureus enterotoxin TSST-1. Further studies are necessary to better understand the underlying mechanisms of NARES.

Allergen endotoxins induce T-cell–dependent and non–IgE-mediated nasal hypersensitivity in mice

“…10 Some patients with authentic NAR, who really do not have allergen-specific IgE, even show nasal infiltration of inflammatory cells. [12][13][14][15] This NAR with inflammation can be further classified into differential subtypes, such as NAR with eosinophilia syndrome or NAR with neutrophils, on the basis of infiltrating cell types. [12][13][14][15] Among them, our mouse model best resembled NAR with eosinophilia syndrome: nasal eosinophilic inflammation with IgE-independent rhinitis symptoms.…”

“…11 Although NAR is not considered an allergy, some patients with NAR show nasal infiltration of inflammatory cells including neutrophils, eosinophils, and mast cells that suggests local activation of innate and/or adaptive immunity. [12][13][14][15] In addition, histamine, a major mediator of type 1 allergic reactions, is involved in the disease symptoms, because antihistamines are often effective in patients with NAR. 11 Thus, the nasal symptoms of NAR with inflammation might be an immune-mediated hypersensitivity reaction.…”

A Precision Medicine Approach to Rhinitis Evaluation and Management

“…ECP levels in nasal secretions can be used to monitor eosinophilic inflammation in different kinds of rhinitis with eosinophilic involvement, and they constitute an indicator of the efficacy of treatment [44]. NARES is not associated with local allergy (entopy) nor with a local inflammation driven by Staphylococcus aureus enterotoxin [45].…”

Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

“…Under this limited perspective, all the other variants of NAR could be defined as non-NARES. Actually, nasal cytology suggested that the situation is more complex than two variants of NAR[73]; moreover, very recent evidences suggested that also NARES might recognize immunological mechanisms other than entopy[74]. Gelardi et al[73] described at least four cytological patterns of NAR (Figure 1): (1) NAR with eosinophils (NARES); (2) NAR with mast cells (NARMA); (3) NAR with neutrophils (NARNE); and (4) NAR with eosinophils and mast cells (NARESMA).…”