Comparison of the level of nasal eosinophils among the different groups (adult) of allergic rhinitis.

BACKGROUND: The nose is the part of the airway system which is most easily accessible for morphological and pathophysiological evaluation of changes occurring as a response to various stimuli.

The predominance of eosinophils in nasal secretion is considered to be intimately involved in nasal allergy. As both history and physical findings maybe equivocal in nasal allergy, the significant clinical procedure in the diagnosis of nasal allergy is to find the predominant eosinophils in nasal smear from the patient. Hansels stain is effective, fast and simple in identifying eosinophils in nasal secretions and it was used in this study. Significant statistical association between clinical evidence of nasal allergy and nasal secretion eosinophilia has been confirmed.

MATERIALS AND METHOD: Data were gathered prospectively from adult patients, 18 years old and above consulting for symptoms of Allergic Rhinitis. Only those who fulfilled the definition of allergic rhinitis were included. Variables noted were patients age, sex, type of symptoms, past and family history of allergy, nasal and peripheral eosinophilia, severity of symptoms and skin test results Nasal smears from both nostrils were taken and stained using the Hansels stain graded quantitatively based on the classification of Jalowayski et al.

RESULT: The incidence of Allergic Rhinitis was found to be higher in those with previous history of allergy, family history of atopy and more common in males. The level of eosinophils smeared from both nostrils is significantly higher in those with more severe forms of Allergy Rhinitis than in moderate with a KWH p-value of 0.004474. Levels in moderate form was significantly higher than in the mild forms with a KWH p-value of 0.000001. The eosinophil level for the mild allergic rhinitis and the control subjects was not statistically significant.

CONCLUSION: The eosinophils are numerous in the nasal secretion that appear during the allergic reaction. Their numbers are strongly correlated with the degree of symptoms. By understanding the mechanisms underlying the allergic inflammatory response, we may provide therapeutic relief to a large segment of the allergic population.

RECOMMENDATION: A good history, physical examination and a positive skin test is needed to clinically diagnose Allergic Rhinitis. In addition, nasal smears for eosinophilia is recommended to further strengthen evidence that rhinitis is secondary to an allergic reaction, especially in the local setting where skin testing for allergens is not available. Eosinophilia, suggests that a good therapeutic response may be obtained from use of topical steroids