BRONCHIAL RESPONSIVENESS AND AIRWAY INFLAMMATION IN PATIENTS WITH NONALLERGIC RHINITIS WITH EOSINOPHILIA SYNDROME

Background: Nonallergic rhinitis with eosinophilia syndrome (NARES) is characterized by persistent nasal symptoms without allergy and by a m arked eosinophil recruitment in the nasal cavities. Objective: We stud ied whether patients with NARES had bronchial responsiveness to methac holine and airway inflammation and examined the relationship between t hese factors. Methods: We selected a group of 39 patients referred to our allergy clinic for symptoms of perennial rhinitis. Atopic status w as excluded by skin prick tests and RASTs. None of the patients had a history of respiratory symptoms. We preliminarily performed nasal lava ge in all patients, and the diagnosis of NARES was made on the basis o f the presence of at least 10% eosinophils in nasal lavage fluid. A me thacholine challenge and sputum induction were also done on two differ ent days. Results: Eosinophils in nasal lavage fluid ranged between 10 % and 86%. Serum IgE levels were within normal range. Total circulatin g eosinophils ranged between 40 and 890/mm(3). Methacholine PD20 value s were measurable in only 18 patients (range, 0.32 to 22.56 mu mol; gr oup 1). In the remaining 21 patients, methacholine PD20 values were gr eater than 24 mu mol (group 2). We found that differential cell counts in nasal lavage fluid in group 1 were not different from those in gro up 2. Methacholine PD20 values were not significantly related to any c ell count in the nasal lavage fluid. Induced sputum was accomplished o nly in 22 patients. Eosinophils in induced sputum ranged between 0% an d 56.5%. Numbers of total cells, macrophages, lymphocytes, neutrophils , and epithelial cells in the two subgroups were not different. The nu mber of metachromatic cells tended to be higher in group 1 compared wi th group 2 (0.31% vs 0.05%), but the difference was not significant. T he 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 wi th the number of eosinophils in sputum (r = -0.63; p < 0.001). Conclus ion: We showed that 46% of patients with NARES but without histories o f 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.