Non-allergic rhinitis with eosinophilia syndrome (NARES) is an inflammatory disease of the nasal mucosa, non-IgE-mediated, associated with the influence of non-specific non-allergic and non-infectious triggers: meteorological, chemical, medicinal. The main clinical manifestations of non–allergic rhinitis with eosinophilic syndrome are difficulty in nasal breathing, runny nose, unexpressed sneezing. Concomitant allergic diseases are not detected, allergological tests are negative. When examining nasal secretions, an increased content of eosinophils, neutrophils and mast cells is detected. The basis of treatment is intranasal glucocorticosteroids.
Non–allergic rhinitis with eosinophilic syndrome is a non-IgE-mediated disease characterized by a nonspecific inflammatory lesion of the nasal mucosa, the main clinical manifestations are progressive nasal breathing disorder, rhinorrhea, sneezing attacks, a tendency to develop polypous rhinosinusitis and aspirin bronchial asthma. According to statistics, non–allergic rhinitis with eosinophilic syndrome accounts for about 20% of all cases of non-infectious non-allergic rhinitis. The disease was first described by R.L. Jacobs and co-authors in 1981. It is the least studied form of inflammation of the nasal mucosa.
The main causes of non–allergic rhinitis with eosinophilic syndrome have not been fully studied. It is assumed that the provoking role of adverse environmental factors (changes in temperature and humidity of atmospheric air, exhaust emissions from cars and industrial enterprises, exposure to tobacco smoke and certain medications). In addition, non–allergic rhinitis with eosinophilic syndrome can become the initial stage of the formation of hypersensitivity to nonsteroidal anti-inflammatory drugs, including aspirin, and lead to the development of aspirin bronchial asthma.
The pathological process in the nasal cavity is characterized by the development of eosinophilic inflammation, which acquires a chronic course and contributes to the appearance of hypertrophic growths (micropoliposis). There are 4 variants of the inflammatory process in non–allergic rhinitis with eosinophilic syndrome. The first is a typical variant characterized mainly by eosinophilic inflammation; the second is a variant in which mast cells mainly participate in the development of the inflammatory process; the third is non-allergic rhinitis with predominantly neutrophilic inflammation; the fourth is a mixed variant, in which eosinophils and mast cells participate in inflammation.
The clinical picture is similar to the symptoms of year-round allergic rhinitis. There is the presence of profuse watery discharge from the nose, sneezing attacks and increasing difficulties of nasal breathing. Often there is a decrease in the sense of smell up to its absence. As a rule, itching in the nasal passages with non–allergic rhinitis with eosinophilic syndrome does not bother or is poorly expressed. Symptoms tend to increase under the influence of adverse meteorological factors, in contact with pungent odors (household chemicals, perfumes, industrial emissions, etc.).
Often the general well-being is disturbed – sleep and appetite worsen, fatigue and weakness appear, and working capacity decreases. Patients suffer from frequent colds with the phenomena of rhinopharyngitis, laryngotracheitis, bronchitis. Over time, chronic polypous rhinosinusitis, laryngospasm phenomena, bronchoobstructive syndrome, sleep apnea may join.
Examination of patients with non–allergic rhinitis with eosinophilic syndrome includes the collection of anamnestic information about past diseases, phenomena of intolerance to certain organic and inorganic substances, medicines and natural environmental factors. The clinical examination involves consultations with an otorhinolaryngologist, an allergist-immunologist, an infectious disease specialist, a pulmonologist and other specialist doctors. Laboratory allergological studies and skin tests conducted in allergology are performed to exclude hypersensitivity caused by immune mechanisms. At the same time, skin testing, provocative tests and determination of the level of specific immunoglobulins of class E give a negative result.
In the clinical picture of non-allergic eosinophilic arthritis, the so-called aspirin triad may be present, including intolerance to acetylsalicylic acid or other nonsteroidal anti-inflammatory drugs, attacks of suffocation and difficulty in nasal breathing with the presence of polyps. Examination of the mucous discharge from the nasal cavity (rhinocytogram) often shows pronounced eosinophilia. Rhinoscopy reveals pallor and cyanotic mucosa of the nasal shells, the presence of polypous changes in the middle and lower nasal passages, as well as in the paranasal sinuses. During radiography and computed tomography of the paranasal sinuses, changes characteristic of sinusitis are detected. The non-allergic nature of rhinitis is evidenced by the fact that there is no effect from the use of antihistamines.
Differential diagnosis is carried out with other rhinitis (allergic, medicinal, infectious) and sinusitis of various etiologies. Unlike allergic rhinitis, eosinophilic inflammation of the nasal cavity is characterized mainly by complaints of difficulty breathing through the nose and rhinorrhea, the absence of conjunctival lesions, the connection of exacerbations with changes in climatic factors and the appearance of pungent odors, negative allergological tests and the ineffectiveness of antihistamines.
Treatment of eosinophilic rhinitis
The main drugs used for rhinitis are intranasal glucocorticosteroids with a pronounced anti-inflammatory effect (mometasone fuorate, fluticasone propionate, etc.). Sometimes leukotriene receptor inhibitors are prescribed, but the effectiveness of such drugs is low. As for antihistamines, there was no pronounced positive result when using them in patients with non–allergic rhinitis with eosinophilic syndrome. In some cases, desensitization may be used in the treatment of patients with established intolerance to acetylsalicylic acid. With severe polypous rhinosinusitis, surgical intervention is performed according to the indications.