We correlated the grade of nasal smear eosinophilia with severity of allergic rhinitis, in 50 children in a cross sectional study conducted at a tertiary care referral hospital, between August 2007 to July 2009. The grade of nasal smear eosinophilia correlated well with increasing severity of allergic rhinitis (P<0.001)(r=0.83).

Key words: Allergic rhinitis, IgE level, Nasal smear eosinophilia.

Allergic rhinitis is most prevalent during school age, affecting up to 15% of 6 to 7 year olds and 40% of 13 to 14 year olds [1]. Nasal smear eosinophilia can be graded cytologically [2]. It does not specify any allergen but can be a cost effective screening test to determine the presence or absence of allergic rhinitis [3,4]. We attempted to correlate its grade with increasing severity of allergic rhinitis.

Children with allergic rhinitis (n=50), aged 5 to 18 years from August 2007 to July 2009 were included in the study. Children with conditions mimicking allergic rhinitis like foreign body, gustatory rhinitis, drug induced rhinitis, chemical and irritant induced rhinitis, hormonal induced rhinitis, cerebrospinal rhinorrhea, and granulomatous rhinitis were excluded. Allergic rhinitis cases were diagnosed and classified on Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines [5]. The nasal smear eosinophilia was carried out on the same day after informed parental consent and graded as per standard guideline based on cytology, in grades I-V [2]. Table I shows that the grade of nasal smear eosinophilia increases with severeity of allergic rhinitis.

TABLE I



Grade of Nasal Smear Easionophilia and Class of Allergic Rhinitis

The correlation between the class of allergic rhinitis and grade of nasal smear eosinophilia, obtained using Spearman correlation, was significant (r=0.82, P<0.001).

We noted that there was an increase in nasal smear eosinophilia with the increasing severity of allergic rhinitis. The limitation of the study lies in the inability to comment on the sensitivity and specificity of the nasal smear eosinophilia due to inadequacy of the sample size. The cases were not followed up to see the response of nasal eosinophilia after treatment, thus making the reproducibility of the test questionable.

1. Strachan D, Sibbald B, Weiland S, et al. Worldwide variations in prevalence of symptoms of allergic rhino-conjunctivitis in children: the International Study of Asthma and Allergies in childhood (ISAAC). Pediatr Allergy Immunol. 1997;8:161-76.

2. Meltzer EO. Evaluating rhinitis: clinical rhinomanometric and cytological assessments. J Allergy Clin Immunol. 1988;82:900-8.

3. Cook PR, Nishioka GJ. Allergic rhinosinusitis in the pediatric population. Otolanyngol Clin North Am. 1996;29:39-56.

4. Sood A. Diagnostic significance of nasal eosinophilia in allergic rhinitis. Indian J Otolaryngol Head Neck Surg. 2005;57:13-6.