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Indian Pediatr 2011;48: 329-330 |
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Correlation of Nasal Smear Eosinophilia with
Class of Allergic Rhinitis |
Sumanth Amperayani and Nagaraju Kuravi
Department of Pediatrics, Pediatric Clinical Allergy and
Immunology, Kanchi Kamakoti CHILDS Trust Hospital,
No. 12A, Nageswara Road, Nungambakkam, Chennai 600 034, India.
Email:
[email protected]
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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.
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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
Grade of
nasal |
Class of
allergic rhinitis |
smear
eosinophils
|
Mild
Intermittent |
Mild
Persistent |
Moderate to
severe intermittent |
Moderate to
severe persistent |
|
n |
% |
n |
% |
n |
% |
n |
% |
II (n=7) |
5 |
71.4 |
2 |
28.6 |
|
|
|
|
III (n=13) |
4 |
30.8 |
7 |
53.8 |
1 |
7.7 |
1 |
7.7 |
IV (n=13) |
|
|
2 |
15.4 |
11 |
84.6 |
|
|
V (n=16) |
|
|
2 |
12.5 |
1 |
6.3 |
13 |
81.3 |
VI (n=1) |
|
|
|
|
|
|
1 |
100.0 |
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.
References
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.
5. Bousquet J, Van Cauwenberge P, Khaltaev N, for the
ARIA Workshop Group. World Health Organization. Allergic rhinitis and its
impact on asthma: ARIA guidelines. J Allergy Clin Immunol.
2001;108:S147-334.
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