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Nasal cellularity in 183 unselected schoolchildren aged 9 to 11 years
Roberto Ronchetti1, Maria Pia Villa, Susy Martella
1Department of Pediatrics, II Faculty of Medicine, University La Sapienza, Rome, Italy. ronchetti@uniroma1.it
Insights
Nasal neutrophil counts in children, while not linked to allergies, indicate inflammation. A 15-day nasal flunisolide treatment effectively reduced high neutrophil levels and improved nasal volume.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Clinical Investigation
Background:
- Rhinitis is common in children, but current severity assessment methods lack clinical significance due to variability.
- Assessing nasal cellularity offers a potential objective measure for pediatric rhinitis severity.
Purpose of the Study:
- To investigate the clinical usefulness of nasal cellularity assessment in children with rhinitis.
- To determine the correlation of nasal white cell populations with clinical history and other diagnostic findings.
Main Methods:
- 183 schoolchildren (9-11 years) provided nasal swabs for white cell counts.
- Evaluated nasal volume, allergy skin tests, lung function, and blood markers (IgE, eosinophils).
- Chlamydia pneumoniae DNA was also assessed in nasal swabs.
Main Results:
- Nasal cell percentages did not correlate with allergy history or clinical findings.
- Repeat swabs confirmed initial results in 77.4% of cases.
- Intranasal flunisolide therapy reduced nasal neutrophils and increased nasal volume in children with high counts.
Conclusions:
- Elevated nasal neutrophils are a common finding in children, independent of clinical history or lab variables.
- A 15-day course of intranasal flunisolide effectively normalizes nasal neutrophilia and improves nasal volume.
Objective:
Although rhinitis is extremely frequent in children, methods for assessing the severity of nasal inflammation produce results with wide variability and hence weak clinical significance. We designed this epidemiologic investigation to define the clinical usefulness of assessing nasal cellularity in children.
Methods:
We studied 183 of 203 eligible unselected schoolchildren who were aged 9 to 11 years and whose parents gave informed consent and completed a questionnaire on the history of atopic and respiratory symptoms. In all children, nasal swabs were obtained from both nostrils and eluted in saline and slides were prepared from cytospin preparations for staining and white cell counts. Children also underwent determination of nasal volume, skin prick tests with 7 common local allergens, flow volume curves, and nitric oxide measurement in expired air. Blood samples were drawn for the measurement of total immunoglobulin E, eosinophil percentage, and detection of Chlamydia pneumoniae antibodies. C pneumoniae DNA was also sought in eluates from nasal swabs. The percentage, standard deviations, and percentiles of the various nasal white cell populations were determined.
Results:
No correlation of the percentage of these cells was found with the history of allergies or respiratory disease or with functional or laboratory finding. Repeat nasal swabs obtained 1 month after the initial examination in 31 children (20 with neutrophils higher and 11 lower than 14%) in 77.4% of the cases confirmed the previous (high or normal) result. Twelve of the 16 eligible children with persistently high nasal neutrophil counts completed a 15-day cycle of intranasal flunisolide therapy (200 micro g twice a day). Therapy significantly reduced nasal neutrophil percentage and increased nasal volume.
Conclusions:
Increased nasal neutrophils, although related neither to the clinical history nor to laboratory variables, are a common important finding in children. A 15-day cycle of intranasal flunisolide is sufficient to restore normal nasal neutrophilia.