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[NARES syndrome. A developing link in the Fernand-Widal triad]
D A Moneret-Vautrin1, M Wayoff, V Hsieh
1Service de Médecine D, Immunologie et Allergologie, CHU de Brabois, Vandoeuvre-les-Nancy.
Summary
Non-allergic rhinitis with eosinophilia syndrome (NARES) affects over 15% of rhinitis cases. This condition involves nasal hyper-reactivity and may precede aspirin-induced asthma and nasal polyps.
Area of Science:
- Rhinology and Allergy
- Immunology
- Autonomic Nervous System
Context:
- Non-allergic rhinitis with eosinophilia syndrome (NARES) is an emerging clinical entity.
- It accounts for over 15% of all rhinitis cases.
- Characterized by nasal hyper-reactivity and frequent hyposmia.
Purpose:
- To describe the clinical, diagnostic, and pathophysiological features of NARES.
- To investigate the potential link between NARES and the aspirin triad.
- To explore the role of autonomic nervous system dysfunction in NARES pathogenesis.
Summary:
- Three cases of NARES meeting diagnostic criteria (negative allergy tests, local eosinophilia >20%) are presented.
- Findings include lack of eosinophil response to house dust mite, tendency for micropolyposis, bronchial hyper-reactivity, aspirin intolerance, and adrenergic hyper-reactivity.
- Pathogenesis may involve neurogenic inflammation due to autonomic dysfunction, leading to chronic eosinophilic rhinosinusitis.
Impact:
- NARES may be a precursor to the aspirin triad (asthma, nasal polyps, aspirin intolerance).
- Understanding the neurogenic inflammation mechanism in NARES can guide therapeutic strategies.
- Highlights the importance of evaluating autonomic nervous system function in refractory rhinitis.