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Eosinophilic nonallergic rhinitis, characterized by nasal eosinophilia and negative allergy tests, affects children with perennial rhinitis. Steroid treatment significantly improved symptoms in these patients.
Area of Science:
- Pediatrics
- Allergy and Immunology
- Otolaryngology
Background:
- Eosinophilic nonallergic rhinitis (ENAR) is a recently identified condition in adults with perennial rhinitis.
- Key features include nasal eosinophilia, negative allergy skin tests, and normal serum IgE.
- This study investigates ENAR in pediatric patients.
Purpose of the Study:
- To identify and characterize eosinophilic nonallergic rhinitis in children.
- To evaluate treatment responses in pediatric patients with ENAR.
Main Methods:
- Study included 12 children (aged 6-17) with severe perennial rhinitis and nasal eosinophilia.
- Patients underwent allergy skin testing and serum IgE measurement.
- Treatment involved antihistamine-decongestants initially, followed by topical or systemic steroids for non-responders.
Main Results:
- All 12 children had nasal eosinophilia and normal serum IgE.
- Antihistamine-decongestants provided partial relief in 7/12 patients.
- Topical or systemic steroids resulted in dramatic symptom improvement in the remaining 5 patients.
Conclusions:
- Eosinophilic nonallergic rhinitis is a significant cause of perennial rhinitis in children.
- Distinguishing ENAR from allergic rhinitis (negative tests) and vasomotor rhinitis (nasal eosinophilia, steroid response) is crucial.
- Increased awareness of ENAR can lead to more effective therapeutic strategies in pediatric populations.
Abstract:
Eosinophilic nonallergic rhinitis is a newly described symptom complex reported to occur in a significant percentage of adult patients who have symptoms of perennial rhinitis. They are characterized by nasal eosinophilia, negative allergy skin tests, and a normal serum immunoglobulin E concentration. Twelve children, aged 6 to 17 years, who represent the syndrome of eosinophilic nonallergic rhinitis, have been identified. All have severe perennial rhinitis and nasal eosinophilia. Physical examination revealed pale, boggy membranes with a clear nasal discharge in ten of 12 patients. All 12 patients had a normal serum IgE concentration. All patients initially received an antihistamine-decongestant preparation with subjective improvement in seven of 12 patients. The remaining five patients were placed on a regimen of either topical or systemic steroids and all five had dramatic responses with marked improvement of symptoms. The negative skin tests and normal serum IgE help distinguish this entity from allergic rhinitis, whereas the positive nasal eosinophilia and response to steroids will differentiate eosinophilic nonallergic rhinitis from vasomotor rhinitis. Eosinophilic nonallergic rhinitis is an important cause of perennial rhinitis in children and better knowledge of this entity should lead to more aggressive and efficacious therapy.