Published: 2022-06-24

A clinic-corelative observational study on nasal smear eosinophilia in allergic rhinitis verses non-allergic rhinitis

Rukma Bhandary, Chitra R. S., Mahesh S. G., Devan P. P., Deepalakshmi ., Vishwas Pai


Background: Diagnostic nasal cytology has been used in distinguishing allergic from nonallergic rhinitis.

Methods: We sought to determine prospectively the frequency of nasal eosinophilia in 100 patients in whom having allergic rhinitis, nonallergic rhinitis, and other atopic conditions not involving the respiratory tract have been diagnosed. A nasal smear was obtained from consenting adults using the rhino-probe curette. Patients taking local or systemic corticosteroids, those with chronic rhinitis associated with aspirin sensitivity, and those with sinusitis were excluded. All cytograms were coded and read by a single ‘blinded’ investigator. NE was considered significant if greater than 20% of sampled cells were eosinophils.

Results: 28 of 50 (56%) patients were with AR had NE. No NE was detected in the control population or in the skin test negative group of patients in whom having nonallergic rhinitis was diagnosed. One of 36 patients with allergic disease not involving the respiratory tract exhibited NE; this patient had atopic dermatitis with peripheral eosinophilia. No cases of eosinophilic nonallergic rhinitis were detected. There was no significant correlation of symptoms or the number of positive skin tests with NE.

Conclusions: These data suggest that the nasal smear for eosinophils is an insensitive but specific test for the diagnosis of allergic rhinitis, when patients with nasal polyposis and aspirin sensitivity and/or negative skin tests are excluded.


Allergic rhinitis, Non-allergic rhinitis, Nasal eosinophilia, Diagnostic nasal cytology

Full Text:



Beasley R. The international study of asthma and allergies in childhood (ISAAC) steering committee. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema: ISAAC. The international study of asthma and allergies in childhood (ISAAC) steering committee. Lancet. 1998;351:1225-32.

Varney VA, Jacobson MR, Sudderick RM. Immunohistology of the nasal mucosa following allergen- induced rhinitis: Identification of activated T lymphocytes, eosinophils and neutrophils. Am Rev Respir Dis. 1992;146:170-6.

Chanda R, Aggarwal AK, Kohli GS, Jaswal TS, Gupta KB. Comparative study of nasal smear and biopsy in patients of allergic rhinitis. Indian J Allergy Asthma Immunol. 2002;16(1):27-31.

Wright AL, Holberg CJ, Martinez FD, Halonen M, Morgan W, Taussig LM. Epidemiology of physician-diagnosed allergic rhinitis in childhood. Pediatrics. 1994;94:895-901.

Meltzer EO. The prevalence and medical and economic impact of allergic rhinitis in the United States. J Allergy Clin Immunol. 1997;99:805-28.

Dykewicz MS, Fineman S, Skoner DP. Diagnosis and management of rhinitis: Complete guidelines of the joint task force on practice parameters in allergy, asthma and immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol. 1998;81:478-518.

Howarth PH. Eosinophils and rhinitis. Clin Exp Allergy. 2005;5:55-63.

Lim MC, Taylor RM, Naclerio RM. The histology of allergic rhinitis and its comparison to cellular changes in nasal lavage. Am J Resp Crit Care Med. 1995;151: 136-44.

Tveld CD, Garrelds IM, Koenders S, Vanwijk RG. Relationship between nasal hyperactivity, mediators and eosinophils in patients with perennial allergic rhinitis and controls. Clin Exp Allergy. 1996;26:903-8.

Bhadari CM, Baldwa VS. Relative value of peripheral blood, secretion and tissue eosinophilia in the diagnosis of different patterns of allergic rhinitis. Ann Allergy. 1976;37:280-4.

Elkhalil M, Fiore L, Bellioni P, Cantani A, Corgiolu M, Businco L. Evaluation of nasal and blood eosinophilia in children suffering from perennial allergic rhinitis treated with beclomethasone dipropionate. Allergol Immunopathol. 1983;11:225-8.

Bradding P, Feather IH, Wilson S, Bardin P, Holgate ST, Howarth PH. Immunolocalisation of cytokines in the nasal mucosa of normal and perennial rhinitis subjects: The mast cell as a source of IL-4, IL-5 and IL-6 in human allergic inflammation. J Immunol. 1993;151:3853-65.

Bradding P, Feather IH, Wilson S, Holgate ST, Howarth PH. Cytokine immunoreactivity in seasonal rhinitis: Regulation by a topical corticoid. Am J Respir Crit Care Med. 1995;151:1900-6.

Jirapongsananuruk O, Vichyanond P. Nasal cytology in the diagnosis of allergic rhinitis in children. Ann Allergy Asthma Immunol. 1998;80(2):165-70.

Salib R, Lau L, Howarth PH. Nasal lavage fluid concentrations of eotaxin-1 in naturally occurring allergic rhinitis: Relationship to disease activity, nasal luminal eosinophil influx, and plasma protein exudation. Clin Exp Allergy. 2005;35(8):995-1002.