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Nasal cytology identifies allergic rhinitis phenotypes for managing allergen immunotherapy in clinical practice

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Abstract

Backgrounds

Allergic rhinitis (AR) and non-allergic rhinitis with eosinophils (NARES) share type 2 inflammation characterized by nasal eosinophilic infiltrate. Allergen immunotherapy (AIT) is the unique specific treatment for AR, but some patients do not respond. AIT failure may depend on possible comorbidity, mainly concerning NARES.

Methods

In all, 33 patients (15 men, mean age 44 years) with AR due to house dust mites allergy were enrolled and treated with sublingual AIT using a monomeric allergoid (LAIS). AIT lasted 3 years. Symptom perception was assessed by visual analog scale (VAS). Symptoms included nasal obstruction, rhinorrhea, sneezing, cough, and olfaction. Nasal cytology evaluated the presence of eosinophils. Patients were evaluated at baseline, after 6 months, and after 1, 2, and 3 years.

Objective

The current study aimed at investigating the role of nasal cytology in identifying non-responders to AIT.

Results

A total of 28 patients significantly (p < 0.001) improved already after 6 months and showed a progressive reduction of eosinophilic infiltrate (p < 0.001). The 5 non-responder patients continued to experience symptoms, and consistent nasal inflammation did not disappear.

Conclusion

Nasal cytology is a fruitful tool to identify non-responder to AIT and phenotype mixed rhinitis, such as AR associated with NARES. Therefore, nasal cytology is useful in AIT management, mainly in non-responders.

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Abbreviations

AIT:

Allergen immunotherapy

AR:

Allergic rhinitis

CRSwNP:

Chronic rhinosinusitis with nasal polyps

MGG:

May-Grünwald-Giemsa

NAC:

Nasal allergen challenge

NARES:

Non-allergic rhinitis with eosinophils

NC:

Nasal cytology

SEM:

Standard error of mean

SLIT:

Sublingual immunotherapy

VAS:

Visual analog scale

References

  1. Hoyte FCL, Nelson HS. Recent advances in allergic rhinitis. F1000Res. 2018;7(F1000 Faculty Rev):1333.

    Article  Google Scholar 

  2. Meltzer EO. Allergic rhinitis: burden of illness, quality of life, comorbidities, and control. Immunol Allergy Clin N Am. 2016;36(2):235–48.

    Article  Google Scholar 

  3. Shirkani A, Mansouri A, Farid Hosseini R, Jabbari Azad F, Alsadat Mahmoudian R, Montazer M, et al. The role of interleukin‑4 and 13 gene polymorphisms in allergic rhinitis: a case-control study. Rep Biochem Mol Biol. 2019;8(2):111–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Ciprandi G, Cirillo I, Klersy C, Marseglia GL, Caimmi D, Vizzaccaro A. Nasal obstruction is the key symptom in hay fever patients. Otolaryngol Head Neck Surg. 2005;133(3):429–35.

    Article  Google Scholar 

  5. Ciprandi G, Cosentino C, Milanese C, Mondino C, Canonica GW. Fexofenadine reduces nasal congestion in perennial allergic rhinitis. Allergy. 2002;56(11):1068–70.

    Article  Google Scholar 

  6. Agnihotri NT, McGrath KG. Allergic and non-allergic rhinitis. Allergy Asthma Proc. 2019;40(6):376–9.

    Article  CAS  Google Scholar 

  7. Scadding GK, Kariyawasam HH, Scadding G, Mirakian R, Buckley RJ, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy. 2017;47(7):856–89.

    Article  CAS  Google Scholar 

  8. Alvaro-Lozano M, Akdis CA, Akdis M, Alviani C, Angier E, Arasi S, et al. EAACI allergen immunotherapy user’s guide. Pediatr Allergy Immunol. 2020;31(Suppl 25):1–101.

    Article  Google Scholar 

  9. Shamji MH, Durham SR. Mechanisms of allergen immunotherapy for inhaled allergens and predictive biomarkers. J Allergy Clin Immunol. 2017;140(6):1485–98.

    Article  CAS  Google Scholar 

  10. Gelardi M, Fiorella ML, Russo C, Fiorella R, Ciprandi G. Role of nasal cytology. Int J Immunopathol Pharmacol. 2010;23(1 Suppl):45–9.

    CAS  PubMed  Google Scholar 

  11. Ciprandi G, Silvestri M. Standardization of the nasal cytology in the work-up of allergic rhinitis. Ann All Asthma Immunol. 2019;123:213–6.

    Article  Google Scholar 

  12. Gauvreau GM, Sehmi R, Ambrose CS, Griffiths JM. Thymic stromal lymphopoietin: its role and potential as a therapeutic target in asthma. Expert Opin Ther Targets. 2020;24(8):777–92.

    Article  CAS  Google Scholar 

  13. Ciprandi G. Treatment of non-allergic perennial rhinitis. Allergy. 2004;59:16–23.

    Article  Google Scholar 

  14. Bousquet J, Bedbrook A, Czarlewski W, et al. Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centered care for rhinitis and asthma. Clin Transl Allergy. 2019;9(1):1–19.

    Article  CAS  Google Scholar 

  15. Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(Suppl S29):1–464.

    PubMed  Google Scholar 

  16. Ciprandi G, Tosca MA, Signori A, Cirillo I. Visual analogue scale assessment of nasal obstruction might define patients candidates to spirometry. Rhinology. 2011;49(3):292–6.

    Article  CAS  Google Scholar 

  17. Ciprandi G, Silvestri M. Serum specific IgE: a biomarker of response to allergen immunotherapy. J Invest Allergol Clin Immunol. 2014;24:35–9.

    CAS  Google Scholar 

  18. Pavord ID, Corren J. Biomarkers of type 2 airway inflammation in airway disease: and then there were two. J Allergy Clin Immunol Pract. 2020;8(8):2640–2264.

    Article  Google Scholar 

  19. Nagata M, Soma T, Nakagome K. Mechanisms of eosinophilic inflammation in allergic airway diseases. Average. 2021;70(2):100–6.

    Google Scholar 

  20. Li Y, Wang W, Ying S, Lan F, Zhang L. A potential role of group 2 innate lymphoid cells in eosinophilic chronic rhinosinusitis with nasal polyps. Allergy Asthma Immunol Res. 2021;13(3):363–74.

    Article  CAS  Google Scholar 

  21. Jacobs RL, Freedman PM, Boswell RN. Non-allergic rhinitis with eosinophilia (NARES syndrome). Clinical and immunologic presentation. J Allergy Clin Immunol. 1981;67(4):253–62.

    Article  CAS  Google Scholar 

  22. Settipane GA, Klein DE. Non allergic rhinitis: demography of eosinophils in nasal smear, blood total eosinophil counts and IgE levels. N Engl Reg Allergy Proc. 1985;6(4):363–6.

    Article  CAS  Google Scholar 

  23. Walsh GM. Biologics for asthma and allergy. Curr Opin Otolaryngol Head Neck Surg. 2017;25(3):231–4.

    Article  Google Scholar 

  24. Agache I, Lau S, Akdis CA, Smolinska S, Bonini M, Cavkaytar O, et al. EAACI guidelines on allergen immunotherapy: house dust mite-driven allergic asthma. Allergy. 2019;74(5):855–73.

    Article  CAS  Google Scholar 

  25. Ciprandi G, De Amici M, Murdaca G, Colombo BM, Quaglini S, Marseglia GL, et al. Serum IL‑4 as a marker of immunological response to sublingual immunotherapy. J Biol Regul Homeost Agents. 2008;22:117–23.

    CAS  PubMed  Google Scholar 

  26. Ciprandi G, Contini P, Fenoglio D, Sormani MP, Negrini S, Puppo F, et al. Relationship between soluble HLA‑G and HLA‑A,-B,-C serum levels and IFN-gamma production after sublingual immunotherapy in patients with allergic rhinitis. Hum Immunol. 2008;69:510–2.

    Article  CAS  Google Scholar 

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Funding

The study had no funding.

Author information

Authors and Affiliations

  1. Otorhinolaryngology Office, ASL BR, Mesagne, Italy

    Paolo Luperto

  2. Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy

    Simonetta Masieri

  3. Department of Sense Organs, Sapienza University of Rome, Rome, Italy

    Carlo Cavaliere

  4. Medical and Scientific Department, Lofarma, Milan, Italy

    Enrico Compalati & Franco Frati

  5. Allergy Clinic, Department of Outpatients, Casa di Cura Villa Montallegro, Via Montezovetto 27, 16132, Genoa, Italy

    Giorgio Ciprandi

Authors
  1. Paolo Luperto
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  2. Simonetta Masieri
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  3. Carlo Cavaliere
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  4. Enrico Compalati
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  5. Giorgio Ciprandi
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  6. Franco Frati
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Corresponding author

Correspondence to Giorgio Ciprandi.

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Conflict of interest

P. Luperto, S. Masieri, C. Cavaliere and G. Ciprandi declare that they have no competing interests. E. Compalati and F. Frati are employers of Lofarma and only provided statistical analysis of the data.

Ethical standards

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Luperto, P., Masieri, S., Cavaliere, C. et al. Nasal cytology identifies allergic rhinitis phenotypes for managing allergen immunotherapy in clinical practice. Allergo J Int 31, 51–55 (2022). https://doi.org/10.1007/s40629-021-00188-0

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  • DOI: https://doi.org/10.1007/s40629-021-00188-0

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