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Non-allergic rhinitis with eosinophilia syndrome is not associated with local production of specific IgE in nasal mucosa

  • Rhinology
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Abstract

Non-allergic rhinitis with eosinophilia syndrome (NARES) is an eosinophilic inflammation of the nasal mucosa without evidence of an allergy or other nasal pathologies. Patients complain about perennial symptoms like nasal obstruction, rhinorrhea, itchiness and sneezing of the nose sometimes accompanied by hyposmia. The aim of the study was to better characterize NARES patients using immunoassay-biochip technology to examine serum and nasal secretion. Sera and nasal secretion of patients with NARES (perennial nasal symptoms, no evidence of acute or chronic rhinosinusitis with or without polyps, negative SX1-Screening test and/or negative skin prick test, eosinophilic cationic protein in nasal secretion >200 ng/ml) were tested by immunoassay-biochip technology (ImmunoCAP® ISAC, Phadia). 112 different allergen components from 51 allergen sources were tested on the chip. Furthermore, serum and nasal secretion were tested for specific IgE to Staphylococcus aureus enterotoxin TSST-1 by fluorescence-enzyme-immunoassay (UniCAP®, Phadia). Unrecognized systemic sensitization could be ruled out by negative ISAC results in sera of all patients. Testing of nasal secretion for allergen-specific IgE by ISAC chip technology was negative as well in all cases. In one patient, a systemic sensitization to Staphylococcus aureus superantigen TSST-1 was detectable but no allergen-specific IgE to TSST-1 was measurable in nasal secretion of any patient. The results demonstrate that NARES is not associated with local allergy (entopy) nor with a local inflammation driven by Staphylococcus aureus enterotoxin TSST-1. Further studies are necessary to better understand the underlying mechanisms of NARES.

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References

  1. Collins JG (1997) Prevalence of selected chronic conditions: United States, 1990–1992. Vital Health Stat 10(194):1–89

    Google Scholar 

  2. Bachert C (2004) Persistent rhinitis—allergic or nonallergic? Allergy 59(Suppl 76):11–15 (discussion 15)

    Article  PubMed  Google Scholar 

  3. Bousquet J, Khaltaev N, Cruz AA et al (2008) Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen. Allergy 63(Suppl 86):8–160

    Article  PubMed  Google Scholar 

  4. Brozek JL, Bousquet J, Baena-Cagnani CE et al (2010) Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 126(3):466–476

    Article  PubMed  Google Scholar 

  5. Bachert C, van Cauwenberge P, Olbrecht J et al (2006) Prevalence, classification and perception of allergic and nonallergic rhinitis in Belgium. Allergy 61(6):693–698

    Article  CAS  PubMed  Google Scholar 

  6. Jacobs RL, Freedman PM, Boswell RN (1981) Nonallergic rhinitis with eosinophilia (NARES syndrome). Clinical and immunologic presentation. J Allergy Clin Immunol 67(4):253–262

    Article  CAS  PubMed  Google Scholar 

  7. Moneret-Vautrin DA, Jankowski R, Bene MC et al (1992) NARES: a model of inflammation caused by activated eosinophils? Rhinology 30(3):161–168

    CAS  PubMed  Google Scholar 

  8. Moneret-Vautrin DA, Hsieh V, Wayoff M et al (1990) Nonallergic rhinitis with eosinophilia syndrome a precursor of the triad: nasal polyposis, intrinsic asthma, and intolerance to aspirin. Ann Allergy 64(6):513–518

    CAS  PubMed  Google Scholar 

  9. Settipane GA, Klein DE (1985) Non allergic rhinitis: demography of eosinophils in nasal smear, blood total eosinophil counts and IgE levels. N Engl Reg Allergy Proc 6(4):363–366

    Article  CAS  PubMed  Google Scholar 

  10. Kramer MF, de la Chaux R, Fintelmann R et al (2004) NARES: a risk factor for obstructive sleep apnea? Am J Otolaryngol 25(3):173–177

    Article  PubMed  Google Scholar 

  11. Fokkens WJ, Lund VJ, Mullol J, et al (2012) European position paper on rhinosinusitis and nasal polyps 2012. Rhinol (Suppl 23):3 (preceding table of contents, pp 1–298)

  12. Bachert C, Gevaert P, Holtappels G et al (2001) Total and specific IgE in nasal polyps is related to local eosinophilic inflammation. J Allergy Clin Immunol 107(4):607–614

    Article  CAS  PubMed  Google Scholar 

  13. Huggins KG, Brostoff J (1975) Local production of specific IgE antibodies in allergic-rhinitis patients with negative skin tests. Lancet 2(7926):148–150

    Article  CAS  PubMed  Google Scholar 

  14. Powe DG, Huskisson RS, Carney AS et al (2001) Evidence for an inflammatory pathophysiology in idiopathic rhinitis. Clin Exp Allergy 31(6):864–872

    Article  CAS  PubMed  Google Scholar 

  15. Powe DG, Jagger C, Kleinjan A et al (2003) ‘Entopy’: localized mucosal allergic disease in the absence of systemic responses for atopy. Clin Exp Allergy 33(10):1374–1379

    Article  CAS  PubMed  Google Scholar 

  16. Rondon C, Canto G, Blanca M (2010) Local allergic rhinitis: a new entity, characterization and further studies. Curr Opin Allergy Clin Immunol 10(1):1–7

    Article  CAS  PubMed  Google Scholar 

  17. Rondon C, Dona I, Torres MJ et al (2009) Evolution of patients with nonallergic rhinitis supports conversion to allergic rhinitis. J Allergy Clin Immunol 123(5):1098–1102

    Article  PubMed  Google Scholar 

  18. Kramer MF, Burow G, Pfrogner E et al (2004) In vitro diagnosis of chronic nasal inflammation. Clin Exp Allergy 34(7):1086–1092

    Article  CAS  PubMed  Google Scholar 

  19. Moneret-Vautrin DA, Wayoff M, Hsieh V et al (1989) NARES syndrome. A developing link in the Fernand-Widal triad. Ann Otolaryngol Chir Cervicofac 106(1):47–50

    CAS  PubMed  Google Scholar 

  20. Ingels K, Durdurez JP, Cuvelier C et al (1997) Nasal biopsy is superior to nasal smear for finding eosinophils in nonallergic rhinitis. Allergy 52(3):338–341

    Article  CAS  PubMed  Google Scholar 

  21. Groger M, Klemens C, Wendt S et al (2012) Mediators and cytokines in persistent allergic rhinitis and nonallergic rhinitis with eosinophilia syndrome. Int Arch Allergy Immunol 159(2):171–178

    Article  PubMed  Google Scholar 

  22. Nelson BL, Jacobs RL (1982) Response of nonallergic rhinitis with eosinophilia (NARES) syndrome to 4 % cromoly sodium nasal solution. J Allergy Clin Immunol 70(2):125–128

    Article  CAS  PubMed  Google Scholar 

  23. Rondon C, Fernandez J, Lopez S et al (2009) Nasal inflammatory mediators and specific IgE production after nasal challenge with grass pollen in local allergic rhinitis. J Allergy Clin Immunol 124(5):1005.e1–1011.e1

    Article  Google Scholar 

  24. Rondon C, Dona I, Lopez S et al (2008) Seasonal idiopathic rhinitis with local inflammatory response and specific IgE in absence of systemic response. Allergy 63(10):1352–1358

    Article  CAS  PubMed  Google Scholar 

  25. Rondon C, Romero JJ, Lopez S et al (2007) Local IgE production and positive nasal provocation test in patients with persistent nonallergic rhinitis. J Allergy Clin Immunol 119(4):899–905

    Article  CAS  PubMed  Google Scholar 

  26. Lupinek C, Wollmann E, Baar A et al (2014) Advances in allergen-microarray technology for diagnosis and monitoring of allergy: the MeDALL allergen-chip. Methods 66(1):106–119

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Powe DG, Groot Kormelink T, Sisson M et al (2010) Evidence for the involvement of free light chain immunoglobulins in allergic and nonallergic rhinitis. J Allergy Clin Immunol 125(1):139.e1–3–145.e1–3

    Article  Google Scholar 

  28. Bachert C, Zhang N, Holtappels G et al (2010) Presence of IL-5 protein and IgE antibodies to staphylococcal enterotoxins in nasal polyps is associated with comorbid asthma. J Allergy Clin Immunol 126(5):962–968 (968.e1–6)

    Article  CAS  PubMed  Google Scholar 

  29. Bachert C, van Steen K, Zhang N et al (2012) Specific IgE against Staphylococcus aureus enterotoxins: an independent risk factor for asthma. J Allergy Clin Immunol 130(2):376.e8–381.e8

    Article  Google Scholar 

  30. Gevaert P, Holtappels G, Johansson SG et al (2005) Organization of secondary lymphoid tissue and local IgE formation to Staphylococcus aureus enterotoxins in nasal polyp tissue. Allergy 60(1):71–79

    Article  CAS  PubMed  Google Scholar 

  31. Seiberling KA, Conley DB, Tripathi A et al (2005) Superantigens and chronic rhinosinusitis: detection of staphylococcal exotoxins in nasal polyps. Laryngoscope 115(9):1580–1585

    Article  PubMed  Google Scholar 

  32. Van Zele T, Vaneechoutte M, Holtappels G et al (2008) Detection of enterotoxin DNA in Staphylococcus aureus strains obtained from the middle meatus in controls and nasal polyp patients. Am J Rhinol 22(3):223–227

    Article  PubMed  Google Scholar 

  33. Swierczynska M, Strek P, Skladzien J et al (2003) Nonallergic rhinitis with eosinophilia syndrome: state of knowledge. Otolaryngol Pol 57(1):81–84

    PubMed  Google Scholar 

  34. Webb DR, Meltzer EO, Finn AF Jr et al (2002) Intranasal fluticasone propionate is effective for perennial nonallergic rhinitis with or without eosinophilia. Ann Allergy Asthma Immunol 88(4):385–390

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Mrs. Elisabeth Pfrogner and Mrs. Gabriele Bärr for their skillful technical assistance.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55101, Mainz, Germany

    Sven Becker

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University, Munich, Germany

    Sven Becker, Julia Rasp, Katharina Eder, Alexander Berghaus, Matthias F. Kramer & Moritz Gröger

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  1. Sven Becker
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  2. Julia Rasp
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  3. Katharina Eder
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  6. Moritz Gröger
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Correspondence to Sven Becker.

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Becker, S., Rasp, J., Eder, K. et al. Non-allergic rhinitis with eosinophilia syndrome is not associated with local production of specific IgE in nasal mucosa. Eur Arch Otorhinolaryngol 273, 1469–1475 (2016). https://doi.org/10.1007/s00405-015-3769-4

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  • DOI: https://doi.org/10.1007/s00405-015-3769-4

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