Non allergic rhinitis with eosinophilia syndrome

ENT

1. NON ALLERGIC RHINITIS WITH EOSINOPHILIA SYNDROME (NARES) AMRUTHA S ROLL NO : 12

2. definition Non – allergic rhinitis with eosinophilia syndrome (NARES) is an eosinophilic inflammation of the nasal mucosa without evidence of an allergy or other nasal pathologies.

3. CLASSIFICATION OF RHINITIS Infectious Viral Bacterial Other infectious agents Allergic Occupational (allergic and non-allergic) Drug – induced Aspirin Other medications Hormonal Other causes NARES Irritants Food Emotional Atrophic gastro esophageal reflux Idiopathic

4. Classification of non allergic rhinitis based on immunologic and nasal cytologic features PERENNIAL NON ALLERGIC RHINITIS (INFLAMMATORY) NON – INFLAMMATORY, NONALLERGIC RHINITIS STRUCTURALLY – RELATED RHINITIS Eosinophilic nasal disease (NARES, BENARS) Rhinitis medicamentosa Septal deviation, turbinate deformation, nasal valve dysfunction Basophilic / metachromatic nasal disease Vasomotor rhinitis Neoplastic and non – neoplastic tumors Nasal polyps Rhinitis sicca Miscellaneous ( choanal atresia/ stenosis, trauma) Atrophic rhinitis Metabolic Immunologic nasal disease

5. epidemiology Female predominance Age of onset - around 22 years

6. Pathophysiology Chronic eosinophilic nasal inflammation Mast cell Histamine Tryptase

7. Pathophysiology : eosinophils Toxin basic proteins eg . Eosinophilic catioinic protein (ECP) Effect on airway epithelium Ciliostasis Lysis of epithelium ECP Well described and standardized marker for tissue eosinophilic and activation Levels in nasal secretions can be used to monitor eosinophilic inflammation in different kinds of rhinitis with eosinophilic involvement. Indicator of the efficacy of treatment

8. Pathophysiology : nasal neural dysfunction Nasal hyper responsiveness develop in inflamed nasal passage Increased blockage and drip after “nonspecific” non immune stimulants Bradykinin , endothelin and methacholine

9. Clinical features Symptoms 1. Perennial symptoms 2. Sneezing 3. Profuse watery rhinorrhea 4. Nasal congestion 5. Postnasal drainage 6. Nasal pruritis 7. Hyposmia / anosmia

10. Conjuctival edema Scleral hyperemia Lacrimation Boggy nasal mucosa Copious amounts of clear nasal secretion No – nasal polyps, sinusitis, otitis media Signs

11. Nasal smear >20% nasal eosinophilia Method Having the patient blow through each nostril into a polyethylene sheet The secretions were transferred to a glass slide and air dried Hansel’s stain Differential cell counts from 10 oil fields

12. Non – allergic disorders associated with nasal eosinophilia Phaeohyphomycosis of the maxilloethmoid sinus Churg – Strauss syndrome

13. treatment Intranasal corticosteroids Eosinophilia in patients with non allergic rhinitis is generally regarded as a good prognostic indicator for response Reduce rhinitis symptoms Improve nasal breathing Reduce the size of polyps and their recurrence Poor effect on the sense of smell Systemic corticosteroids All the types of symptoms and pathology Sense of smell (particularly if there are concomitant polyps) 2 nd generation antihistamines 1. Inhibiting the release of LTC4, PGD2 2 . Decreasing neutrophil and eosinophil chemotaxis

14. Thank you