A Multidisciplinary Approach in the Diagnosis of Allergic and Non-allergic Respiratory Diseases: Nasal Cytology and Feno. - A Multidisciplinary Approach in the Diagnosis of Allergic and Non-allergic Respiratory Diseases: Nasal Cytology and Feno. - Open Access Pub

Upper and lower airway disease is a common condition. Its prevalence is increasing in different areas of the world, but, at present, non-allergic rhinitis is underestimated. The aim of this study was to investigate FeNO (fractional exhaled nitric oxide) and nasal cytology in allergic and non-allergic patients, in order to reach a correct diagnosis. This study was performed on 120 children with rhinitis and/or asthma, evaluated by an allergist and an otolaryngologist. Skin prick-test and nasal cytology were tested in all patients; FeNO only in the asthmatic ones. The proportion of positive results in nasal cytology was higher in non-allergic than in allergic children: 22 out of 23 patients, vs 91 out of 97 patients. A significant correlation was found between FeNO levels and increase in nasal eosinophil counts. There is compelling evidence of a close relationship between upper and lower airway in asthma and rhinitis. The presence of rhinitis should always be investigated in children with asthma; therefore, FeNO and nasal cytology have clinical benefit both in allergic and non-allergic children. Our finding also supports the use of nasal cytology to evaluate non-allergic rhinitis (NAR). DOI10.14302/issn.2379-8572.joa-15-807 Asthma and rhinitis are common throughout the world with a high burden of morbidity and cost. The quality of life of patients suffering from AR and allergic asthma is often severely impaired as is their social life, their career and their school performance 1, 2. Despite the spread of respiratory allergies (AR: 113 million of patients; allergic asthma: 63 million of patients) the prevalence of non-allergic rhinitis is increasing and often largely underestimated (NAR:AR=1:4). NAR, a diverse syndrome including 4 main types of inflammatory disorders (NARES: NAR infiltrated by eosinophils; NARMA: NAR infiltrated by mast cells; NARESMA, NAR infiltrated by eosinophils and mast cells; NARNE, NAR infiltrated by neutrophils), is a risk factor for headache, sinusitis, nasal polyps and chronic nasal symptoms3. Dysfunctions of the upper and lower airways frequently coexist: data from epidemiological studies indicate that rhinitis is experienced by as many as 80% of patients with allergic asthma and 75% of patients with non-allergic asthma; while asthma is experienced by as many as 34% of patients with AR and 25% of patients with NAR 4, 5. Nasal cytology represents a valid method in the differential diagnosis of allergic and non-allergic nasal diseases as it is simple, safe, non-invasive (local anaesthesia is not required), easy to perform and able