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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 28  |  Issue : 2  |  Page : 74-77

Comparison of blood absolute eosinophil count and nasal smear eosinophils with symptoms and severity of clinical score in patients of allergic rhinitis


1 Department of Respiratory Medicine, G. M. E. R. S. Medical College and General Hospital, Gotri, India
2 Department of ENT, S. B. K. S. Medical Institute and Research Centre, Sumandeep Vidhyapeeth University, Piparia, Vadodara, Gujarat, India

Date of Web Publication15-Sep-2014

Correspondence Address:
Anand K Patel
A/15, Krishnadeep Society, B/h Saurabh Park, Near Samta, Subhanpura, Vadodara - 390 021, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-6691.140774

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  Abstract 

Introduction: Allergic rhinitis is one of the most common chronic conditions with a significant impact on the quality of life. The association between eosinophils and allergic disease has been known for many years. Nasal smear eosinophilia (NSE) (normal septal motion [NSM]) is a valuable test for the diagnosis of allergic rhinitis. Objective: The objective was to compare NSM and blood absolute eosinophil count (AEC) with the severity of the clinical score and to see the levels in patients with different symptoms and different group of patients with allergic rhinitis. Materials and Methods: In this prospective study, all patients aged more than 12 years presented to our institute; with a clinical diagnosis of allergic rhinitis were enrolled after taking written consent. Then, all patients were subjected for blood AEC and nasal smear for eosinophils. Results: There was a good correlation of NSE with severity of clinical score. There was no correlation of blood AEC with severity of clinical score and majority (94.29%) of the patients had no eosinophilia. The mean values of blood AEC, NSE, and clinical severity score were much higher in group of patients having nasal and respiratory system involvements as compared to only nasal and nasal with ocular system involvement. Conclusions: Nasal smear cytology is a simple, economical, and semi-invasive procedure having good correlation with severity of clinical score should be used routinely. There is a need to revise the normal standard value and grading of blood AEC.

Keywords: Absolute eosinophil count, allergic rhinitis, nasal smear eosinophilia, severity, symptoms


How to cite this article:
Patel AK, Nagpal TP. Comparison of blood absolute eosinophil count and nasal smear eosinophils with symptoms and severity of clinical score in patients of allergic rhinitis. Indian J Allergy Asthma Immunol 2014;28:74-7

How to cite this URL:
Patel AK, Nagpal TP. Comparison of blood absolute eosinophil count and nasal smear eosinophils with symptoms and severity of clinical score in patients of allergic rhinitis. Indian J Allergy Asthma Immunol [serial online] 2014 [cited 2017 Jul 27];28:74-7. Available from: http://www.ijaai.in/text.asp?2014/28/2/74/140774


  Introduction Top


Allergic rhinitis is one of the most common chronic conditions with a significant impact on the quality of life. [1] Allergic rhinitis may be seasonal or perennial. With an appropriate history and detailed examination, the diagnosis is usually not problematic. However, it has been found that the common symptomatology of rhinitis congestion, sneezing, nasal itching, and rhinorrhea show significant overlap with nonallergic rhinitis (NAR). [2] Allergic rhinitis can be confirmed by skin prick tests (SPT) or radio allegro sorbent test (RAST), enzyme-linked immune sorbent assay (ELISA) tests. Hence, it is difficult in most of the clinics of developing countries to determine whether these cases are allergic or NAR type where access to SPT, RAST, or ELISA are not available.

The association between eosinophils and allergic disease has been known for many years. Nasal smear eosinophilia (NSE) (normal septal motion [NSM]) is a valuable test for the diagnosis of allergic rhinitis. [3] Various studies have attempted correlating NSE and absolute eosinophil count (AEC) in peripheral blood in patients of allergic rhinitis, though very little is known about correlation of symptoms and severity of clinical score with NSE and peripheral blood AEC.

The objective of our study was to compare NSM and blood AEC with the severity of the clinical score and to see the levels in patients with different symptoms and different group of patients with allergic rhinitis.


  Materials and methods Top


A prior permission of this study was taken from Ethical Committee of the Institute. In this prospective study, all patients aged more than 12 years presented to ENT Department of Dhiraj General Hospital, Piparia, Vadodara, Gujarat, India; with a clinical diagnosis of allergic rhinitis for more than 8 weeks were enrolled after taking written consent from December 2010 to December 2012 with the following exclusion criteria.

Exclusion criteria

  • Patients with evident causes of nasal symptoms like deviated nasal septum or any other anatomic variants in nose
  • Patients who have taken any antihistamines, mast cell stabilizers; nasal corticosteroids; or antileukotrienes for at least 1 week prior.


After taking detail history, all patients were undergone thorough clinical examination. Assessment of severity of symptoms was done by visual analog scoring on a continuum scale from 0 to 10. Then all patients were subjected for blood AEC and nasal smear for eosinophils.

Blood eosionphil count >440 cell/cumm is being considered for the presence of eosinophilia by few authors but without grading. [4],[5] Hence, as per widely accepted criteria we had considered blood eosinophilia to be present if AEC was >600 cells/μL and degree of blood eosinophilia was categorized as mild (600-1500 cells/μL), moderate (1500-5000 cells/μL), and severe (>5000 cells/μL). [6]

Nasal smear was considered as positive if there is the presence of eosinophils and negative if there is the absence of eosinophils as it was found that majority (87.6%) of the normal population have negative nasal smear for eosinophils. [3] As we do not find any satisfactory specific criteria for grading of eosinophilia, we graded it as rare, mild, moderate, and severe if NSE are <5% of total leukocytes, 5-15% of total leukocytes, 16-25% of total leukocytes, and >25% of total leukocytes, respectively.


  Results Top


A total of 70 patients were enrolled in the present study. Age ranged from 13 to 61 years with a mean age of 32.67 ΁ 9.73. Male patient were 37 (52.86%), while female patients were 33 (47.14%). The most common symptom was rhinorrea present in all patients (100%), followed by sneezing present in 67 (95.71%) patients and nasal blockage present in 16 (22.86%) patients. Ocular symptoms were present in six (8.56%) patients while bronchial asthma was present in 10 (15.30%) patients. Hence, pulmonary system was the most commonly involved other system in our study.

As we could be inferred from [Table 1], the main age groups affected in our study were those that comprise the work force of any population. The absence of pediatric patients in our study probably reflects our concern regarding pediatric patient's compliance to semi-invasive means of investigation (nasal smear study).
Table 1: Age-wise distribution of patients

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Six (8.57%) patients out of 70 patients had negative nasal smear, whereas 64 (91.43%) patients had a positive smear for eosinophils. There was a good correlation of NSM with severity of clinical score [Table 2].
Table 2: Distribution of NSE according to the severity of the symptoms

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It can be seen from [Table 3] that there was no correlation of blood AEC with severity of clinical score and majority (94.29%) of the patients had no eosinophilia according to widely accepted standard criteria. There was no patient with rare or mild nasal eosinophilia with a concurrent moderate or severe blood AEC. Hence, from [Table 3] and [Table 4], it is very clear that NSM is a much more reliable indicator of hypereosinophilia than an AEC in patients of allergic rhinitis.
Table 3: Distribution of severity of the symptoms according to standard grading of eosinophilia

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Table 4: Distribution of severity of the symptoms according to our own grading

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But when we modified our criteria for the presence of eosinophilia (if AEC > 100 cells/μL) and degree of eosniophilia (101-250 cells/μL: Mild, 251-500 cells/μL: Moderate, 501-750 cells/μL: Severe and >750: Very severe), we saw good correlation between AEC and severity of the clinical score [Table 4].

The mean values of blood AEC, NSE, and clinical severity score were much higher in group of patients having nasal and respiratory system involvements as compared to only nasal and nasal with ocular system involvement, while there was little difference between patients with only nasal and nasal with ocular system involvement [Table 5].
Table 5: Mean values of blood AEC, NSE, and clinical

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The mean values of blood AEC, NSE were much higher in group of patients having nasal blockage than the patients having rhinorrea and/or sneezing without nasal blockage while there was only little difference in clinical severity score among these two groups [Table 6].
Table 6: Mean values of blood AEC, NSE, and clinical severity score according to symptoms

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  Discussion Top


In the present study, we compared NSM and blood AEC with the severity of the clinical score and compared the levels in patients with different symptoms and different group of patients with allergic rhinitis. SPT as well as RAST were not done to confirm the allergy in this study, but that will have very little effect as it has been found that SPT and NSE have equal sensitivity and specificity in the diagnosis of allergic rhinitis, and there is no statistical difference between these two methods in the diagnosis of allergic rhinitis. [3] This might be of advantage of our study as the few centers in the country where SPT are being done. Although it may have biased in diagnosis of allergic rhinitis, but it has not influenced the objective of the study, which is to comparison of blood AEC and NSE with severity of clinical score and with different symptoms and different group of patients.

General belief of that severity of allergic rhinitis is associated with blood AEC did not correlate with our findings if we consider standard grading of blood AEC as 94.29% of patients had blood AEC < 600. Chowdary et al. [5] had found their more than 90% of patients with allergic rhinitis had blood AEC < 440.

The mean value of blood AEC was below the standard normal value with 307.6 in patients having only nasal symptoms and 460 in patients having nasal with respiratory symptoms. Hence, blood AEC tends to be more in the respiratory system is also involved. Similar finding was observed by Jagdeeshwar et al. but with a little higher value of AEC which was 416.26 in patients having only nasal symptoms and 683.76 in patients having nasal and respiratory systems. [7] The difference may be because they had included all patients with noninfective rhinitis. Along with that he has also found that mean value of blood AEC in normal controls was much lower being 150. [7] Based on the lower value of blood AEC in the normal population and our finding of increase correlation with severity of clinical score after revision of grading criteria to much lower level, there is a need to revise the normal standard value and grading of blood AEC. As such, there is no role of blood AEC in patients of allergic rhinitis without above revision and it should not be done.

Our study showed a trend toward increasing incidence of eosinophilia with severity of clinical score. Olusesi et al. [8] had found the same result but in patients of both allergic and NAR patients. Chanda et al.[9] showed direct proportional relationship between eosinophilia and severity of nasal obstruction in allergic rhinitis patients.


  Conclusion Top


Nasal smear cytology is a simple, economical, and semi-invasive procedure having good correlation with severity of clinical score should be used routinely where access to SPT, RAST, or ELISA is not available. Blood AEC does not contribute in diagnosis of allergic rhinitis with present standardization of grading. There is a need to revise the normal standard value and grading of blood AEC, till that time it should not be done in patients with allergic rhinitis.

 
  References Top

1.Skoner DP. Allergic rhinitis: Definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol 2001;108:S2-8.  Back to cited text no. 1
[PUBMED]    
2.Bachert C. Persistent rhinitis - Allergic or non allergic? Allergy 2004;59:11-5.  Back to cited text no. 2
[PUBMED]    
3.Sanli A, Aydin S, Ates G, Eken M, Celebi O. Comparison of nasal smear eosinophilia with skin prick test positivity in patients with allergic rhinitis. Kulak Burun Bogaz Ihtis Derg 2006;16:60-3.  Back to cited text no. 3
    
4.Kumar N, Bylappa K, Ramesh AC, Redy S. A study of eosinophil count in nasal and blood smear in allergic respiratory diseases in a rural setup. Internet J Med Update 2012;7:40-6.  Back to cited text no. 4
    
5.Chowdary VS, Vinaykumar EC, Rao JJ, Rao R, Rambabu K, Rangamani V. A study of serum IgE and eosinophils in respiratory allergy patients. Indian J Allergy Asthma Immunol 2003;17:21-4.  Back to cited text no. 5
    
6.Brito-Babapulle F. The eosinophilias, including the idiopathic hypereosinophilic syndrome. Br J Haematol 2003;121:203-23.  Back to cited text no. 6
[PUBMED]    
7.Jagdeeshwar K, Venumadhav V, Chowdary S, Sudharani V, Kumar V. A study on serum IgE levels, peripheral eosinophils and individual symptoms in patients with non infective rhinitis and asthma and related conditions. Int J Pharm Pharm Sci 2012;4:88-92.  Back to cited text no. 7
    
8.Olusesi AD, Said MA, Amodu EJ. A correlation of symptomatology with nasal smear eosinophilia in non-infectious chronic rhinitis preliminary report. Niger J Clin Pract 2007;10:238-42.  Back to cited text no. 8
[PUBMED]    
9.Chanda R, Kumar A, Aggarwal GS, Kohli GS, Jaswal TS, Gupta KB. Comparative study of nasal smear and biopsy in patients of allergic rhinitis. Indian J Allergy Asthma Immunol 2002;16:27-31.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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