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Abstract
ABSTRACT
Background. Previous studies have suggested that nasal eosinophilia could be used as an alternative to skin prick test for diagnosing allergic rhinitis. The aim of the present study was to evaluate the performance of nasal eosinophilia in the diagnosis of allergic rhinitis in Yaounde. Methods. Fifty-two patients (7-51 years old, 35 women) presenting recurrently or permanently at least two rhinological signs among rhinorrhea, sneezing and nasal obstruction were cross-sectionally included in the study. They were classified as allergic rhinitis and non-allergic rhinitis according to their reaction to 9 allergens (ALK-Abelló®) on skin prick test (gold standard). Nasal secretion swabs for eosinophil quantification were performed concomitantly in all patients. A double entry contingency table was established for the calculation of nasal eosinophilia performance indices for the diagnosis of allergic rhinitis. Results. Forty patients (77%) had allergic rhinitis. House dust mites were the most common allergens. Nasal eosinophilia was noted in 15 patients with an average of 19.2 eosinophils per 100 cells counted. The sensitivity, specificity, positive predictive value and negative predictive value of nasal eosinophilia were 37.5%, 75%; 83.3% and 26.4% respectively. The positive and negative likelihood ratio was 1.5 and 0.5 respectively. The Youden index was 0.125. There was no cut-off value for nasal eosinophilia that improved its sensitivity and specificity. Conclusion. The performance of nasal eosinophilia in the diagnosis of allergic rhinitis is poor. It is not very sensitive and moderately specific, and therefore cannot be used in the diagnostic strategy of allergic rhinitis in our milieu.
RÉSUMÉ
Introduction. Selon plusieurs études, l'éosinophilie nasale pourrait être utilisée comme alternative aux tests cutanés pour le diagnostic de la rhinite allergique. Le but de notre étude était ainsi d'évaluer la performance de l'éosinophilie nasale dans le diagnostic de la rhinite allergique à Yaoundé. Méthodes. Cinquante-deux patients (7-51 ans, 35 femmes) présentant de manière récurrente ou permanente au moins deux signes rhinologiques parmi la rhinorrhée, les éternuements et l'obstruction nasale ont été inclus transversalement dans l'étude. Ils ont été classés en rhinite allergique et non allergique selon leur réaction à 9 allergènes (ALK-Abelló®) au test cutané allergique (gold standard). Des prélèvements de sécrétions nasales pour la quantification des éosinophiles ont été réalisés simultanément. Des indices de performance de l'éosinophilie nasale pour le diagnostic de la rhinite allergique ont été calculés. Résultats. Quarante patients (77 %) avaient une rhinite allergique. Les acariens étaient les allergènes les plus courants. Une éosinophilie nasale a été notée chez 15 patients avec une moyenne de 19,2 éosinophiles/100 cellules comptées. La sensibilité, la spécificité, la valeur prédictive positive et la valeur prédictive négative de l'éosinophilie nasale étaient de 37,5 %, 75 % ; 83,3 % et 26,4 % respectivement. Le rapport de vraisemblance positif et négatif était respectivement de 1,5 et 0,5. L'indice de Youden était de 0,125. Il n'y avait pas de valeur seuil pour l'éosinophilie nasale qui améliorait sa sensibilité et sa spécificité. Conclusion. Les performances de l'éosinophilie nasale dans le diagnostic de la rhinite allergique sont médiocres. Elle est peu sensible et moyennement spécifique, et ne peut donc pas être utilisée dans la stratégie diagnostique de la rhinite allergique dans notre milieu.
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References
- Braun J J, Devillier P , Wallaert B, Rancé F, Jankowski R, Acquavita J-L, Beley G, Demoly P. Recommandations pour le diagnostic et la la prise en charge de la rhinite allergique (épidémiologie et physiopathologie exclues) - texte long Revue française d'allergologie. 2010;27:79-105.
- Skoner D. Allergic rhinitis: definition,epidemiology,pathophysiology, detection and diagnosis. Journal of Allergy and Clinical Immunology. 2001;108(1):2-8.
- Bousquet J, Van Cauwenberg P, Khaltaev N, ARIA workshop group, World Health Organization. Allergic rhinitis and its impact on asthma. The Journal of allergy and clinical immunology. 2001;108(5):147-334.
- Bernstein DI, Schwartz G, Bernstein JA. Allergic Rhinitis: Mechanisms and Treatment. Immunol Allergy Clin North Am. 2016 ; 36 (2):261-78.
- Schwartz DA. Gene-environment interactions and airway disease in children. Pediatrics. 2009;123(3):151-9.
- Sanli A, Aydin S, Ateş 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(2):60-3.
- Annesi-Maesano I, Didier A, Klossek M, Chanal I, Moreau D, Bousquet J. The score for allergic rhinitis (SFAR): a simple and valid assessment method in population studies. Allergy. 2002; 57(2):107-14.
- Pefura-Yone EW, Kengne AP, Balkissou AD, et al. Prevalence of asthma and allergic rhinitis among adults in Yaounde, Cameroon. PLoS One. 2015;10(4):e0123099. doi:10.1371/journal.pone.0123099
- Gelardi M IC, Passalacqua G, Quaranta N, Frati F. The classification of allergic rhinitis and its cytological correlate. Allergy. 2011; 66:1624–5.
- Tantilipikorn P, Pinkaew B, Talek K, Assanasen P, Triphoon Suwanwech TS, Bunnag C. Pattern of allergic sensitization in chronic rhinitis: A 19-year retrospective study. Asian Pac J Allergy Immunol. 2021;39(3):156-162.
- Ciprandi G, Alesina R, Ariano R, Aurnia P, et al. Characteristics of patients with allergic polysensitization: the POLISMAIL study. European annals of allergy and clinical immunology. 2008;40(3):77-83.
- Bellonti J A, Wallerstedt DB. Allergic rhinitis update: Epiddemiology and nature history. Allergy Asthma Proceedings. 2000;21(6):367-70.
- Rosário CS, Cardozo CA, Neto HJC, Filho NAR. Do gender and puberty influence allergic diseases? Allergol Immunopathol (Madr). 2012 ;49(2):122-125.
- Naclerio R, Proud D, Togias A. Inflammatory mediators in late antigen-induced rhinitis. New England Journal of Medicine. 1985;313:65-9.
- Pipkorn U, Enerback L. A method for the preparation of inprints from the nasal mucosa. Journal of immunological methods. 1984;73:133-7.
- Pelikan Z, Pelikan Filipek M. Cytologic changes in the nasal secretions during the immediate nasal response. Journal of Allergy and Clinical Immunology. 1988;82:1103-12.
- Pal I, Sinha Babu A, Halder I, Kumar S. Nasal smear eosinophils and allergic rhinitis. Ear Nose Throat J. 2017; 96 (10-11):17-22.
- Qamar S, Awan N, Cheema KM, Raza N, Ashraf S, Rehman A. Comparative Analysis of Nasal Smear Eosinophilia and Serum IgE Levels for the Diagnosis of Allergic Rhinitis. J Coll Physicians Surg Pak. 2020 ;30 (12):1297-1300.
- Collado-Chagoya R, Hernández-Romero J, Eliosa-Alvarado GA, et al. Non-allergic rhinitis with eosinophilic syndrome. Case report. Rev Alerg Mex. 2018;65(3):310-315.
- Takwoingi Y, Akang E, Nwaorgu G, Nwawolo C. Comparing nasal secretion eosinophil count with skin sensitivity test in allergic rhinitis in Ibadan, Nigeria. Acta Otolaryngol. 2003;123(9):1070-4.
- Nendaz M.R., Perrier A. Sensibilité, spécificité, valeur prédictive positive et valeur prédictive négative d’un tes diagnostique. Rev mal respir. 2004 ; 21 : 390-3.
- Delacour H., François N., Servonnet A., Gentile A., Roche B. Les rapports de vraisemblance : un outil de choix pour l’interprétation des test biologiques. Immunoanalyse et biologie spécialisée. 2009 ; 24 : 92-99.
References
Braun J J, Devillier P , Wallaert B, Rancé F, Jankowski R, Acquavita J-L, Beley G, Demoly P. Recommandations pour le diagnostic et la la prise en charge de la rhinite allergique (épidémiologie et physiopathologie exclues) - texte long Revue française d'allergologie. 2010;27:79-105.
Skoner D. Allergic rhinitis: definition,epidemiology,pathophysiology, detection and diagnosis. Journal of Allergy and Clinical Immunology. 2001;108(1):2-8.
Bousquet J, Van Cauwenberg P, Khaltaev N, ARIA workshop group, World Health Organization. Allergic rhinitis and its impact on asthma. The Journal of allergy and clinical immunology. 2001;108(5):147-334.
Bernstein DI, Schwartz G, Bernstein JA. Allergic Rhinitis: Mechanisms and Treatment. Immunol Allergy Clin North Am. 2016 ; 36 (2):261-78.
Schwartz DA. Gene-environment interactions and airway disease in children. Pediatrics. 2009;123(3):151-9.
Sanli A, Aydin S, Ateş 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(2):60-3.
Annesi-Maesano I, Didier A, Klossek M, Chanal I, Moreau D, Bousquet J. The score for allergic rhinitis (SFAR): a simple and valid assessment method in population studies. Allergy. 2002; 57(2):107-14.
Pefura-Yone EW, Kengne AP, Balkissou AD, et al. Prevalence of asthma and allergic rhinitis among adults in Yaounde, Cameroon. PLoS One. 2015;10(4):e0123099. doi:10.1371/journal.pone.0123099
Gelardi M IC, Passalacqua G, Quaranta N, Frati F. The classification of allergic rhinitis and its cytological correlate. Allergy. 2011; 66:1624–5.
Tantilipikorn P, Pinkaew B, Talek K, Assanasen P, Triphoon Suwanwech TS, Bunnag C. Pattern of allergic sensitization in chronic rhinitis: A 19-year retrospective study. Asian Pac J Allergy Immunol. 2021;39(3):156-162.
Ciprandi G, Alesina R, Ariano R, Aurnia P, et al. Characteristics of patients with allergic polysensitization: the POLISMAIL study. European annals of allergy and clinical immunology. 2008;40(3):77-83.
Bellonti J A, Wallerstedt DB. Allergic rhinitis update: Epiddemiology and nature history. Allergy Asthma Proceedings. 2000;21(6):367-70.
Rosário CS, Cardozo CA, Neto HJC, Filho NAR. Do gender and puberty influence allergic diseases? Allergol Immunopathol (Madr). 2012 ;49(2):122-125.
Naclerio R, Proud D, Togias A. Inflammatory mediators in late antigen-induced rhinitis. New England Journal of Medicine. 1985;313:65-9.
Pipkorn U, Enerback L. A method for the preparation of inprints from the nasal mucosa. Journal of immunological methods. 1984;73:133-7.
Pelikan Z, Pelikan Filipek M. Cytologic changes in the nasal secretions during the immediate nasal response. Journal of Allergy and Clinical Immunology. 1988;82:1103-12.
Pal I, Sinha Babu A, Halder I, Kumar S. Nasal smear eosinophils and allergic rhinitis. Ear Nose Throat J. 2017; 96 (10-11):17-22.
Qamar S, Awan N, Cheema KM, Raza N, Ashraf S, Rehman A. Comparative Analysis of Nasal Smear Eosinophilia and Serum IgE Levels for the Diagnosis of Allergic Rhinitis. J Coll Physicians Surg Pak. 2020 ;30 (12):1297-1300.
Collado-Chagoya R, Hernández-Romero J, Eliosa-Alvarado GA, et al. Non-allergic rhinitis with eosinophilic syndrome. Case report. Rev Alerg Mex. 2018;65(3):310-315.
Takwoingi Y, Akang E, Nwaorgu G, Nwawolo C. Comparing nasal secretion eosinophil count with skin sensitivity test in allergic rhinitis in Ibadan, Nigeria. Acta Otolaryngol. 2003;123(9):1070-4.
Nendaz M.R., Perrier A. Sensibilité, spécificité, valeur prédictive positive et valeur prédictive négative d’un tes diagnostique. Rev mal respir. 2004 ; 21 : 390-3.
Delacour H., François N., Servonnet A., Gentile A., Roche B. Les rapports de vraisemblance : un outil de choix pour l’interprétation des test biologiques. Immunoanalyse et biologie spécialisée. 2009 ; 24 : 92-99.