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Non-Allergic Cell-Mediated Rhinitis
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Clinical Characterizations of Non-Allergic Cell-Mediated Rhinitis
NAR (Non-Allergic Rhinitis)
Non-allergic vasomotor rhinitis, among chronic rhinitis, represents a sector for which the diagnostic and therapeutic approach is not univocal. Most often, this type of rhinitis has no specific diagnosis and is classified as "non-specific vasomotor rhinitis" or "idiopathic."
NAR is characterized by intense, pseudo-allergic symptoms, such as nasal obstruction, itching, sneezing, burning nasal mucosa, and runny nose. It can be confused with IgE-mediated rhinitis. Furthermore, it presents a non-specific reactivity, manifested by the onset of symptoms by various stimuli, such as sudden changes in temperature, cold air, strong perfumes, tobacco smoke, nasal irrigation, and topical pharmacological treatments. Pool swimmers are sometimes forced to abandon their sport due to nasal hyperreactivity (sneezing, nasal obstruction, and burning) resulting from contact of the nasal mucosa with chlorinated water. These individuals complain of nasal obstruction, often a tilting nasal congestion, which worsens during sleep, causing snoring and mouth breathing. They also experience easy irritation of the nasal mucosa, triggered by nonspecific stimuli.
A characteristic history of NAR is the high number of specialist visits to which parents, seeking a definitive diagnosis, submit their pediatric patient. Indeed, NAR is rarely diagnosed by a specialist during the first visit, especially if the specialist does not use effective diagnostic and instrumental tests for rhinoallergological diagnosis: prick testing, endoscopy, nasal cytology, rhinomanometry, and diagnostic kits for specific nasal provocation tests. Since these are cellular diseases, the diagnostic gold standard is cytological examination of the nasal mucosa.
NARs have a significant impact, both in terms of healthcare costs and in terms of social and quality of life losses, due to their intense and persistent nasal symptoms, along with their tendency to be associated with more serious diseases such as bronchial asthma, ASA sensitivity, rhinobronchial syndrome, sinusitis, and nasal polyposis in adults.
The group of nonallergic or "cellular" vasomotor rhinitis includes NARNE (Non-Allergic Rhinitis with Neutrophils), NARES (Non-Allergic Rhinitis with Eosinophils), NARMA (Non-Allergic Rhinitis with Mast Cells), and finally NARESMA (Non-Allergic Rhinitis with Eosinophils and Mast Cells).
The Vicious Circle of Non-Allergic Cell-Mediated Rhinitis
When a non-allergic cell-mediated rhinopathy is present, remodeling (structural damage) of the respiratory mucosa is evident, which intensifies the inflammatory process and, consequently, the symptoms.
Furthermore, the remodeling of the respiratory mucosa leads to increased sensitization of the mast cells, which fuel and chronicize the inflammatory state.
In these cases, it is necessary to address on the remodeling of the respiratory mucosa and the sensitization of the mast cells to interrupt the vicious cycle that causes the typical symptoms of non-allergic cell-mediated rhinitis and sinusitis.
What are the symptoms of rhinosinusitis?
The symptoms of rhinosinusitis can vary depending on the etiology, that is, the factor or factors that caused it.
We can distinguish the following three types of rhinosinusitis:
SYMPTOMS
- Mucus discharge from the nose that is yellow or greenish in color, or you find it on the handkerchief when you blow your nose
- Facial pain in one or more places (above the jaws, around the eyes at the sides of the nose, at the forehead above the eyebrow arches, in the back of the skull)
- Sensation of not being able to smell
- Nosebleed
- Mucus going down the throat
- Symptoms in only one nostril of the nose (nasal obstruction, presence of purulent mucus, bleeding).
CAUSES
A very commonplace cold that lasts for more than 5-7 days, brought on by an infection caused by viruses, fungi, and/or pathogenic bacteria (Infectious rhinosinusitis).
SYMPTOMS
- Mucus discharge from the nose almost as clear as water, indistinctly from both nostrils
- Frequent sneezing even without the discharge of mucus from the nose
- Itchy nose
- Facial pain in one or more places (above the jaws, around the eyes at the sides of the nose, at the forehead above the eyebrow arches, in the back of the skull)
- Conjunctivitis with red or itchy eyes.
CAUSES
An underlying respiratory allergy, caused by exposure to particular types of allergens such as pollens, dust mites, chemicals…
SYMPTOMS
- Mucus discharge from the nose almost as clear as water, indistinctly from both nostrils
- Frequent sneezing even without the discharge of mucus from the nose
- Itchy nose
- Facial pain in one or more places (above the jaws, around the eyes at the sides of the nose, at the forehead above the eyebrow arches, in the back of the skull)
- Conjunctivitis with red or itchy eyes.
CAUSES
The presence of non-allergic cell-mediated rhinitis, caused by the dysfunction of certain cells found in the respiratory mucosa such as: mast cells, eosinophils and neutrophils). Depending on the cells affected by the dysfunction, the following cellular diseases are distinguished: nares, narne, narma, and naresma – nonallergic cell-mediated rhinosinusitis.
How to effectively treat Non-Allergic Cell-Mediated Rhinitis
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Recurrent Respiratory Infections
