[Clinical and pathogenic aspects of NARES (non-allergic rhinitis with eosinophilic syndrome)]

Abstract

Non-allergic rhinitis with eosinophilic syndrome (NARES) accounts for 14% of rhinitis. It is defined by a syndrome of nasal hyper-reactivity over more than three months, the absence of any atopic factor, and an eosinophilia of nasal secretions 20% greater than the leukocytes. The main features are evidenced by the authors on the basis of 20 observations. The symptoms are significantly more marked than in other forms of rhinitis. Olfactive disorders occur very frequently. The symptoms often fail to respond to anti-histamines and even corticoids. The frequency of a micropolyposis starting in the meatus is confirmed by endoscopy and a CT-scan reveals the frequency of hyperplasia of the sinusal mucosa (affecting first and foremost the ethmoid cells). Hyperadrenergy is frequently evidenced by papavenire IDR and by the isoprenaline IV test. Two cases revealed the coexistence of an intolerance to aspirin and a bronchial hyper-reactivity, evidenced by the Carbachol test. The histological and immunofluorescent examination of the pituitary mucosa evidenced an eosinophilic infiltration in 40% of cases. This infiltrate is often labelled by the BB10 monoclonal antibody. The evolution of NARES appears to involve three stages: secretory eosinophilia with a healthy mucosa, eosinophilic mucosa infiltration, and in situ activation of the eosinophils. An evolution towards an eosinophilic PNS and then a triad was observed in two cases. Hopothèses are put forward by the authors to explain the local nasal influx of eosinophils.