Eosinophilic nonallergic rhinitis in children

Abstract

Eosinophilic nonallergic rhinitis is a newly described symptom complex reported to occur in a significant percentage of adult patients who have symptoms of perennial rhinitis. They are characterized by nasal eosinophilia, negative allergy skin tests, and a normal serum immunoglobulin E concentration. Twelve children, aged 6 to 17 years, who represent the syndrome of eosinophilic nonallergic rhinitis, have been identified. All have severe perennial rhinitis and nasal eosinophilia. Physical examination revealed pale, boggy membranes with a clear nasal discharge in ten of 12 patients. All 12 patients had a normal serum IgE concentration. All patients initially received an antihistamine-decongestant preparation with subjective improvement in seven of 12 patients. The remaining five patients were placed on a regimen of either topical or systemic steroids and all five had dramatic responses with marked improvement of symptoms. The negative skin tests and normal serum IgE help distinguish this entity from allergic rhinitis, whereas the positive nasal eosinophilia and response to steroids will differentiate eosinophilic nonallergic rhinitis from vasomotor rhinitis. Eosinophilic nonallergic rhinitis is an important cause of perennial rhinitis in children and better knowledge of this entity should lead to more aggressive and efficacious therapy.