Allergic and nonallergic rhinitis in children: The role of nasal cytology

Nasal cytology is a diagnostic tool currently used in rhinology to study either allergic and vasomotor rhinological disorders or infectious and inflammatory rhinitis. Over the past few years nasal cytology has been rarely used in pediatrics, nevertheless its clinical and scientific applications seem to be very promising. The advantages of this technique are different: the ease of performance, the noninvasiveness allowing repetition and the low cost. We evaluated 100 children, from 2 to 15 years old, referred to our outpatient service for allergic children for suspected allergic rhinitis (AR). After skin prick test (SPT) or Radio Allergo Sorbent Test (RAST), 59/100 subjects were classified as affected by AR, while 8 children refused to be tested. According to ARIA guidelines, the 59 children with AR (4 - 15 years old) were divided in 56 with persistent AR and 3 with an intermittent form. Nine out of 59 children with AR had a significant number of neutrophils and eosinophils at the nasal cytology, documenting the presence of “minimal persistent inflammation”. Eleven out of 59 AR patients showed a positive swab for bacteria. Children with nonallergic rhinitis (NAR) were 33/100 (2 - 15 years old). After nasal cytology, 17/33 children were classified as NARES (nonallergic rhinitis with eosinophils), including one X-linked agammaglobulinemia (XLA) child, 1/33 as NARESMA (nonallergic rhinitis with eosinophils and mast cell) and another 1/33 as NARMA (nonallergic rhinitis with mast cell). In conclusion, nasal cytology allowed us to correctly classify children with NAR and to better assess the condition of children with AR.