Titolo della tesi: The role of Nasal Cytology in Identifying Rhinitis phenotypes for managing Allergen Immunotherapy in Clinical Practice
Backgrounds Allergic rhinitis (AR) and non-allergic rhinitis with eosinophils (NARES) share type 2
inflammation characterized by nasal eosinophilic infiltrate. Allergen immunotherapy (AIT) is the unique
specific treatment for AR, but some patients do not respond. AIT failure may depend on possible
comorbidity, mainly concerning NARES.
Methods 33 patients (15 males and 18 females, mean age 44 years) with AR due to house dust mites
allergy were enrolled and treated with sublingual AIT using a monomeric allergoid (LAIS). AIT lasted
Symptom perception was assessed by visual analog scale (VAS). Symptoms included nasal obstruction,
rhinorrhea, sneezing, cough, and olfaction. Nasal cytology evaluated the presence of eosinophils.
Patients were evaluated at baseline, after six months, and after one, two, and three years.
Objective The current study, therefore, aimed at investigating the role of nasal cytology in identifying
non-responders to AIT.
Results 28 patients significantly (p<0.001) improved already after six months and showed a progressive
reduction of eosinophilic infiltrate (p<0.001). The five non-responder patients continued to complain of
symptoms, and consistently nasal inflammation did not disappear.
Conclusion Nasal cytology is a fruitful tool to identify non-responder to AIT and phenotype mixed
rhinitis, such as AR associated with NARES. Therefore, nasal cytology is fruitful in AIT management,
mainly in non-responders.
Keywords: allergic rhinitis; NARES; mixed rhinitis; allergen immunotherapy; nasal cytology;