ENT

1. NON ALLERGIC RHINITIS
WITH EOSINOPHILIA
SYNDROME
(NARES)
AMRUTHA S
ROLL NO : 12

2. DEFINITION
Non – allergic rhinitis with eosinophilia syndrome (NARES) is an
eosinophilic inflammation of the nasal mucosa without evidence of
an allergy or other nasal pathologies.

3. CLASSIFICATION OF RHINITIS
Infectious
• Viral
• Bacterial
• Other infectious agents
Allergic
Occupational (allergic and non-allergic)
Drug – induced
• Aspirin
• Other medications
Hormonal
Other causes
• NARES
• Irritants
• Food
• Emotional
• Atrophic
• gastro esophageal reflux
Idiopathic

4. CLASSIFICATION OF NON ALLERGIC RHINITIS
BASED ON IMMUNOLOGIC AND NASAL CYTOLOGIC
FEATURES
PERENNIAL NON ALLERGIC
RHINITIS (INFLAMMATORY)
NON – INFLAMMATORY,
NONALLERGIC RHINITIS
STRUCTURALLY – RELATED
RHINITIS
Eosinophilic nasal disease
(NARES, BENARS)
Rhinitis medicamentosa Septal deviation, turbinate
deformation, nasal valve
dysfunction
Basophilic / metachromatic nasal
disease
Vasomotor rhinitis Neoplastic and non – neoplastic
tumors
Nasal polyps Rhinitis sicca Miscellaneous (choanal atresia/
stenosis, trauma)
Atrophic rhinitis Metabolic
Immunologic nasal disease

5. EPIDEMIOLOGY
• Female predominance
• Age of onset - around 22 years

6. PATHOPHYSIOLOGY
• Chronic eosinophilic nasal inflammation
• Mast cell
• Histamine
• Tryptase

7. PATHOPHYSIOLOGY :
EOSINOPHILS
Toxin basic proteins eg. Eosinophilic catioinic protein (ECP)
Effect on airway epithelium
• Ciliostasis
• Lysis of epithelium
ECP
• Well described and standardized marker for tissue eosinophilic and
activation
• Levels in nasal secretions can be used to monitor eosinophilic
inflammation in different kinds of rhinitis with eosinophilic involvement.
• Indicator of the efficacy of treatment

8. PATHOPHYSIOLOGY : NASAL NEURAL
DYSFUNCTION
Nasal hyper responsiveness develop in inflamed nasal passage
Increased blockage and drip after “nonspecific” non immune stimulants
• Bradykinin, endothelin and methacholine

9. CLINICAL FEATURES
Symptoms
1. Perennial symptoms
2. Sneezing
3. Profuse watery rhinorrhea
4. Nasal congestion
5. Postnasal drainage
6. Nasal pruritis
7. Hyposmia / anosmia

10. • Conjuctival edema
• Scleral hyperemia
• Lacrimation
• Boggy nasal mucosa
• Copious amounts of clear nasal secretion
• No – nasal polyps, sinusitis, otitis media
Signs

11. NASAL SMEAR
>20% nasal eosinophilia
Method
1. Having the patient blow through each nostril into a polyethylene sheet
2. The secretions were transferred to a glass slide and air dried
3. Hansel’s stain
4. Differential cell counts from 10 oil fields

12. NON – ALLERGIC DISORDERS
ASSOCIATED WITH NASAL EOSINOPHILIA
• Phaeohyphomycosis of the maxilloethmoid sinus
• Churg – Strauss syndrome

14. TREATMENT
Intranasal corticosteroids
1. Eosinophilia in patients with non allergic rhinitis is generally regarded as a good prognostic
indicator for response
2. Reduce rhinitis symptoms
3. Improve nasal breathing
4. Reduce the size of polyps and their recurrence
5. Poor effect on the sense of smell
Systemic corticosteroids
1. All the types of symptoms and pathology
2. Sense of smell (particularly if there are concomitant polyps)
2nd generation antihistamines
1. Inhibiting the release of LTC4, PGD2
2. Decreasing neutrophil and eosinophil chemotaxis

15. THANK YOU