Diagnosis of allergic rhinitis phenotypes

Shchurok I.N., Novikov D.K.

Vitebsk State Medical University, Vitebsk, Belarus

Aim of study: to develop a method for diagnosing neutrophilic, basophilic and eosinophilic phenotypes of allergic rhinitis (AR) by conducting a nasal provocative test (NPT) with a low dose of allergen and determining the increase in tryptase ,myeloperoxidase(MPO) and eosinophilic cationic protein(ECP) levels in nasal lavage.
Materials and methods: in 30 patients with allergic rhinitis and 20 healthy volunteers before and 30 minutes after the NPT with Dermathophagoides pt. determined the result by estimating the release of myeloperoxidase (MPO) from neutrophiles, tryptase from mast cells and basophiles , as well as eosinophilic cationic protein from eosinophiles in nasal lavage.
Results: A provocative test with a minimally selected concentration of allergen did not cause the development of clinical symptoms, but allowed to verify the response of the nasal mucosa to an allergen intake. After a provocative test, 27 (90%) patients with allergic rhinitis showed a significant increase in tryptase level after 30 min (p = 0.043) in contrast to healthy volunteers. The diagnostic criterion for an increase in the level of tryptase in nasal lavage after a NPT in patients with allergic rhinitis was 7.8 pg/ml (according to ROC analysis). After the NPT, it was revealed that 53% of patients with allergic rhinitis experienced a significant increase (over 16%) of myeloperoxidase activity in nasal lavage (p = 0.03). In 23 (76.6%) patients with allergic rhinitis, a positive increase in the level of eosinophilic cationic protein was detected. Before provocation, the level was 829.9 [673.3; 986.6] pg/ml, and 30 minutes after it was 1080.9 [896.6; 1265.3] pg/ml, p = 0.001. The revealed correlation between the level of IgE and the increase in the level of tryptase and myeloperoxidase in nasal lavage confirms the involvement of basophils and neutrophils in allergic reactions. The level of eosinophilia in smear imprints most correlated with the level of eosinophilic cationic protein (R=0.62).
Conclusions: The developed nasal provocative test with the determination of biomarkers in nasal lavage is a method for diagnosing neutrophilic, basophilic and eosinophilic phenotypes of allergic rhinitis.