[Rhinocytology Analysis for Chronic Rhinitis in Children: An Allergist's Perspective].

UNLABELLED: Nasal mucus cytology (rhinocytology) is a simple and non-invasive diagnostic method that can help doctors identify rhinitis phenotypes and clarify the diagnosis in patients with protracted rhinitis (runny nose and/or nasal congestion for more than 3 weeks). Aim of the work is to evaluate rhinocytology data in children referred by otolaryngologists to an allergist-immunologist to clarify the causes of protracted rhinitis.

STUDY DESIGN AND CONDITIONS: A one-time retrospective study of children with protracted rhinitis observed in Moscow Children's Clinic No. 94 in the period 2022-2023. The analysis of rhinocytology results was carried out based on the data from the EMIS database.

MATERIAL AND METHODS: The study included data from 344 rhinocytograms obtained from patients aged 2-18 years with persistent rhinitis (runny nose/nasal congestion for more than 3 weeks) referred by otolaryngologists for consultation with an allergist-immunologist in the period from October 1, 2022 to June 30, 2023. Exclusion criteria: acute respiratory inflammatory diseases; acute inflammatory process in the paranasal sinuses; nasal polyps; curvature of the nasal septum; previously undiagnosed (not confirmed by allergological examination) diagnoses of seasonal, episodic or year-round allergic rhinitis in the patient; grade 2-3 adenoids, as well as acute or chronic rhinosinusitis according to examination and X-ray examination (or computed tomography of the paranasal sinuses).

RESULTS: Analysis of rhinocytograms in children with symptoms of prolonged rhinitis allowed us to identify two main types of changes in the cellular composition of nasal mucus: 1). cytological profile of non-allergic rhinitis, characterized by an increase in the number of inflammatory cells: neutrophils and / or lymphocytes (from a moderate amount to - completely in the field of vision with a normal level of eosinophils) - in 56.6% of cases; 2). cytological profile of mixed rhinitis with an increase in the level of inflammatory cells in combination with hypereosinophilia of more than 15% in the field of vision - in 10.6%. From the mixed rhinitis group (n=36), 2 patients had large accumulations of flora (bacteria) in the rhinocytogram in combination with an increased number of eosinophils. In 28.4% of children, significant changes in the rhinocytogram were not found. In 4.4% of cases, the material for research was insufficient. Overall, infectious-type pathological changes were significantly more common among the examined patients (59.3% [95% CI: 54.0-64.6]), while mixed-type changes were 5 times less common (10.9% [7.6-14.3%], p<0.001).

CONCLUSIONS: According to rhinocytograms, the majority of children with persistent rhinitis referred by otolaryngologists to an allergist-immunologist had infectious-type inflammation, while mixed-type cytological changes were less common. Rhinocytograms can assist physicians in diagnosing allergic and non-allergic rhinitis, clarifying the type of inflammatory changes in the nasal cavity, and optimizing treatment for children with persistent rhinitis.