Evidence for an inflammatory pathophysiology in idiopathic rhinitis
Open accessAbstract
Background The pathophysiology of idiopathic rhinitis is unknown but the disease is classified as being non‐allergic on the basis of negative serum IgE radioallergosorbent assay (RAST) and skin prick tests. In contrast, allergic rhinitis has a Th2 type inflammatory pathology mediated by IgE and mast cells. Objective To test the null hypothesis that there would be no difference in the cellular infiltrate for key Th2‐associated inflammatory cells between allergic and idiopathic rhinitis. Methods We applied strict selection criteria in the recruitment of allergic and idiopathic rhinitis cases. In contrast to previous studies which used cytology or small biopsies, we studied all layers of the mucosa by using whole, full‐thickness nasal turbinate specimens with an average length of 2.5 cm. Immunohistochemistry and in situ hybridization techniques were used to compare the distribution and cell populations of mast cells, IgE positive (IgE + ) cells, eosinophils and plasma cells in perennial allergic ( n = 11) and idiopathic ( n = 17) rhinitis, and control nasal mucosal tissue ( n = 9). Results Mast cells and IgE + cells were significantly increased within the epithelium of allergic and idiopathic mucosa compared to normal mucosa ( P < 0.05). More IgE + cells were present in the allergic group compared to the idiopathic group with the majority of IgE + cells being mast cells. Both rhinitic groups showed increased eosinophilia localized to the superficial submucosa compared to normal mucosa ( P < 0.05). More plasma cells were present in the allergic rhinitic tissue. Conclusion Idiopathic and allergic rhinitic mucosa show similarities in their inflammatory infiltrate suggesting that both groups share a highly localized Th2, IgE‐mediated cellular immunopathology.
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Nasal biopsies from NARES patients commonly show increased numbers of mast cells and prominent mast cell degranulation.
“In addition, nasal biopsies from these patients commonly show increased numbers of mast cells and prominent mast cell degranulation.177,178”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [177]
The Mast cells results and Mast cells and IgE+ cells discussion report increased epithelial mast cells in idiopathic rhinitis compared with controls, with most of those cells degranulated. However, the paper studied patients selected for idiopathic rhinitis, not specifically NARES; its Eosinophils discussion says not all idiopathic cases had increased eosinophils. The findings therefore support the mast-cell observations but not their attribution specifically to NARES patients. (LLM, conf=0.84)
Experimental — accuracy not yet measuredImmunologic studies have revealed a Th2 inflammatory response in the nasal mucosa of LAR patients, with positive response to NPT and local production of sIgE and inflammatory mediators.
“Immunologic studies have revealed the existence of a Th2 inflammatory response in the nasal mucosa of LAR patients,177,299-301 with positive response to NPT,291,300-302 and local production of sIgE177,290,299-301,303-305 and inflammatory mediators.304,306,307”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [177]
The Results and Discussion (pages unavailable) report increased IgE-positive cells, mast cells, and eosinophils in idiopathic rhinitis and suggest a localized Th2-type response. The study did not establish that these patients had LAR through a positive nasal provocation test, nor did it demonstrate local production of allergen-specific IgE; its Th2 conclusion is also more tentative than the citing sentence suggests. (LLM, conf=0.86)
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“In accordance with this eosinophilia, he found increased numbers of IgE-positive cells.”
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- Authors
- Powe, D. G., Huskisson, R. S., Carney, A. S., Jenkins, D., & Jones, N. S.
- Affiliations
- Queen's Medical Centre (GB)
- Corresponding author
- Powe, D. G.
- Venue
- Clinical & Experimental Allergy
- Publisher
- Wiley
- Published
- 2001-06
- Volume
- 31
- Issue
- 6
- Pages
- 864-872
- ISSN
- 0954-7894 (ISSN-L)
- 1365-2222
- OpenAlex
- W1977005065
- Cited by
- 135
- References
- 37
- Citations by year
- 2026: 1 · 2025: 10 · 2024: 1 · 2023: 4 · 2022: 5 · 2021: 2 · 2020: 8 · 2019: 5 · 2018: 2 · 2017: 5 · 2016: 10 · 2015: 8 · 2014: 5 · 2013: 5 · 2012: 11
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical & Experimental Allergy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Otorhinolaryngology › Sinusitis and nasal conditions
- Keywords
- vasomotor rhinitis, allergic rhinitis, type 2 inflammation, IgE, mast cells, eosinophils, plasma cells, nasal mucosa, nasal turbinates, non-allergic rhinitis, inflammatory cell infiltration
- MeSH terms
- Adolescent, Adult, Eosinophils, Epithelial Cells, Female, Humans, Immunoglobulin E, Immunohistochemistry, Leukocyte Count, Male, Mast Cells, Middle Aged, Nasal Mucosa, Plasma Cells, Rhinitis, Rhinitis, Allergic, Perennial, Staining and Labeling, Cell Degranulation
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