[NARES syndrome. A developing link in the Fernand-Widal triad].
The NARES is a new entity in rhinology. The incidence is more than 15% among all types of rhinitis. The clinical picture is a somewhat variable nasal hyper-reactivity, with frequent hyposmia. Three cases are recorded, which fit for classical criteria of diagnosis: negative allergic tests, more than 20% of local eosinophilia. The authors point out the absence of variation of eosinophilia after nasal challenge with an extract of house dust mite D. Ptéronyssinus. Nasal endoscopy and the computerized tomography show a propensity towards micropolyposis in 2 cases. A bronchial hyper-reactivity to carbamylcholine is detected twice. A cutaneous intolerance to aspirin is proved in one case. A state of adrenergic hyper-reactivity is established in the three patients. The authors suggest that NARES is precursor of the aspirin triad. A dysfunction of the autonomic nervous system, characterized by an adrenergic hyper-reactivity, leads to a neurogenic inflammation of the nasal mucosa. Eosinophils are attracted, and infiltrate the mucosa. Then the eosinophil-derived chemical mediators maintain a chronic inflammatory state. The best therapeutical means are discussed.
Moneret-Vautrin
D A
DA
Service de Médecine D, Immunologie et Allergologie, CHU de Brabois, Vandoeuvre-les-Nancy.
Wayoff
M
M
Hsieh
V
V
Wirte
Maria
Y
Y
Jankowski
R
R
D000328:Adult; D001241:Aspirin / Q000009:adverse effects*; D001249:Asthma / Q000175:diagnosis; D001342:Autonomic Nervous System Diseases / Q000150:complications; D004802:Eosinophilia / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000175:diagnosis; D009299:Nasal Provocation Tests; D011943:Receptors, Adrenergic, beta / Q000502:physiology; D012220:Rhinitis / Q000175:diagnosis / Q000209:etiology; D013577:Syndrome
D011943:Receptors, Adrenergic, beta; D001241:Aspirin
Le NARES, maillon evolutif de la triade de Fernand-Widal.