Nasal cellularity in 183 unselected schoolchildren aged 9 to 11 years.
OBJECTIVE
Although rhinitis is extremely frequent in children, methods for assessing the severity of nasal inflammation produce results with wide variability and hence weak clinical significance. We designed this epidemiologic investigation to define the clinical usefulness of assessing nasal cellularity in children.


METHODS
We studied 183 of 203 eligible unselected schoolchildren who were aged 9 to 11 years and whose parents gave informed consent and completed a questionnaire on the history of atopic and respiratory symptoms. In all children, nasal swabs were obtained from both nostrils and eluted in saline and slides were prepared from cytospin preparations for staining and white cell counts. Children also underwent determination of nasal volume, skin prick tests with 7 common local allergens, flow volume curves, and nitric oxide measurement in expired air. Blood samples were drawn for the measurement of total immunoglobulin E, eosinophil percentage, and detection of Chlamydia pneumoniae antibodies. C pneumoniae DNA was also sought in eluates from nasal swabs. The percentage, standard deviations, and percentiles of the various nasal white cell populations were determined.


RESULTS
No correlation of the percentage of these cells was found with the history of allergies or respiratory disease or with functional or laboratory finding. Repeat nasal swabs obtained 1 month after the initial examination in 31 children (20 with neutrophils higher and 11 lower than 14%) in 77.4% of the cases confirmed the previous (high or normal) result. Twelve of the 16 eligible children with persistently high nasal neutrophil counts completed a 15-day cycle of intranasal flunisolide therapy (200 micro g twice a day). Therapy significantly reduced nasal neutrophil percentage and increased nasal volume.


CONCLUSIONS
Increased nasal neutrophils, although related neither to the clinical history nor to laboratory variables, are a common important finding in children. A 15-day cycle of intranasal flunisolide is sufficient to restore normal nasal neutrophilia.
Ronchetti
Roberto
R
Department of Pediatrics, II Faculty of Medicine, University La Sapienza, Rome, Italy. ronchetti@uniroma1.it
Villa
Maria Pia
MP
Martella
Susy
S
La Grutta
Stefania
S
Ronchetti
Francesco
F
Biscione
Gian Luca
GL
Pagani
Jacopo
J
Falasca
Carlo
C
Guglielmi
Francesco
F
Barreto
Mario
M
D000281:Administration, Intranasal; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001483:Base Sequence; D001707:Biopsy, Needle; D001944:Breath Tests; D002648:Child; D005122:Exudates and Transudates / Q000737:chemistry; D005446:Fluocinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D007958:Leukocyte Count; D009297:Nasal Mucosa / Q000166:cytology* / Q000473:pathology*; D009504:Neutrophils / Q000166:cytology / Q000473:pathology; D009589:Nitrogen Oxides / Q000032:analysis; D015203:Reproducibility of Results; D012140:Respiratory Tract Diseases / Q000188:drug therapy / Q000473:pathology*; D012220:Rhinitis / Q000473:pathology; D012882:Skin Tests
D000893:Anti-Inflammatory Agents; D009589:Nitrogen Oxides; D005446:Fluocinolone Acetonide; C007734:flunisolide