Rhinitis: Is It Beyond a Local Inflammation?
Objective: Rhinitis affects most of the population and its economic burden is serious. Even though it is the local inflammation of the nasal mucosa with Allergic (AR) Or Non-Allergic (NAR) mechanisms, it is not known whether it causes systemic inflammation which can increase the morbidity and mortality. In this study, we aimed to investigate the systemic inflammation in patients with chronic rhinitis using novel serum inflammation markers. Therewith, we would answer if these parameters have an effect on determining various endotypes.
Methods: In this retrospective case-control study, we included 436 patients with newly diagnosed AR (n:179), NAR (n:157), and 103 healthy individuals. Inflammation related blood parameters were collected as Lymphocyte/Monocyte Ratio (LMR), Neutrophil/Lymphocyte Ratio (NLR), Eosinophil/Neutrophil Ratio (ELR), and Systemic Immune Inflammation Index (SII).
Results: All groups were similar in terms of age, gender, or body mass index. Neutrophil counts were significantly higher both in AR and NAR groups compared to controls (4.51 ± 0.09, 4.54 ± 0.1 vs. 3.73 ± 0.1, p<0.001). NLR (1.91 ± 0.56, 1.89 ± 0.61, 1.61 ± 0.59, p<0.001), LMR (5.76 ± 0.17, 5.93 ± 0.17, 5.1 ± 0.15, p=0.005), ELR (0.1335 ± 0.007, 0.0999 ± 0.006, 0.12 ± 0.009, p=0.003), SII (533.3 ± 16.6, 558.1 ± 20.9, 479.9 ± 22.2, p=0.035), and CRP (1.44 ± 0.09, 1.67 ± 0.09, 0.87 ± 0.04, p<0.001) were significantly higher in AR and NAR groups than the controls, respectively. SII (r=0.146, p=0.007) and ELR (r=0.254, p<0.001) was significantly correlated with presence of asthma.
Conclusion: We found that systemic circulation of inflammatory cells was significantly increased in patients with/without allergy compared to the control group. This study showed that not only AR, but also NAR triggers a systemic increase of inflammation which supports the link between rhinitis and comorbid conditions such as asthma, chronic hyperplastic eosinophilic sinusitis, nasal polyposis, and serous otitis media. Therefore, effective treatment is suggested for both local inflammation and its systemic manifestations.
Sümeyra Alan Yalim*, Ayse Füsun Kalpaklıoglu, Ayşe Baccıoglu, Merve Poyraz, Gulistan Alpagat, Betul Dumanoglu
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