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| NARES | |
|---|---|
| Name | NARES |
| Synonyms | Nonallergic rhinitis with eosinophilia syndrome |
| Specialty | Otolaryngology, Allergy and immunology |
| Symptoms | Nasal congestion, rhinorrhea, sneezing, anosmia |
| Onset | Adult onset common |
| Duration | Chronic |
| Causes | Eosinophilic inflammation without IgE sensitization |
| Diagnosis | Nasal cytology, nasal provocation, exclusion of Allergic rhinitis |
| Treatment | Intranasal corticosteroids, intranasal antihistamines, anticholinergics |
NARES
NARES is a clinical syndrome characterized by chronic nasal symptoms associated with eosinophilic inflammation in the absence of systemic allergen-specific IgE sensitization. First described in otolaryngology and allergy literature in the late 20th century, it occupies a diagnostic niche among chronic rhinitis entities alongside Allergic rhinitis, Vasomotor rhinitis, and Chronic rhinosinusitis. Management typically involves topical anti-inflammatory and symptomatic therapies delivered by specialists in Otolaryngology and Allergy and immunology.
NARES stands for nonallergic rhinitis with eosinophilia syndrome and is defined by persistent nasal obstruction, watery rhinorrhea, and sneezing with nasal eosinophilia on cytology despite negative skin prick tests and serum specific IgE testing. Terminology has evolved through contributions from investigators in Rhinology, including case series from centers at institutions such as Mayo Clinic, Johns Hopkins Hospital, and Cleveland Clinic. Related eponyms and overlapping classifications appear in consensus statements from professional bodies like the American Academy of Otolaryngology–Head and Neck Surgery and the European Academy of Allergy and Clinical Immunology.
Epidemiologic data derive from observational cohorts in tertiary clinics and population studies from regions including North America, Europe, and Asia. Prevalence estimates vary widely, in part due to differing diagnostic criteria and referral bias; case series from Boston, Toronto, Oslo, Tokyo, and São Paulo report proportions among chronic rhinitis patients ranging from single digits to over 20%. Adult onset is more common than pediatric presentation, with associations noted in cohorts from Harvard Medical School-affiliated clinics and registries maintained by hospitals such as Massachusetts General Hospital.
Pathophysiology implicates local eosinophil recruitment and activation within the nasal mucosa without systemic atopy. Studies from laboratories at Stanford University, University of Pennsylvania, and Imperial College London have examined cytokine patterns including elevated interleukin-5 and eosinophil cationic protein, drawing parallels to tissue inflammation characterized in Eosinophilic esophagitis and Aspirin-exacerbated respiratory disease. Neurogenic mechanisms involving treatment targets evaluated by researchers at Karolinska Institutet and Mount Sinai Hospital also contribute, overlapping with descriptions in literature concerning neuropeptides and transient receptor potential channels investigated at University College London.
Patients typically present with perennial nasal obstruction, clear anterior rhinorrhea, frequent sneezing, and anosmia or hyposmia; symptoms are documented across clinics in New York City, Los Angeles, Chicago, Berlin, and Seoul. Examination may reveal pale, boggy nasal mucosa and increased secretions noted during endoscopy performed by otolaryngologists at centers like Royal Free Hospital and Guy's and St Thomas' NHS Foundation Trust. Comorbidities reported in cohort studies from Cincinnati Children's Hospital Medical Center and adult practices include chronic cough and overlap with Nonsteroidal anti-inflammatory drug hypersensitivity in some series.
Diagnosis is by exclusion: negative allergy testing (skin prick testing and serum specific IgE panels from commercial laboratories such as Quest Diagnostics and Mayo Clinic Laboratories) with demonstration of nasal eosinophilia (commonly >20% on nasal smear or brush cytology) obtained in outpatient clinics at institutions including University of California, San Francisco and Vanderbilt University Medical Center. Imaging with Computed tomography of the sinuses may be performed at radiology departments like those at Mount Auburn Hospital to exclude chronic rhinosinusitis or structural disease. Nasal provocation testing and biomarkers studied at research centers such as Johns Hopkins University can aid differentiation from occupational rhinitis seen in workers at sites like Centers for Disease Control and Prevention investigations.
First-line therapy includes intranasal corticosteroids and intranasal antihistamines, prescribed in practice patterns from clinics at Mayo Clinic and Cleveland Clinic Foundation. Anticholinergic sprays (ipratropium bromide) are effective for watery rhinorrhea and are used in pharmaceutical protocols reviewed by agencies such as the European Medicines Agency and the U.S. Food and Drug Administration. For refractory disease, short courses of systemic corticosteroids, allergen avoidance counseling from specialists at Johns Hopkins Hospital, and consideration of endoscopic surgical interventions to address anatomic contributors are strategies described in case series from Stanford Health Care and Mount Sinai Health System. Emerging therapies targeting eosinophilic inflammation reference biologics studied in trials at centers including National Institutes of Health and university hospitals like Oxford University Hospitals.
Prognosis is variable: many patients achieve symptomatic control with topical therapy, as demonstrated in longitudinal cohorts from University of Michigan and Duke University Hospital, while others experience chronic symptoms and decreased quality of life measured by instruments validated at Brigham and Women's Hospital and Johns Hopkins Bloomberg School of Public Health. Complications may include chronic sinusitis, nasal polyposis in selected patients paralleling findings from Cleveland Clinic research, and sleep-disordered breathing documented in sleep labs affiliated with Stanford University School of Medicine. Regular follow-up with otolaryngology or allergy specialists is recommended to monitor response and adjust therapy.
Category:Rhinology