Nonallergic rhinitis with eosinophilia syndrome is a type of rhinitis where you have large numbers of immune cells called eosinophils in your nasal tissue but no symptoms of allergies. It can be treated with intranasal medications.

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Rhinitis is a term that refers to inflammation in your nose. It can be classified as either allergic or nonallergic.

Allergic rhinitis is when your immune system reacts to factors in the environment, such as pollen, molds, and animal dander. This causes an allergic reaction.

Nonallergic rhinitis is nasal inflammation that occurs in the absence of an allergic reaction. Nonallergic rhinitis with eosinophilia syndrome (NARES) is a subtype of nonallergic rhinitis.

In the article below, we’ll dive into more detail about NARES. We’ll cover its symptoms, causes, how it’s diagnosed and treated, and more.

NARES is a type of nonallergic rhinitis that’s associated with a high number of eosinophils in the tissues of your nose. It’s estimated to affect 2–33% of people with chronic rhinitis globally.

Eosinophils are a type of immune cell. When they’re activated, they can make a variety of factors that promote inflammation. Typically, eosinophils are involved in protecting your body from infections, especially those due to parasites.

Sometimes, eosinophils are activated inappropriately. When this occurs, they can be involved in a variety of inflammatory conditions, including allergies and asthma.

People with NARES have high levels of eosinophils in their nasal tissue. However, they have no evidence of an existing allergy or other nasal conditions that could be causing their symptoms.

The symptoms of NARES include:

NARES and several other types of nonallergic rhinitis are chronic, meaning that symptoms last for 3 months or longer.

People with NARES may also have more severe nasal symptoms than people with other types of allergic or nonallergic rhinitis.

The symptoms of NARES are believed to be caused by the movement of eosinophils into nasal tissue.

Prolonged release of histamine, which is made by immune cells called mast cells and basophils, is also suspected to play a role. Histamine is the compound that causes allergy symptoms.

What exactly triggers NARES is unknown. The researchers of a 2015 study suggest that the acute stage of NARES could be brought on by triggers like certain climate conditions, temperature changes, or strong odors.

Because the symptoms of nonallergic rhinitis like NARES are so similar to allergic rhinitis, your doctor may do allergy testing. This may include skin-prick tests or blood testing.

People with NARES don’t have any evidence of allergies. As such, allergy testing comes back negative.

A doctor may also take a sample of nasal secretions or tissue to check for the presence of certain immune cells.

People with NARES have increased eosinophils and mast cells. There may also be evidence of mast cell degranulation, which is the process by which mast cells release histamine and other factors.

Typically, 20% or more of cells in a nasal sample are eosinophils in NARES. However, there’s no set cutoff. Researchers from a 2020 study note that the cutoff they found varied quite widely from 5% to 25%.

There are several medications that may be used alone or in combination to treat NARES. These are typically given intranasally and include:

Some people with NARES may also find that nasal irrigation with a saline rinse may provide some relief. A 2016 review found some benefit over a placebo for daily 150 milliliter nasal rinses with saline solution for people with chronic rhinitis.

Can allergic rhinitis cause high eosinophil levels?

Yes, high levels of eosinophils can also be found in people with allergic rhinitis. Unlike NARES, people with allergic rhinitis have allergy-specific markers, such as a type of antibody called IgE.

What are other types of nonallergic rhinitis?

In addition to NARES, there are several other types of nonallergic rhinitis. A few examples are:

Are there other conditions associated with high levels of eosinophils?

High levels of eosinophils may be present in many different health conditions. Some examples include:

NARES is a type of rhinitis where there are high levels of eosinophils in your nasal tissue. People with NARES have no markers of allergies or other nasal conditions that may be causing their symptoms.

A variety of intranasal medications may be used to help manage the symptoms of NARES. These include things like steroids and antihistamines.

If you’ve had sneezing, runny nose, or reduced sense of smell for a prolonged period of time, see your doctor. They can do tests to determine what may be causing your symptoms and develop a plan to help you manage them.