Non-allergic rhinitis with eosinophilia syndrome treated with mepolizumab: A case report

Bono Eleonora; Zucca Federica; Ortolani Valeria Giuseppina Rita; Caron Lea; Eplite Angelo; Carsana Luca; Iemoli Enrico; Bono Eleonora; Zucca Federica; Ortolani Valeria Giuseppina Rita; Caron Lea; Eplite Angelo; Carsana Luca; Iemoli Enrico

doi:10.3934/Allergy.2023012

AIMS Allergy and Immunology

2023, Volume 7, Issue 3: 176-182. doi: 10.3934/Allergy.2023012

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Case report Special Issues

Non-allergic rhinitis with eosinophilia syndrome treated with mepolizumab: A case report

1.
University of Milan, Milan, Italy
2.
Allergy and Clinical Immunology Unit, ASST FBF Sacco, Milan, Italy
3.
Department of Otolaryngology, ASST FBF Sacco, Milan, Italy
4.
Department of Pathology, ASST FBF Sacco, Milan, Italy

Received: 19 March 2023 Revised: 08 June 2023 Accepted: 26 June 2023 Published: 30 June 2023

Non-allergic rhinitis with eosinophilia syndrome (NARES) is a chronic inflammatory rhinopathy characterized by nasal obstruction, rhinorrhea, sneezing and/or an itchy nose. Although eosinophilic nasal cytology is common in NARES patients, identifying the condition is challenging due to a lack of consensus on the diagnostic processes and the role of nasal cytology in clinical practice. Patients may undergo several allergy tests with negative or inconclusive results and are eventually diagnosed with idiopathic/aspecific rhinitis. Treatment options may include intranasal corticosteroids, intranasal antihistamines or a combination of both types of medication. This case report describes a patient with NARES who was unresponsive to conventional therapies and experienced significant improvement after treatment with Mepolizumab, a drug approved for severe asthma with hypereosinophilia, hypereosinophilic syndrome (HES), chronic rhinosinusitis with nasal polyposis (CRSwNP) and eosinophilic granulomatosis with polyangiitis (EGPA). Mepolizumab was administered once a month at a dose of 100 mg subcutaneously. The patient experienced a complete remission of symptoms a year after starting the off-label treatment. Blood counts remained stable and no adverse effects were observed. Mepolizumab appears to be a potential therapeutic alternative in patients with NARES who are unresponsive to conventional therapies.
- non-allergic rhinitis,
- chronic inflammatory rhinopathy,
- nasal cytology,
- mepolizumab,
- eosinophilic inflammation,
- treatment
Citation: Bono Eleonora, Zucca Federica, Ortolani Valeria Giuseppina Rita, Caron Lea, Eplite Angelo, Carsana Luca, Iemoli Enrico. Non-allergic rhinitis with eosinophilia syndrome treated with mepolizumab: A case report[J]. AIMS Allergy and Immunology, 2023, 7(3): 176-182. doi: 10.3934/Allergy.2023012

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Abstract

Non-allergic rhinitis with eosinophilia syndrome (NARES) is a chronic inflammatory rhinopathy characterized by nasal obstruction, rhinorrhea, sneezing and/or an itchy nose. Although eosinophilic nasal cytology is common in NARES patients, identifying the condition is challenging due to a lack of consensus on the diagnostic processes and the role of nasal cytology in clinical practice. Patients may undergo several allergy tests with negative or inconclusive results and are eventually diagnosed with idiopathic/aspecific rhinitis. Treatment options may include intranasal corticosteroids, intranasal antihistamines or a combination of both types of medication. This case report describes a patient with NARES who was unresponsive to conventional therapies and experienced significant improvement after treatment with Mepolizumab, a drug approved for severe asthma with hypereosinophilia, hypereosinophilic syndrome (HES), chronic rhinosinusitis with nasal polyposis (CRSwNP) and eosinophilic granulomatosis with polyangiitis (EGPA). Mepolizumab was administered once a month at a dose of 100 mg subcutaneously. The patient experienced a complete remission of symptoms a year after starting the off-label treatment. Blood counts remained stable and no adverse effects were observed. Mepolizumab appears to be a potential therapeutic alternative in patients with NARES who are unresponsive to conventional therapies.

Ethical approval

The authors have drafted the necessary documentation for informed consent, in accordance with the guidelines, for the off-label treatment received by the patient. Furthermore, the patient has given informed consent for the publication of this case report.

Use of AI tools declaration

The authors declare they have not used Artificial Intelligence (AI) tools in the creation of this article.

Conflict of interest

The authors declare no conflict of interest.

Author contributions

Bono Eleonora drafted the manuscript and agreed to be accountable for all aspects of the work. Zucca Federica acquired the clinical data. Ortolani Valeria Giuseppina Rita analyzed the clinical data. Caron Lea analyzed the literature. Eplite Angelo performed the nasal cytology and supported the writing of the manuscript, particularly for sections related to the otorhinolaryngological field. Carsana Luca analyzed the nasal cytology samples, provided photographic material, and assisted in writing the manuscript for sections related to pathology. Iemoli Enrico designed the study, reviewed, and approved the manuscript.

References

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