Aliyah Hidayati, Roestiniadi , Hoetomo Aatpoera , Nyilo Purnami

Validity of eosinophil examination results of natural nasal mucosal scraps in patients with persistent allergic rhinitis

Introduction

Validity of eosinophil examination results of natural nasal mucosal scraps in patients with persistent allergic rhinitis. Validate nasal eosinophil scraping for persistent allergic rhinitis diagnosis. High agreement with skin prick tests shows it's a reliable, practical, and cost-effective tool.

Abstract

Introduction: Allergic rhinitis is a nasal disorder caused by an immunoglobulin E (IgE)-mediated inflammatory process. Diagnosis is typically based on clinical history and physical examination; however, objective confirmation of allergic involvement is often required. Examination of eosinophils from nasal mucosal scrapings offers a simple, minimally invasive, and low-cost diagnostic option suitable for primary healthcare settings. This study aimed to analyse the validity of nasal mucosal eosinophil scraping compared with the skin prick test as the gold standard. Methods: This study was a diagnostic test (analytical observational) using a cross-sectional design. The diagnostic accuracy study employed a cross-sectional design involving 17 patients with persistent allergic rhinitis treated at the Allergy–Immunology Polyclinic, Department of Otorhinolaryngology–Head and Neck Surgery, Dr. Soetomo General Academic Hospital, Surabaya. All subjects met the inclusion criteria and underwent both nasal mucosal eosinophil scraping and skin prick testing. Results: Nasal mucosal eosinophil scraping demonstrated a sensitivity of 92.30%, specificity of 75.00%, positive predictive value of 92.30%, negative predictive value of 75.00%, and overall accuracy of 88.23%. The Kappa test showed a coefficient value (κ) of 0.673 with a p-value of 0.006, indicating a significant agreement between the two diagnostic methods (p < 0.05). The McNemar test yielded a p-value of 1.000, showing no significant difference between nasal eosinophil scraping and the skin prick test results (p > 0.05). Conclusion: Nasal mucosal eosinophil scraping demonstrates high validity and good agreement with the skin prick test, supporting its use as a reliable, practical, and cost-effective diagnostic tool for persistent allergic rhinitis.

Review

This study investigates the validity of nasal mucosal eosinophil scraping (NMES) as a diagnostic tool for persistent allergic rhinitis, comparing it against the established skin prick test (SPT). The authors highlight the need for objective confirmation of allergic involvement beyond clinical history, particularly in primary healthcare settings where NMES offers a simple, minimally invasive, and low-cost alternative. The research aims to assess the diagnostic accuracy of NMES, positioning it as a potentially practical and cost-effective method for widespread use. The study employed a diagnostic test (analytical observational) with a cross-sectional design, involving 17 patients diagnosed with persistent allergic rhinitis. Each participant underwent both NMES and SPT. The results presented are promising, with NMES demonstrating a high sensitivity of 92.30% and an overall accuracy of 88.23%, alongside a specificity of 75.00%. The Kappa coefficient of 0.673 (p=0.006) indicates a significant agreement between NMES and SPT, while the McNemar test (p=1.000) suggests no significant difference in the results obtained from both methods. While the reported high sensitivity and good agreement are encouraging for the potential utility of NMES, a significant limitation of this study is its very small sample size (n=17). This limits the generalizability and statistical power of the findings, making it difficult to draw definitive conclusions applicable to a broader population. Although the initial results suggest NMES could be a reliable, practical, and cost-effective diagnostic tool, future studies with considerably larger cohorts are essential to validate these findings and firmly establish NMES as a robust alternative to SPT for persistent allergic rhinitis.

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