Quantitative Nasal Eosinophilia: An Objective Tool to Optimize Intranasal Topical Steroid Spray in the Management of Perennial Pediatric Allergic Rhinitis

Abstract

Background: Perennial allergic rhinitis (PAR) is a common chronic inflammatory disorder in children and may adversely affect sleep, school performance and quality of life. Intranasal corticosteroids (INCS) are an important component of treatment; however, determining the optimal duration and intensity of topical steroid therapy is often based predominantly on subjective symptom improvement. Quantitative nasal eosinophilia (QNE), assessed from nasal cytology, may provide an objective indicator of local allergic inflammation and could assist in optimizing therapy. Objective: To evaluate the usefulness of quantitative nasal eosinophilia as an objective parameter for assessing response to intranasal topical corticosteroid therapy in children with perennial allergic rhinitis.Methods: A retrospective observational study was conducted among 100 pediatric patients diagnosed with perennial allergic rhinitis who attended the Department of Pediatrics, A.N.M. Medical College, Gaya/NMCH, Patna, between January and June 2026. Relevant demographic, clinical and treatment data were retrieved from medical records. Nasal smear findings were reviewed for eosinophil quantification before and after intranasal corticosteroid therapy where available. Clinical symptom severity was assessed using recorded symptom scores. The association between change in nasal eosinophil count and clinical response was evaluated statistically.Results: In this analysis, the mean nasal eosinophil count decreased from [15.2 ± 5.6] cells/high-power field (HPF) before treatment to [5.8 ± 3.1 cells/HPF] following treatment, representing a significant reduction (p < 0.001). Mean total symptom score decreased from [7.4 ± 1.8] to [3.1 ± 1.4] (p < 0.001). A significant positive correlation was observed between reduction in nasal eosinophilia and improvement in symptom score (r = [0.68], p < 0.001). Patients demonstrating greater reduction in eosinophilic inflammation were more likely to show satisfactory clinical improvement.Conclusion: Quantitative nasal eosinophilia may serve as a simple, inexpensive and objective adjunct for monitoring response to intranasal corticosteroid therapy in pediatric perennial allergic rhinitis. Incorporating nasal cytology with clinical assessment may facilitate more rational treatment optimization and potentially reduce unnecessary prolonged exposure to higher corticosteroid doses. Prospective studies with standardized dosing and serial measurements are warranted.