What are the common causes of eosinophilia in a patient with rhinitis but no evidence of allergy, asthma, atopy, gastrointestinal, cardiac, or hematologic disease?

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Last updated: October 19, 2026 • View editorial policy

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Rinitis No Alérgica con Eosinofilia (NARES)

En un paciente con rinitis y eosinofilia sin evidencia de alergia, asma, atopia, o afectación sistémica, la causa más probable es el Síndrome de Rinitis No Alérgica con Eosinofilia (NARES). 1

Características Diagnósticas de NARES

NARES se caracteriza por:

  • Eosinófilos nasales elevados (>5-20% en frotis nasal) en pacientes con síntomas perennes 1
  • Ausencia de evidencia alérgica: pruebas cutáneas negativas y/o IgE específica sérica negativa 1, 2
  • Síntomas perennes: estornudos paroxísticos, rinorrea acuosa profusa, prurito nasal 1, 3
  • Hiposmia/anosmia ocasional: característica prominente que NO se comparte con rinitis alérgica 3
  • Edad media de presentación: típicamente adultos de mediana edad 1

La evidencia más reciente confirma que NARES no está asociada con producción local de IgE específica en la mucosa nasal (entopía), descartando un mecanismo alérgico local 2.

Otras Causas a Considerar en Este Contexto

1. Rinitis Inducida por Medicamentos

Debe investigarse exposición a 1:

  • Inhibidores de la ECA
  • Inhibidores de fosfodiesterasa-5
  • Antagonistas α-adrenérgicos
  • AINEs y aspirina
  • Rinitis medicamentosa: uso excesivo de descongestivos nasales tópicos α-adrenérgicos

2. Rinitis Ocupacional

Exposición a sustancias en el lugar de trabajo 1:

  • Antígenos de animales de laboratorio
  • Polvos de granos o madera
  • Químicos e irritantes
  • Puede ser mediada por factores no alérgicos

3. Rinitis Hormonal

  • Rinitis del embarazo: congestión nasal significativa después del segundo mes, desaparece dentro de 2 semanas postparto 1
  • Rinitis relacionada con el ciclo menstrual

4. Rinitis por Alimentos/Alcohol

Mecanismos vagales, vasodilatación nasal, u otros mecanismos no definidos 1

Advertencias Importantes

NARES es un factor de riesgo para:

  • Desarrollo de poliposis nasal 1, 3
  • Sensibilidad a aspirina 1, 3
  • Apnea obstructiva del sueño 1, 3

La patofisiología involucra inflamación eosinofílica nasal crónica autoperpetuante con desarrollo de micropoliposis y poliposis nasal 3.

Diferenciación Clave

Rinitis vasomotora (idiopática) generalmente NO se asocia con eosinofilia nasal 1, lo que la distingue claramente de NARES. Esta es una diferencia diagnóstica crucial en su caso.

Enfoque Diagnóstico Específico

Para confirmar NARES en este paciente:

  1. Citología nasal: demostrar >20% eosinófilos en frotis nasal 3
  2. Confirmar negatividad de IgE: ya descartada la alergia según su descripción
  3. Historia ocupacional detallada: exposiciones laborales específicas 1
  4. Revisión exhaustiva de medicamentos: especialmente los mencionados arriba
  5. En mujeres: considerar relación con embarazo o ciclo menstrual

La eosinofilia sistémica en ausencia de causas secundarias (parasitosis, malignidad, síndrome hipereosinofílico) junto con rinitis no alérgica apunta fuertemente a NARES como diagnóstico primario 4, 5.

References

1
Guideline

the diagnosis and management of rhinitis: an updated practice parameter.

Journal of Allergy and Clinical Immunology, 2008

2
Research

Non-allergic rhinitis with eosinophilia syndrome is not associated with local production of specific IgE in nasal mucosa.

European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2016

3
Research

Nonallergic rhinitis with eosinophilia syndrome.

Current allergy and asthma reports, 2006

5
Research

Eosinophilia.

Primary care, 2016

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.