DIAGNOSTIC ACCURACY OF NASAL CYTOLOGY IN DIFFERENTIATING ALLERGIC AND NON-ALLERGIC RHINITIS: A SYSTEMATIC REVIEW

Abstract

ABSTRACT

Allergic Rhinitis and Non-Allergic Rhinitis have similar clinical symptoms but require different therapeutic approaches. Accurate diagnosis often relies on the Skin Prick Test or specific IgE, which are not always available. Nasal cytology is a simple, non-invasive method with potential as an alternative diagnostic tool. This review aimed to evaluate the diagnostic accuracy of nasal cytology in distinguishing these conditions and the potential relationship between nasal smear eosinophils and allergic rhinitis symptom severity. A systematic review was conducted according to PRISMA 2020. Literature searches were conducted in PubMed and Google Scholar for 2020–2025. Inclusion criteria based on PICOSTD included diagnostic and observational studies involving patients with rhinitis symptoms, using nasal cytology as the index test and standard methods as comparators. Study quality was assessed using the JBI Critical Appraisal Tools, and data were analyzed qualitatively. Four studies met the inclusion criteria. Nasal cytology showed sensitivity ranging from 76.66% to 100% and specificity from 49.6% to 87.77%. Eosinophilia was consistently associated with allergic rhinitis, whereas neutrophilic patterns were more dominant in non-allergic rhinitis. However, the strength of the relationship between nasal smear eosinophil levels and symptom severity could not be quantitatively determined because correlation coefficients and comparable severity measures were not consistently reported. Heterogeneity in examination methods, diagnostic standards, and confounding factors contributed to variations in diagnostic accuracy. Nasal cytology is a simple, cost-effective, and semi-invasive tool that is best used as an adjunctive or screening method rather than a standalone replacement for SPT.

ABSTRAK

Rinitis alergi dan rinitis non-alergi memiliki gejala klinis serupa, tetapi memerlukan pendekatan terapeutik yang berbeda. Diagnosis yang akurat sering bergantung pada Skin Prick Test atau IgE spesifik yang tidak selalu tersedia. Sitologi hidung merupakan metode sederhana dan non-invasif yang berpotensi menjadi alat diagnostik alternatif. Tinjauan ini bertujuan mengevaluasi akurasi diagnostik sitologi hidung dalam membedakan kedua kondisi tersebut serta potensi hubungan antara eosinofil nasal smear dan derajat keparahan gejala rinitis alergi. Tinjauan sistematis dilakukan sesuai PRISMA 2020. Pencarian literatur dilakukan di PubMed dan Google Scholar untuk periode 2020–2025. Kriteria inklusi berdasarkan PICOSTD mencakup studi diagnostik dan observasional pada pasien dengan gejala rinitis, menggunakan sitologi hidung sebagai tes indeks dan metode standar sebagai pembanding. Kualitas studi dinilai menggunakan JBI Critical Appraisal Tools dan data dianalisis secara kualitatif. Sebanyak empat studi memenuhi kriteria inklusi. Sitologi hidung menunjukkan sensitivitas 76,66%–100% dan spesifisitas 49,6%–87,77%. Eosinofilia secara konsisten berkaitan dengan rinitis alergi, sedangkan pola neutrofilik lebih dominan pada rinitis non-alergi. Namun, kekuatan hubungan antara kadar eosinofil nasal smear dan derajat keparahan gejala belum dapat ditentukan secara kuantitatif karena koefisien korelasi dan ukuran keparahan yang sebanding tidak dilaporkan secara konsisten. Heterogenitas metode pemeriksaan, standar diagnostik, dan faktor pengganggu berkontribusi terhadap variasi akurasi diagnostik. Sitologi hidung merupakan metode sederhana, hemat biaya, dan semi-invasif yang lebih tepat digunakan sebagai pemeriksaan pendukung atau skrining, bukan sebagai pengganti tunggal SPT.