Nasal eosinophilia and eosinophil peroxidase in children and adolescents with rhinitis

Background: Researchers have shown that eosinophil peroxidase (EPO) is a relatively accurate marker of eosinophilia and eosinophil activity. However, its use as a marker of eosinophilic inflammation in nasal secretions is limited because the diagnostic cutoff values of EPO for use as a one-time test for allergic diseases such as allergic rhinitis have not been established. Purpose: To identify the correlation between nasal eosinophil count and EPO in children and adolescents with rhinitis. Methods: We recruited patients <18 years of age with rhinitis for more than 2 weeks or more than 2 episodes a year whose nasal eosinophil and EPO were measured at a single allergy clinic. The eosinophil percentage was calculated by dividing the eosinophil count by the number of total cells under light microscopy at ${\times}1,000$ magnification. EPO and protein were measured from nasal secretions. We retrospectively analyzed the correlation between nasal eosinophils and protein-corrected EPO (EPO/protein) value. Results: Of the 67 patients enrolled, 41 were male (61.2%); the mean age was $8.2{\pm}4.0years$. The median nasal eosinophil count was 1 and percentage was 1%. The median protein-corrected EPO value was $12.5ng/{\mu}g$ (range, $0-31ng/{\mu}g$). There was a statistically significant correlation between eosinophil count and percentage (P<0.001). However, the eosinophil percentage and EPO did not correlate. The eosinophil count and EPO had a statistically significant correlation (P=0.01). The EPO cutoff value examined for nasal eosinophil counts of 2, 5, 10, and 20 was $17.57ng/{\mu}g$ regardless of the reference count. The largest area under the curve value was obtained when the receiver operating characteristic curve was drawn using the eosinophil count of 2. Conclusion: Nasal eosinophil count was significantly associated with protein-corrected EPO.