Non-Allergic Rhinitis with Eosinophilia Syndrome (NARES): Symptoms, Triggers, and Targeted Care
Non-Allergic Rhinitis with Eosinophilia Syndrome (NARES) is a chronic nasal condition characterised by persistent rhinitis symptoms — including sneezing, nasal congestion, and a reduced sense of smell — alongside elevated eosinophils in nasal secretions, despite negative allergy test results. Understanding NARES is an important first step toward better managing your nasal health and overall wellbeing.
If you've been experiencing year-round nasal symptoms that don't appear to be allergy-driven, NARES may be worth exploring with appropriate healthcare professionals. This guide provides an educational overview of the condition — its symptoms, known triggers, how it's distinguished from other forms of rhinitis, and how health screening can support a more informed picture of your health.
What Is NARES?
NARES (Non-Allergic Rhinitis with Eosinophilia Syndrome) is a subtype of non-allergic rhinitis in which the nasal mucosa contains a high proportion of eosinophils — a type of white blood cell typically associated with inflammation — yet standard allergy testing returns negative results. It accounts for a significant proportion of non-allergic rhinitis cases and is considered a distinct clinical entity from allergic rhinitis, infectious rhinitis, and other nasal inflammatory conditions.
Unlike allergic rhinitis, NARES is not triggered by allergen exposure. Instead, it involves an eosinophilic inflammatory process that persists independently of allergic sensitisation.
Snippet Definition: NARES is a chronic nasal condition marked by persistent rhinitis symptoms and elevated nasal eosinophils, occurring without identifiable allergic sensitisation. It affects adults most commonly and may be associated with conditions such as aspirin sensitivity and nasal polyps.
Recognising NARES: Common Symptoms
NARES shares several symptoms with allergic rhinitis, which can sometimes make initial identification challenging. Key symptoms often associated with NARES include:
- Profuse, watery rhinorrhoea (runny nose)
- Frequent, intense sneezing episodes
- Nasal congestion (often bilateral and persistent)
- Nasal pruritus (itching inside the nose)
- Anosmia or hyposmia (loss or reduced sense of smell)
- Symptoms present year-round rather than seasonally
- Absence of ocular symptoms (which helps differentiate from allergic rhinitis)
One helpful distinguishing feature is that NARES symptoms are typically perennial (persistent throughout the year), are not triggered by specific environmental allergens, and do not respond to antihistamine therapy in the way allergic rhinitis does.
Practical Insight: If you're experiencing chronic nasal symptoms that seem unrelated to pollen seasons or known allergens, and conventional allergy advice hasn't provided clear answers, this may suggest a non-allergic inflammatory process worth investigating through appropriate health screening and professional assessment.
NARES vs Other Types of Rhinitis: A Comparison
Understanding how NARES differs from other rhinitis types can help you have more informed conversations with healthcare professionals.
| Feature | Allergic Rhinitis | NARES | Non-Allergic Rhinitis (Other) |
|---|---|---|---|
| Allergy Test Result | Positive (IgE-mediated) | Negative | Negative |
| Nasal Eosinophils | May be elevated | Significantly elevated | Not elevated |
| Seasonal Pattern | Often seasonal | Perennial | Variable |
| Ocular Symptoms | Common | Uncommon | Uncommon |
| Triggers | Specific allergens | Non-specific / unclear | Irritants, hormones, medications |
| Associated Conditions | Asthma, eczema | Nasal polyps, aspirin sensitivity | Vasomotor changes |
| Antihistamine Response | Generally good | Limited | Variable |
This table illustrates why NARES can sometimes be misidentified — it presents similarly to allergic rhinitis but requires a different clinical approach for accurate characterisation.
Known and Suspected Triggers of NARES
Unlike allergic rhinitis — where triggers are allergen-specific and identifiable through allergy testing — NARES triggers are less clearly defined. However, several factors are understood to influence symptom intensity:
- Environmental irritants — strong fragrances, cigarette smoke, air pollution, and cleaning chemicals can aggravate nasal mucosa
- Temperature changes — moving between cold and warm environments may provoke symptoms
- Aspirin and NSAIDs — a subgroup of people with NARES may have co-existing aspirin sensitivity
- Hormonal fluctuations — symptoms may worsen during pregnancy or hormonal changes
- Alcohol consumption — can trigger nasal congestion and rhinorrhoea in some individuals
- Occupational exposures — prolonged exposure to dust, fumes, or chemical vapours in working environments
Practical Insight: In cities like London, where air quality, traffic pollution, and indoor environmental exposure are particularly significant health factors, understanding your personal triggers may be an important element of managing persistent nasal symptoms more effectively.
Who Should Consider Health Screening?
Whilst NARES itself requires clinical assessment and diagnosis by an appropriate healthcare professional, targeted health screening can play a meaningful supporting role — particularly in helping to establish a clearer baseline picture of your inflammatory and immune markers.
You may benefit from a health screening review if you:
- Experience persistent, year-round nasal symptoms without a clear allergic cause
- Have previously had inconclusive or negative allergy testing despite ongoing symptoms
- Have a history of nasal polyps or aspirin/NSAID sensitivity
- Want to understand your eosinophil levels or wider inflammatory blood markers
- Are seeking clarity before a forthcoming appointment with a healthcare professional
- Are proactively monitoring your health and immune function
At our nurse-led clinic in London, we provide professional health screening and blood testing services that can help you gather meaningful health data. Our services are reporting-focused — we provide clear, accurate test results to support your ongoing care conversations. We do not offer prescriptions, treatment plans, or diagnostic services.
You can learn more about our allergy blood testing services and the types of panels available through our clinic.
What Blood Markers May Be Relevant?
Whilst NARES is characterised by nasal eosinophilia (detected via nasal secretion analysis), several blood markers may provide useful contextual information when reviewed alongside clinical findings:
Eosinophil Count (Absolute and Percentage)
A full blood count (FBC) includes an eosinophil count, which measures the proportion of eosinophilic white blood cells in your bloodstream. Elevated peripheral eosinophils may sometimes correlate with eosinophilic inflammatory conditions, though nasal eosinophilia in NARES can exist independently of raised blood eosinophils.
An elevated eosinophil count may suggest an ongoing inflammatory process, allergic response, or other immune-mediated condition — and can sometimes highlight the need for further clinical assessment. For a detailed explanation of what eosinophil readings in a standard blood report may indicate, see our article on eosinophils in your blood report.
Total IgE Levels
Measuring total serum IgE can assist in differentiating between allergic and non-allergic mechanisms. In NARES, total IgE is typically within normal range, which — alongside negative specific IgE testing — supports the non-allergic classification. This is important context that screening results can provide.
Specific IgE Allergy Testing
Comprehensive allergy blood testing can help rule out IgE-mediated sensitivities to common aeroallergens such as house dust mite, grass pollen, cat dander, and mould spores. A negative panel supports consideration of non-allergic rhinitis subtypes, including NARES. For those presenting with severe nasal symptoms despite negative systemic tests, Localised Allergic Rhinitis (LAR) is another distinct condition worth exploring alongside a specialist.
C-Reactive Protein (CRP) and ESR
Inflammatory markers such as CRP and ESR may sometimes be reviewed as part of a broader health picture, though they are not specific to NARES.
Practical Insight: Understanding your biomarker profile provides valuable context — even when individual results fall within reference ranges. It equips you with data to discuss meaningfully with a GP or relevant healthcare professional.
How Often Should You Consider Screening?
Frequency of health screening depends on your personal health history, symptom profile, and the advice of your healthcare team. As a general educational guide:
- Initial baseline screening is useful if you are experiencing unresolved symptoms and have not had recent blood testing
- Annual review of key inflammatory and immune markers may be appropriate for those with ongoing nasal or respiratory symptoms
- Follow-up testing may be considered after significant lifestyle changes, environmental changes, or following healthcare appointments
Our clinic does not set clinical review intervals — we recommend discussing appropriate screening frequency with your GP or relevant healthcare professional.
What Do Your Results Mean?
Blood test results are best interpreted in the context of your full clinical history and symptoms. Our nurse-led team will provide clear, professional reporting on your results. Here is a general educational guide to common findings:
| Result | What It May Suggest |
|---|---|
| Normal IgE + normal eosinophils | May support non-allergic mechanism; further clinical review advised |
| Elevated eosinophils | May indicate an eosinophilic inflammatory process; professional review recommended |
| Positive specific IgE | Suggests allergic sensitisation — NARES less likely to be primary cause |
| Normal specific IgE + elevated nasal eosinophils (via nasal cytology) | Consistent with NARES profile — requires clinical confirmation |
Results from our clinic are provided as clear, structured reports. We recommend sharing these with your GP or appropriate healthcare professional for full clinical interpretation.
Local London Context: Why Proactive Screening Matters Here
London's urban environment — with its high levels of particulate air pollution, diverse housing types, and significant occupational variation — means that nasal and respiratory health concerns are particularly common among residents. Many Londoners experience persistent nasal symptoms that may go unaddressed for years, either assumed to be allergic or attributed to general environmental exposure.
With both NHS services and private health screening options available across the capital, proactive health monitoring is increasingly accessible. Our nurse-led clinic offers convenient, professional blood testing for those seeking clarity and a data-informed starting point for health conversations.
If you're based in London and experiencing persistent rhinitis symptoms, our article on allergic vs non-allergic rhinitis with negative tests may help contextualise your symptom pattern before your next healthcare appointment.
Frequently Asked Questions About NARES
What is Non-Allergic Rhinitis with Eosinophilia Syndrome (NARES)?
NARES is a chronic inflammatory nasal condition characterised by persistent rhinitis symptoms — including sneezing, congestion, and reduced sense of smell — combined with elevated eosinophils in nasal secretions. Crucially, allergy testing returns negative results, distinguishing it from allergic rhinitis.
How is NARES different from allergic rhinitis?
In allergic rhinitis, symptoms are triggered by specific allergens and IgE-mediated immune responses. In NARES, allergy tests are negative, yet nasal eosinophilia persists. NARES is perennial rather than seasonal and typically does not respond to antihistamines in the same way.
Can a blood test diagnose NARES?
No single blood test confirms NARES. However, blood testing — including full blood count, total IgE, and specific IgE panels — can help rule out allergic causes and provide a broader inflammatory picture. Definitive assessment requires nasal cytology and clinical evaluation by a healthcare professional.
What blood markers are relevant to NARES?
Key markers include eosinophil count (from a full blood count), total IgE levels, and specific IgE allergy panels. These may help distinguish NARES from allergic rhinitis and provide useful context when reviewed alongside clinical findings.
Is NARES associated with other conditions?
NARES is sometimes associated with nasal polyps, aspirin-exacerbated respiratory disease (AERD), and may be linked to non-steroidal anti-inflammatory drug (NSAID) sensitivity. If you have these conditions, professional assessment is recommended.
What triggers NARES symptoms?
Common non-specific triggers may include environmental irritants (smoke, strong fragrances, pollution), temperature changes, alcohol, hormonal changes, and certain medications. Triggers vary between individuals and are not allergen-specific.
Should I see a doctor if I think I have NARES?
Yes. If you experience persistent nasal symptoms, we recommend speaking with your GP or an appropriate healthcare professional for clinical assessment. Health screening can support this process by providing baseline data, but does not replace professional medical evaluation.
Can health screening help if I suspect NARES?
Health screening can provide meaningful baseline blood data — including eosinophil counts and IgE levels — which may support informed conversations with your healthcare team. Our nurse-led clinic provides professional testing and reporting to help you understand your health picture.
How long does NARES last?
NARES is typically a chronic condition, meaning symptoms can persist over months or years without appropriate management. The course varies between individuals. Proactive health monitoring and regular communication with a healthcare professional is advisable.
Where can I get health screening for nasal and immune health in London?
Our nurse-led clinic in London offers a range of health screening and blood testing panels relevant to nasal and immune health. Explore our health and allergy screening options to find the most suitable starting point for your needs.
Start Your Health Screening Journey
If you've been experiencing persistent nasal symptoms and want to build a clearer picture of your immune and inflammatory health, proactive screening is a positive and empowering step. Our nurse-led team in London provides professional, confidential blood testing with clear result reporting — giving you the data you need to have informed conversations with your healthcare team.
Take a look at our available screening options and contact our clinic to find the approach that feels right for you. Understanding your health is always a worthwhile investment.
