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Title: Allergic and non-allergic rhinitis in children - clinical and functional interrelationships


Nasal symptoms mostly acute, but often recurrent or chronic are the most common health problems in children. In the specifications of chronic non-infectious rhinitis dominate inflammation of the nasal mucosa caused by allergic and non-allergic factors. Studies on the clinical course of the allergic rhinitis (AR) are common, but in the case of non-allergic rhinitis (Non-AR) are rare, particularly in children.In view of the much similarity of the sings of AR and Non-AR, the possibility of evolution of the inflammation processes, it would be advantageous to find the symptom/s, marker/s, which differentiate these two disorders and give prognostic factors.The aim of this study was to determine the interdependence between AR and Non-AR by extracting the clinical symptoms, lung function parameters, biochemical and pathophysiological factors, differentiating these disorders in a group of school children with symptoms of non-infectious rhinitis. Furthermore, the identification of such allergic inflammation markers which of that best discriminate AR and Non-AR between each other.The study was cross-sectional, comparative, done in Pulmonology and Allergy Clinic, Children's University Hospital in Cracow. There were 141children meeting the inclusion criteria for the study. In children enrolled to the study, it was done: a questionnaire study, anterior rhinoscopy, determination of the exhaled nitric oxide level (FeNO), spirometry, nasal cytology, skin prick tests and blood collection for the determination of selected biochemical parameters (serum total IgE (tIgE), complete peripheral blood eosinophilia (Eoscomp), interleukin-4 (IL-4) and tumor necrosis factor (TNF-). Furthermore, evaluation of bronchial hyperresponsiveness (BHR) in children was made in exercise challenge tests by estimation of relative FEV1 fall (%FEV1). In the studied children, 45% were girls and 55% boys, in the age: 10,62,2 and 10,52,1 years, respectively. AR and Non-AR occurred with similar frequency in the studied children (53% and 47%, respectively) and the majority of rhinitis have a persistent form that 79% (112/141), of which the persistent allergic rhinitis (PAR) (n=63) and persistent non-allergic rhinitis (PNon-AR) (n=49). Children with PNon-AR were significantly younger than those with PAR (mean difference app.1 year) (p=0,037). Other demographic data (gender, ; height, weight, BMI) did not differ significantly between groups.In children with PNon-ANN occurred almost 5-fold increased risk of moderate/severe course of disease compared to PAR (odds ratio (OR)=4.8; p=0.018). Among the local symptoms only the fact of severe nasal obstruction was significantly more often seen in PNon-AR (OR=3.791; p=0.003) than in the PAR. The incidence, severity of symptoms PAR and PNon-AR were comparable in all months of the year.PNon-AR was an important risk factor of more than 2.5-fold (OR=2.653; p=0.022) of wheeze presence in the last year compared to PAR. Similarly, the incidence of wheeze in the past was higher in children with PNon-AR, although the difference was on the borderline significance. In contrast, the severity and frequency of wheeze in the last year were not significantly associated with the type of analyzed rhinitis.Analysis of the incidence of atopic dermatitis (AD) symptoms in the past and in the last year in children with PAR and PNon-AR showed no difference in their occurrence. The frequency of AD diagnosis in children with PAR (56%) was higher than in the PNon-AR (41%), but was not statistically significant.The prevalence assessment of allergic diseases in family members of children with PAR and PNon-AR indicated similar rates of their presence in both groups. The exception was the occurrence of allergic disease in siblings – there was a more than 2-fold higher risk of PNon-AR compared to the PAR (OR=2.468; p=0.039). On the other hand, allergic diseases in the mother or father were more common in children with PAR (the difference on the borderline significance, p=0.050).Among the environmental factors that child exposure to tobacco smoke (mother smoked in the first year age of child and smoking households) was burdened with nearly 3-fold increased risk of PNon-ANN (respectively: OR=3.081; p=0.038 and OR=2.909; p=0.024) comparing to the PAR. There was a significant upward trend in the incidence of PNon-AR with increasing estimated exposure to tobacco smoke (p=0.004). Other factors (contacts with animals, housing dampness, mold presence, type of flooring, windows construction) failed to modify the relative proportions of Non-AR and AR.In all children with PAR and 90% PNon-AR was found eosinophilic rhinitis (in the presence of ≥ 10% eosinophils in the nasal cytology examination). The percentage of eosinophils, neutrophils, the relative proportions of these cells were similar in PAR and PNon-AR and does not differentiate between these inflammation’s processes.Similarly, spirometry parameters and the frequency and degree of BHR in AR and Non-AR were similar. BHR was observed in 12% children with PNon-AR and in 28% ones with PAR (difference in frequency at the borderline significance, p=0.077). In children with intermittent non-allergic rhinitis (INon-AR) the average value of FEV1 was significantly lower compared to the intermittent allergic rhinitis (IAR) (p=0.014). Moreover, BHR was present in 5 out of 17 children (29%) with INon-AR and in 2 of 12 (18%) with IAR (p=0.49). The values %FEV1 in the two groups did not differ significantly.Among the analyzed markers of allergic inflammation, only the values FeNO, tIgE, Eoscomp were those that were significantly ; higher in the PAR than PNon-AR. However, the greatest diagnostic efficiency in differentiation AR and Non-AR showed the estimation of tIgE level in serum (AUC=0.829; p=0.0001). Total IgE equal to 68 kU/L, was the marker that with moderate accuracy diagnose AR in the studied school children (sensitivity=79%; specificity=79%; (+)PV=81%; (-)PV=77%).FeNO revealed that its levels were significant higher in children sensitized to given allergen (grass, dust mites, pets (dog, cat), molds), compared to children without sensitization to the given allergen.None of the analyzed markers of allergic inflammation (FeNO, IL-4, TNF-, tIgE, Eoscomp) was significantly related to BHR in children with rhinitis.It is believed that the results, observations and thesis included in this work will be helpful in clinical practice for the diagnosis, differentiation, accurate assessment of AR and Non-AR in children.

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2 - studia doktoranckie

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Uniwersytet Jagielloński. Collegium Medicum. Wydział Lekarski.


Grzegorz Lis

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Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

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May 24, 2021

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Dec 2, 2015

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ZB-123156 May 24, 2021


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