Clinical characteristics of allergic rhinitis and nonallergic rhinitis in Korean children

PURPOSE: Recently, the prevalence of allergic rhinitis (AR) in Korean children has been increased. The aim of this study was to investigate the clinical characteristics of rhinitis and to compare clinical parameters between AR and nonallergic rhinitis (NAR) in children.METHODS: We retrospectively reviewed the medical records of 1,034 children under 18 years of age who visited Korea University Anam Hospital for rhinitis symptoms from January 2008 to December 2017. Clinical data, including clinical features, comorbidities, blood test results, allergen sensitization profile, and pulmonary function test parameters, were collected.RESULTS: Among the 1,034 children with rhinitis, 737 (71.3%) were AR and 297 (28.7%) were NAR. The prevalence of AR gradually increased with age. The median levels of eosinophil count (4.1%), serum total IgE (204.4 IU/L), eosinophil cationic protein (ECP) concentration (17.9 µg/L), and fractional exhaled nitric oxide (FeNO) (22.0 ppb) were significantly higher in children with AR than in those with NAR. The sensitization rate to the inhalant allergens increased with age; however, food allergen sensitization rate tended to decrease. Median levels of eosinophil count, total IgE, ECP, and FeNO were significantly higher in the poly-sensitized group than in the mono-sensitized and nonsensitized groups.CONCLUSION: More than 70% of Korean children who have rhinitis symptoms are AR. Children with AR more likely to have higher levels of FeNO and bronchial asthma. Poly-sensitized children showed increased rates of atopic dermatitis and bronchial asthma.

Relationship of serum vitamin D and interleukin-31 levels to allergic or nonallergic rhinitis in children

PURPOSE: Serum vitamin D (25-hydroxyvitamin D, 25[OH] D) and interleukin-31 (IL-31) are related to atopic dermatitis, but their relationship with allergic rhinitis is unclear. The purpose of this study was to compare the levels of serum IL-31 and 25 (OH) D between the allergic rhinitis (AR), nonallergic rhinitis (NAR), and control groups and to investigate the relationship between IL-31 and 25 (OH) D. METHODS: We recruited 59 children with only rhinitis and 33 controls without any allergic diseases. Serum IL-31 and 25(OH) D levels were assayed using an enzyme-linked immunosorbent assay and high-performance liquid chromatography, respectively. The patients were considered to have atopic sensitization if the levels of serum specific IgE to inhalant allergens as assessed using immunoCAP were ≥0.35 IU/mL or if they tested positive for one or more allergens by the skin prick test. RESULTS: Of children with rhinitis, 25 had nonatopy (NAR), and 34 children had atopy (AR). Serum 25(OH) D levels were significantly lower in the rhinitis group than in the control group, while there was no significant difference serum 25(OH) D levels between the AR and NAR groups. Children with rhinitis demonstrated higher serum IL-31 levels than controls; however, there was no difference in serum IL-31 levels between the AR and NAR groups. Serum 25(OH) D levels were inversely correlated with serum IL-31 levels and blood eosinophil counts. On the other hand, serum 25(OH) D levels were not correlated with total serum IgE levels. CONCLUSION: Serum 25(OH) D and IL-31 may play a role in the pathogenesis of rhinitis via mechanisms other than IgE-related pathway.

Inflammation characteristics of different types of nonallergic rhinitis / 医学研究生学报

Objective Allergic rhinitis (AR) is studied extensively while nonallergic rhinitis (NAR) insufficiently in the recent years .The aim of this study is to describe the inflammation characteristics of different types of NAR . Methods Using the skin prick test , we investigated the characteristics , nasal cytokine levels , serum cytokine levels , and the proportion of peripheral blood Treg cells in 12 cases of AR, 10 cases of NAR with eosinophilia (EOS) syndrome (NARES), 12 cases of NAR without ES (NAR), and 11 control adults . Results The NARES patients had a signifi-cantly higher level of IFN-γ(28.89 [10.97-127.07] pg/mL) than the control (8.98 [7.88-14.90] pg/mL) and the NAR patients (7.92 [7.67-45.85] pg/mL) ( P<0.05) but a lower level of nasal IL-10 than the control ([3.97±0.68] vs [4.80±1.32] pg/mL, P<0.05) .The contents of nasal IL-4, serum IL-4, nasal IL-17 and ser-um IL-17 were all markedly higher in the AR and NARES groups than in the control (P<0.05).The proportion of CD4+CD25+FOXP3+Treg cells in the CD4+T cells in the peripheral blood was (4.5±1.3)%in the AR group and (4.0±1.8) %in the NARES group, both significantly lower than (6.5±1.0) %in the control group (P<0.05) and (6.5±1.0) %in the NAR group (P<0.05). Conclusion NAR was classified according to the EOS level into NARES and NAR without EOS, which had different mechanisms and manifestations of inflammation and similar inflammatory manifestations of Th 2 and Th17.The classification of rhinitis by the level of EOS has more practical significance .

Inflammation characteristics of nonallergic rhinitis with eosinophilia syndrome / 医学研究生学报

Objective Nonallergic rhinitis with eosinophilia syndrome (NARES) is associated with such diseases as bronchial asthma , nasal polyps , and aspirin intolerance , but there is a lack of studies on its inflammatory conditions .The aim of this study is to describe the inflammation characteristics of NARES . Methods This study included 101 cases of allergic rhinitis ( AR) , 39 cases of NARES, and 162 adult controls .We analyzed the inflammation char-acteristics of the patients using skin prick test ( SPT) , nasal douche , fractional exhaled nitric oxide ( FeNO ) measurement , serum eosino-phil (EOS) counting, serum total IgE (tIgE) determination, induced sputum detection, and nasal and bronchial provocation tests . Results Compared with the controls , the NARES and AR groups showed significant increases in the positive rate of nasal provocation (32.1%vs 69.2%and 75.2%, P<0.05), positive rate of bronchial provocation (1.2%vs 10.3%and 14.9%, P<0.05), and FeNO level ([15.70 ±5.20] ppb vs [37.25 ±22.95] and [39.00 ±24.29] ppb, P<0.05), as well as in the serum EOS and tIgE levels, EOS count, and ratio of EOS in the induced sputum (P<0.05).However, the level of serum tIgE was significantly lower in the NARES than in the AR group (53.3 [23.3-186.0] kU/L vs 197.0 [62.6-391.0] kU/L, P<0.05). Conclusion NARES is a syndrome with nasal, lower airway, and systematic inflammation, similar to AR in inflammatory intensity.Therefore, for patients with NARES, attention should be paid not only to upper airway but also to lower airway and systemic inflammation .

Response to Nonallergenic Irritants in Children With Allergic and Nonallergic Rhinitis

PURPOSE: Nonallergenic irritants can aggravate the symptoms of rhinitis. We investigated the clinical responses of children with allergic rhinitis (AR) and nonallergic rhinitis (NAR) to nonallergenic irritants, and identified factors associated with these responses. METHODS: Children with chronic rhinitis (n=208) were classified as having AR or NAR based on the presence of aeroallergen-specific IgE. Healthy controls (n=24) were recruited for comparison. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines were used to classify patients, and their irritant score (0-21 points) and current symptom score (5-35 points) were measured. Subjects with irritant scores ≥3 and <3 were classified as having irritant and nonirritant rhinitis, respectively. RESULTS: The mean age of enrolled subjects was 6.8 years (range: 1.8-16.0 years). The AR and NAR groups had similar irritant scores (P=0.394) and proportions of subjects with irritant scores ≥3 (P=0.105). Irritant score correlated positively with symptom score (P=0.005), and the proportion of subjects with irritant scores ≥3 was greater in children with moderate-severe rhinitis than in those with mild rhinitis (P=0.046). Multiple logistic regression analysis indicated that the presence of atopic eczema increased the risk for sensitivity to a nonallergenic irritant (aOR=2.928, 95% CI 1.567-5.473, P=0.001). CONCLUSIONS: Response to a nonallergenic irritant was useful for gauging the severity of rhinitis, but not for differentiating AR from NAR. AR and NAR patients with atopic eczema may increase nasal sensitivity to nonallergenic irritants.

Effects of allergic and nonallergic rhinitis on bronchial inflammation / 医学研究生学报

Objective To describe the effects of allergic and nonallergic rhinitis on patients with bronchial inflammation by comparing the bronchial inflammation characteristics . Methods All patients enrolled in the study were categorized into two groups according to rhinitis diagnostic criteria , 377 cases in the allergic rhinitis ( AR) group, 262 cases in non-allergic rhinitis ( NAR) group and another 264 patients without rhinitis as control group .Induced sputum differential cytology tests , exhaled nitric oxide concentration measurements and methacholine bronchial provocation tests were performed .The characteristics and differences in lower airway inflam-mation among the three groups were compared . Results The exhaled nitric oxide level and the positive rate of the exhaled nitric ox-ide were different significantly in AR group and NAR group than the control group (P0.05). Conclusion Bronchial inflammation may be aggravated by AR and NAR , so all patients with AR and NAR need treatment , and the degree of inflammation was higher in AR patients than the NAR patients .

The relationship between allergic, non-allergic rhinitis and obstructive sleep apnea-hypopnea syndrome / 天津医药

Objective To investigate the relationship between allergic rhinitis (AR), non-allergic rhinitis (NAR) and obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Forty-eight patients with AR symptoms and snoring symptoms for at least 2 years, who received treatment in our outpatient, were included in this study. Skin prick test, serum specific IgE, polysomnography (PSG), acoustic rhinometry, nasal resistance (RM), Müller's test (FPMM) and Epworth sleepi?ness scale (ESS) were performed in patients. Results There were 25 AR patients (AR group) and 23 NAR cases (NAR group). ESS>9 scores were found in 19 patients, including 15 NAR cases and 4 AR cases. There was higher incidence of drowsiness in NAR group than that of AR group (P<0.05). Results of PSG showed that there were significantly higher proportions of apnea, poor sleep quality, AHI index, and lower values of the lowest oxygen saturation (LSpO2) and mean oxygen saturation (ASpO2) in NAR group than those of AR group (P<0.05). The incidence of OSAHS was significantly higher in NAR group than that of AR group (82.6%vs 36.0%, P<0.05). Conclusion Both AR and NAR were risk factors for OSAHS, and both can induce sleep disorders. NAR patients were more likely to result in OSAHS, and showing higher disease severity. NAR may have an important role in the initiation of OSAHS.

Fractional exhaled nitric oxide in Korean children with allergic rhinitis

PURPOSE: Fractional exhaled nitric oxide (FeNO) is useful for the diagnosis of allergic rhinitis (AR) as well as bronchial asthma (BA). However, FeNO may differ according to race, age, and other determinants. There have been few studies about FeNO in Korean children with AR. The aims of this study were to evaluate the value of FeNO in AR and to compare FeNO, and determinants of FeNO levels between AR, BA, and combined AR and BA. METHODS: This study included 647 children aged 5 to 17. The children were classified into 5 groups after performing the skin test, FeNO measurement, the pulmonary function test, and the methacholine challenge test: those with nonallergic rhinitis (NAR), those with AR, those with BA, and those with combined AR and BA, and healthy controls,. RESULTS: The values of FEV1 (forced expiratory volume in one second) %predicted were 94.4%+/-12.6%, 93.8%+/-20.7%, 90.0%+/-17.4% in AR, BA, and combined AR and BA, respectively. The values of FeNO in AR (32.3+/-25.0 ppb), BA (31.1+/-20.5 ppb), and combined AR and BA (34.5+/-30.4 ppb) were significantly higher compared to those of NAR (16.8+/-13.5 ppb) and controls (15.9+/-12.5 ppb). There was no significant difference in FeNO among AR, BA, and combined AR and BA. FeNO was significantly higher in patients with > or =4 positive results (36.6+/-29.2 ppb) than in those with <4 positive skin test results (27.6+/-20.7 ppb). When the receiver operating characteristic curve analysis for prediction of AR showed 0.756 of area under the curve, the cutoff level of FeNO was 16 ppb. CONCLUSION: In this study, children with AR had increased levels of FeNO. It is suggested that AR may have eosinophilic bronchial inflammation without BHR or clinical asthma.

Clinical features of allergic rhinitis in Korean children

PURPOSE: The characteristics of allergic rhinitis can be different among countries and areas because causative allergens and aggravating factors depend on the living environment. However, there have been few studies on the clinical feature of Korean children with allergic rhinitis, as well as on clinical characteristics in different age groups. The aim of this study was to investigate the clinical characteristics of Korean children with allergic rhinitis. METHODS: The medical records of children under 12 years of age who had rhinitis symptoms were analyzed in terms of clinical symptoms and positive allergens. Subjects were classified into 2 groups: those with allergic rhinitis (AR group) and nonallergic rhinitis (NAR group). Both groups were subdivided into 3 categories: the 1-4 years, 5-8 years, and 9-12 age groups. RESULTS: Among 516 children, 397 (76.94%) belonged to the AR group and 119 (23.06%) belonged to the NAR group. The male to female ratios were 2:1 in both groups. There were significant differences in sneezing and itching between the AR and NAR groups across different age subgroups. There were significant differences in nasal obstruction between the AR and NAR groups in the 9-12 age group. The incidence of AR was 77.8 % in chronic sinusitis patients. Sensitized allergens were house dust mites, animal hair, pollen, and mold in decreasing order in the AR group. Children who were sensitized to animal hair more frequently had sneezing than those who were not. CONCLUSION: Sneezing and itching strongly suggest allergic rhinitis in Korean children. Clinical characteristics of allergic rhinitis in Korean children would helpful in early diagnosis and adequate treatment of disease.

Relationship between the asthma and rhinitis in asthmatic children: comparison of allergic rhinitis and nonallergic rhinitis

PURPOSE: We aimed to determine the prevalence of allergic rhinitis and nonallergic rhinitis, difference in symptoms between allergic rhinitis and nonallergic rhinitis, and the association between lung function and the degree of asthma control in children with asthma. METHODS: One hundred seventy patients who were followed-up for asthma treatment at the department of pediatrics of CHA Bundang Medical Center were enrolled in this study. We conducted the questionnaire regarding coexistence of rhinitis, childhood asthma control test (C-ACT), and the basic lung function test. The patients were classified as allergic rhinitis group and nonallergic rhinitis group according to the response to 11 common inhalation and food allergens, and assessed the degree of asthma control and the severity of rhinitis. RESULTS: One hundred thirty patients (73%) were found to have rhinitis. Of these, 79 patients (53%) had allergic rhinitis and 34 patients (20%) had nonallergic rhinitis. The allergic rhinitis group was older than the nonallergic rhinitis group or the nonrhinitis group (7.73+/-2.85 vs. 5.97+/-2.48 vs. 6.12+/-2.70, P<0.001). Nasal itching sense was more prevalent in the allergic-rhinitis group than in the nonallergic rhinitis group (3.23+/-1.90 vs. 2.44+/-1.56, P=0.036). There was an inverse correlation between the rhinitis and C-ACT (r= -0.329, P<0.05). Of note, nasal obstruction symptom was highly correlated with C-ACT (r=-0.334, P<0.001). CONCLUSION: Allergic rhinitis and nonallergic rhinitis were highly prevalent in the pediatric patients with asthma and both of them had a significantly adverse impact on asthma control by rhinitis-itself. Therefore, regardless of atopic status, clinicians should focus on relieving rhinitis symptoms.

Management of Rhinitis: Allergic and Non-Allergic

Rhinitis is a global problem and is defined as the presence of at least one of the following: congestion, rhinorrhea, sneezing, nasal itching, and nasal obstruction. The two major classifications are allergic and nonallergic rhinitis (NAR). Allergic rhinitis occurs when an allergen is the trigger for the nasal symptoms. NAR is when obstruction and rhinorrhea occurs in relation to nonallergic, noninfectious triggers such as change in the weather, exposure to caustic odors or cigarette smoke, barometric pressure differences, etc. There is a lack of concomitant allergic disease, determined by negative skin prick test for relevant allergens and/or negative allergen-specific antibody tests. Both are highly prevalent diseases that have a significant economic burden on society and negative impact on patient quality of life. Treatment of allergic rhinitis includes allergen avoidance, antihistamines (oral and intranasal), intranasal corticosteroids, intranasal cromones, leukotriene receptor antagonists, and immunotherapy. Occasional systemic corticosteroids and decongestants (oral and topical) are also used. NAR has 8 major subtypes which includes nonallergic rhinopathy (previously known as vasomotor rhinitis), nonallergic rhinitis with eosinophilia, atrophic rhinitis, senile rhinitis, gustatory rhinitis, drug-induced rhinitis, hormonal-induced rhinitis, and cerebral spinal fluid leak. The mainstay of treatment for NAR are intranasal corticosteroids. Topical antihistamines have also been found to be efficacious. Topical anticholinergics such as ipratropium bromide (0.03%) nasal spray are effective in treating rhinorrhea symptoms. Adjunct therapy includes decongestants and nasal saline. Investigational therapies in the treatment of NAR discussed include capsaicin, silver nitrate, and acupuncture.

Alteraciones olfatorias en rinitis alérgicas / Olfactory alterations in allergic rhinitis

Los trastornos del olfato pueden causar serias consecuencias por la incapacidad de detectar señales olorosas de riesgo (humo, gases, alimentos en mal estado), y pueden afectar significativamente la nutrición y aun el comportamiento sexual. Estos trastornos tienen un impacto significativo en la calidad de vida de los pacientes. La hiposmia es una queja común entre los pacientes afectados por rinitis alérgica o no alérgica de larga data. En la consulta clínica por estas afecciones la pérdida del olfato es raramente explorada, centrándose la atención en los estornudos, rinorrea, congestión y prurito nasal. En la rinitis alérgica parece haber un continuo en la duración y severidad de la afección y la pérdida olfatoria, paralelo al grado de afectación rinosinusal. La pérdida olfatoria es mayor en los pacientes con rinitis no alérgica que en los afectados por rinitis alérgica estacional o perenne. En general los estudios no encuentran correlación entre la medición del grado de congestión nasal y la pérdida de olfato. En cambio existe mejor correlación con la inflamación eosinofílica. Los mecanismos subyacentes por los cuales la rinitis /rinosinusitis afectan el olfato probablemente sean multifactoriales, y podrían incluir la alteración del flujo aéreo y depósito de las sustancias olorosas, cambios en la composición del moco, y efectos de los mediadores inflamatorios en la diferenciación, maduración y función de las células receptoras. Las terapias actuales son efectivas en revertir la pérdida olfatoria solo parcial o transitoriamente. Los corticoides inhalados o sistémicos han probado ser parcialmente efectivos en mejorar el olfato en pacientes con rinitis alérgica.(AU)

Olfactory disorders can cause serious consequences from the inability to detect many olfactory warning signals (eg, smoke, spoiled food, and gas leaks) and can significantly impact nutritional status and even sexual behavior. Disorders of olfaction have significant quality of life impact. Hyposmia is a fairly common complaint in patients with long-continuing allergic or nonallergic rhinitis. Smell loss is often overlooked in the clinical setting of rhinitis, with attention instead focused on the respiratory complaints of nasal obstruction, hypersecretion, sneezing and nasal pruritus. There appears to be a continuum of duration and severity of olfactory loss in allergic rhinitis that parallels increasing severity of nasal-sinus disease. The nonallergic rhinitis patients' sense of smell was poorer than that of seasonal or perennial allergic rhinitis patients. Associations are generally lacking between measures of airway patency and olfactory function in this patients. The eosinophilic inflammation has a better correlation with the olfactory loss. The underlying mechanisms by which rhinitis/rhinosinusitis impact olfactory ability are likely to be multifactorial and might include altered air flow and odor deposition, changes in mucus composition, and effects of inflammatory mediators on receptor cell differentiation, maturation, or function. Current therapies are only partially or transiently effective in reversing olfactory loss. Inhaled and systemic steroids have been proved partially effective in improving olfactory function in patients with allergic rhinitis (AU)

Effect of Intranasal Corticosteroid Therapy for Perennial Nonallergic Rhinitis and Perennial Allergic Rhinitis / 소아알레르기및호흡기학회지

PURPOSE: The efficacy of intranasal corticosteroids for the treatment of allergic rhinitis has been reported. But the efficacy of intranasal corticosteroids has not been compared between perennial nonallergic rhinitis (PNAR) and perennial allergic rhinitis (PAR). METHODS: Twenty-three patients with PNAR and 19 patients with PAR were enrolled in this study. Every patient received fluticasone propionate (FP) 200 g (100 g, bid) daily for 4weeks. Control group (n=16) was received only anti-histamine (hydroxyzine 0.6 mg/kg/dose) intermittently. Efficacy of FP was evaluated by the mean change in nasal congestion, rhinorrhea, nasal itching, sneezing and total nasal symptom score (a sum of patient ratings of nasal congestion, rhinorrhea, nasal itching, and sneezing). RESULTS: Both groups (PNAR and PAR) showed similar improvement of nasal symptom with FP 200 g compared with control. (P< 0.05) In the total population, both groups showed significant improvements from baseline in TNSS compared with control during each week of treatment. (P< 0.05) In PNAR and PAR, nasal congestion was significantly improved more than in control. (P< 0.01, P< 0.01) Rhinorrhea and itching in PAR were improved more than in control. (P=0.02, P=0.03) In sneezing, all three groups showed no differences. (P=1.00, P=0.31, P= 0.29) CONCLUSION: Intranasal FP is an effective treatment for perennial nonallergic rhinitis as same as perennial allergic rhinitis.