Airway Nitric Oxide in Children with HDM-Induced Allergic Rhinitis

Abstract

Background Rhinitis is a common problem in children. Airway nitric oxide (NO) was proposed to represent eosinophilic inflammation. Objectives To evaluate airway NO level in children with house dust mite (HDM)-induced allergic rhinitis Methods Children aged 5 to 18 years old with moderate–severe persistent rhinitis and positive result for the HDM nasal provocation test (NPT) was enrolled. The nasal symptoms evaluated by total nasal symptom score (TNSS) and visual analog scale (VAS) were recorded. Skin prick test (SPT) to common aeroallergens, fractional exhaled nitric oxide (FeNO), nasal nitric oxide (nNO), and blood test for specific IgE (sIgE) to HDM was measured. Rhinitis severity was categorized as severe if the VAS score > 7. Results Forty-eight children with HDM-induced allergic rhinitis with the mean age of 9.3 ± 2.4 years were enrolled. nNO levels and VAS score were significantly correlated (R = 0.398, P = .005). Children with severe rhinitis had significantly higher nNO levels than moderate rhinitis (1652.05 vs 941.30 parts per billion [ppb], P = .002), while there was no difference in FeNO level. ROC curve analysis demonstrated the cut-off value of nNO at 1350 ppb (AUC 0.764, 95% CI: 0.616-0.911, P = .002) for detecting severe HDM-induced allergic rhinitis with the sensitivity of 78% and the specificity of 71%. The level of FeNO in children who had HDM mean wheal diameter (MWD) > 8 mm was significantly higher than those with HDM MWD of 3 to 8 mm and those with a negative test (39.7 vs 14.3 vs 14.4 ppb; P = .006, respectively). Children who had sIgE to HDM < 0.35 KUA/L had significantly lower FeNO than those with sIgE to HDM 0.35 to 50 KUA/L and >50 KUA/L (9.5 vs 19.7 vs 40.4 ppb; P = .029, respectively). Conclusions Cut-off value for the diagnosis of severe HDM-induced chronic rhinitis was proposed. Rhinitis children who had a higher degree of HDM sensitization had a higher level of FeNO.

Nasal Nitric Oxide in Children: A Review of Current Outreach in Pediatric Respiratory Medicine

“…Specifically, children with severe allergic rhinitis exhibited markedly elevated nNO levels compared to their counterparts with moderate rhinitis (as illustrated in Table 2). Fraction of exhaled NO (FeNO) levels were not changed as a function of severity of allergic rhinitis [26]. In seasonal allergic rhinitis, nNO levels are significantly elevated during and after pollen exposure, suggesting increased activity of inducible NOS during pollen exposure.…”

Role of Nasal Nitric Oxide in Primary Ciliary Dyskinesia and Other Respiratory Conditions in Children

“…In the study of Sutiratanachai et al [41], 48 children with house dust mite (HDM)induced allergic rhinitis were tested for nNO levels, finding a positive correlation between higher nNO levels and the degree of HDM sensitization.…”

“…Allergic rhinitis is an inflammatory condition of the upper respiratory airway due to an allergen exposition, which causes a Th2-type inflammatory response, with eosinophilic inflammation and release of histamine and inflammatory cytokines. Allergic airway inflammation promotes the hyperactivity of NOS2 and then aggravates the production of NO concentration in the airway [41].…”

Predictive Value of Nasal Nitric Oxide and Serum NOS2 Levels in the Efficacy of Subcutaneous Immunotherapy in Pediatric Patients with Allergic Rhinitis

“…Studies have shown that NOS2 was widely expressed in human bronchial epithelial cells, macrophages, endothelial cells, and vascular smooth muscle cells [ 14 ], and abnormal expression of NOS2 was involved in a variety of inflammatory diseases, including asthma, psoriasis, AR, and chronic rhinosinusitis (CRS) [ 12 , 15 , 16 ]. Allergic airway inflammation can promote the hyperactivity of NOS2 and then aggravate the production of NO concentration in the airway [ 17 ]. Sakthivel and Guruvayoorappan [ 18 ] found that serum NOS2 levels were elevated in murine models of carrageenan- and formaldehyde-induced inflammation, and the concentration was significantly reduced in murine treated with extracts with anti-inflammatory effects.…”