Impact of rhinitis on lung function in children and adolescents without asthma

Saranz, Ricardo J; Lozano, Alejandro; Valero, Antonio; Lozano, Natalia A.; Martijena, María del Pilar Bovina; Agresta, Franca; Ianiero, Luciano; Ponzio, Marina Flavia

doi:10.1016/j.aller.2016.04.006

Cited by 15 publications

(18 citation statements)

References 30 publications

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“…Por otro lado, mientras que el defecto observado en FeNO es casi exclusivo del fenotipo alérgico de rinitis, la HRB y la alteración espirométrica en rinitis son independientes del estado atópico, 14,24,25 lo que sugiere un nexo entre el tracto respiratorio superior e inferior más allá de la presencia de alergia. 3 Las alteraciones subclínicas de la vía aérea in-una investigación que incluyó niños con RA, RNA y controles sin rinitis, 9 los primeros tuvieron los niveles más elevados de FeNO respecto a los otros grupos (15.9 ppb versus 6.8 versus 6.6 ppb).…”

Section: Discussionunclassified

“…En un estudio previo en pacientes con rinitis sin asma se comprobaron alteraciones funcionales respiratorias, detectadas en la curva flujo-volumen, más frecuente en aquellos con mayor gravedad clínica de la rinitis. 25 Del mismo modo, otros estudios demostraron HRB como defecto más prevalente en diferentes poblaciones de pacientes con rinitis persistente moderada y grave. 26 Con estas observaciones, se podría inferir que la determinación de la FeNO refleja la magnitud de la inflamación de la vía aérea intratorácica en forma proporcional a la gravedad clínica de la rinitis.…”

Section: Discussionunclassified

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Análisis comparativo de la fracción exhalada de óxido nítrico en niños y en adolescentes con rinitis alérgica y no alérgica

Saranz

Lozano

et al. 2019

RAM

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Antecedentes: Existe inflamación bronquial subclínica en pacientes con rinitis alérgica. Son menos las evidencias de inflamación de la vía aérea inferior en rinitis no alérgica.Objetivo: Investigar inflamación de la vía aérea inferior por la fracción exhalada de óxido nítrico (FeNO) en pacientes con rinitis alérgica y rinitis no alérgica sin asma y su asociación con función pulmonar, gravedad de la rinitis y biomarcadores de atopia.Métodos: Estudio transversal de pacientes entre seis y 18 años, con rinitis alérgica o rinitis no alérgica sin asma. Se realizó espirometría, IgE sérica, recuento de eosinófilos hemáticos y FeNO. Se clasificó la rinitis según guía ARIA.Resultados: Se incluyeron 40 pacientes, 28 con rinitis alérgica y 12 con rinitis no alérgica. Los pacientes con rinitis alérgica tuvieron niveles de FeNO más elevados (mediana 36.5 ppb, rango 5-114) que aquellos con rinitis no alérgica (mediana 7 ppb, rango 5-24) (p = 0.0011). La FeNO elevada se asoció con anormalidad espirométrica (RM = 7.14 [IC 95 % = 1.04-49.04], p = 0.049). En la rinitis alérgica, existió correlación entre FeNO y eosinófilos en sangre (r = 0.41, p = 0-33).Conclusiones: Los niños y adolescentes con rinitis alérgica tuvieron FeNO más elevada que los pacientes con rinitis no alérgica, que se correlacionó con eosinofilia hemática y función pulmonar alterada.

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Section: Discussionunclassified

Análisis comparativo de la fracción exhalada de óxido nítrico en niños y en adolescentes con rinitis alérgica y no alérgica

Saranz

Lozano

et al. 2019

RAM

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“…One study confirmed that the association between AR and SA remained significant even after adjustment for total serum IgE and polysensitization to aeroallergens, suggesting rhinitis may directly impact on asthma severity. 48 Nasal obstruction due to AR necessitates mouth-breathing which may result in bronchial hyperreactivity due to cold dry air, and greater delivery of allergens to the lower airways. 34,44,45 AR may also be causally linked to asthma severity through impaired function of the upper airways, which includes filtering, warming and humidifying air before it reaches the lower airways.…”

Section: Allergic Rhinitismentioning

confidence: 99%

“…19,34,[45][46][47] This idea is supported by findings of significantly impaired lung function in children with moderate-severe persistent rhinitis, compared to mild intermittent rhinitis, in children without overt asthma symptoms, which was independent of atopic status. 48 Nasal obstruction due to AR necessitates mouth-breathing which may result in bronchial hyperreactivity due to cold dry air, and greater delivery of allergens to the lower airways. 44,46 These mechanisms may underlie the relationship between AR and STRA.…”

Section: Allergic Rhinitismentioning

confidence: 99%

Does allergy explain why some children have severe asthma?

Bonner

Roberts

2018

Clin Experimental Allergy

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Asthma is a common disease in childhood with a minority of affected children having severe therapy-resistant asthma (STRA). Children with STRA can be differentiated from those with mild-moderate disease by greater allergic sensitization, increased eosinophilic airway inflammation, increased airway remodelling and reduced corticosteroid responsiveness. The aetiology of STRA in children is multifactorial but allergy seems to play a key role. Many children with asthma have coexisting allergic disease, and severe rhinitis seems to be an important driver of STRA in children. Allergies to foods, moulds, pollen and pets have also been associated with severe asthma exacerbations. Identifying allergens that are driving asthma symptoms in children with STRA may provide additional strategies for improving their disease control. Avoidance strategies may be possible. Additional monoclonal antibody therapy with Omalizumab or Mepolizumab may be helpful in children with clinically important polysensitization.

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“…The spirometric abnormalities are directly proportional to the clinical severity of rhinitis, implying that patients with persistent, moderate‐severe rhinitis have the lower pulmonary function measurements as compared to those with intermittent and mild rhinitis. This observation has been described both in allergic and non‐allergic rhinitis and therefore is likely to be inherent to the rhinitis condition and unrelated to the aetiology …”

Section: Subclinical Impairment Of Lung Functionmentioning

confidence: 99%

Subclinical lower airways correlates of chronic allergic and non‐allergic rhinitis

Saranz

Lozano

et al. 2017

Clin Experimental Allergy

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The upper and lower airways behave as a physiological and pathophysiological unit. Subclinical lower airways abnormalities have been described in patients with rhinitis without asthma. These are expressed as bronchial hyperreactivity, abnormalities in lung function and bronchial inflammation, likely as a result of the same phenomenon with systemic inflammatory impact that reaches both the nose and the lungs, which for unknown reasons does not always have a full clinical expression. Patients with rhinitis are at increased risk of developing asthma; therefore, most authors suggest a careful clinical evaluation and monitoring of these patients, especially if symptoms related to inflammation in the lower airways are observed. Although current treatments, such as H1-antihistamines, intranasal steroids and allergen immunotherapy, are quite effective for the management of rhinitis, it is difficult to prove their capacity to prevent asthma among subjects with rhinitis. Evidence showing that the treatment of rhinitis has a favourable impact on indicators of bronchial hyperreactivity and inflammation among subjects that have no symptoms of asthma is more frequently described. In this review, we address the frequency and characteristics of lower airway abnormalities in subjects with rhinitis, both in paediatric and adult populations, their likely predictive value for the development of asthma and the possibilities for therapeutic intervention that could modify the risk of subjects with rhinitis towards presenting asthma.

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Impact of rhinitis on lung function in children and adolescents without asthma

Abstract: Impaired lung function was associated with persistence and severity of rhinitis and there was no significant difference between patients with moderate and severe rhinitis. The spirometric abnormality was demonstrated in patients with allergic and non-allergic rhinitis.

Cited by 15 publications

References 30 publications

Análisis comparativo de la fracción exhalada de óxido nítrico en niños y en adolescentes con rinitis alérgica y no alérgica

Análisis comparativo de la fracción exhalada de óxido nítrico en niños y en adolescentes con rinitis alérgica y no alérgica

Does allergy explain why some children have severe asthma?

Subclinical lower airways correlates of chronic allergic and non‐allergic rhinitis

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