New concepts in pediatric rhinitis

Papadopoulos, Nikolaos G.; Aggelides, Xenophon; Stamataki, Sofia; Prokopakis, Emmanuel P.; Katotomichelakis, Michael; Xepapadaki, Paraskevi

doi:10.1111/pai.13454

Cited by 21 publications

(23 citation statements)

References 131 publications

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“…Besides AR, children and adolescents can suffer from non‐allergic rhinitis (NAR) 2 . The differentiation between these phenotypes has classically been based on the results of skin prick test (SPT) and serum allergen–specific IgE (sIgE) (collectively called atopy tests) 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, the atopy‐based division of chronic rhinitis is being progressively replaced by an allergy‐based classification grounded on the pattern of nasal allergen–specific reactivity. In this regard, AR patients are defined as those showing positive NAC, SPT, and/or serum sIgE results 2,3 . Conversely, the NAR phenotype comprises a heterogeneous group of diseases, who only share the negativity of the NAC 8 .…”

Section: Introductionmentioning

confidence: 99%

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Systematic evaluation of allergic phenotypes of rhinitis in children and adolescents

Prieto

Rondón

Eguiluz‐Gracia

et al. 2021

Pediatric Allergy Immunology

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Background Three allergic phenotypes of rhinitis have been described in adults: allergic rhinitis (AR), local allergic rhinitis (LAR), and dual allergic rhinitis (DAR, coexistence of AR and LAR). Nevertheless, most centers follow a diagnostic approach only based on skin prick test and serum allergen–specific IgE (collectively called atopy tests, AT). This approach prevents the recognition of LAR and DAR, the diagnosis of which requires a nasal allergen challenge (NAC). Here, we investigate the existence of LAR and DAR phenotypes in children and adolescents, and the misdiagnosis rate associated with a work‐up exclusively based on AT. Methods Clinical data were obtained during physician‐conducted interviews, and AT and NAC were systematically performed in 5‐ to 18‐year‐old patients with chronic rhinitis. The misdiagnosis rate was defined as the proportion of cases where AT and NAC results were discordant. Results A total of 173 patients (mean age 15.1 years, 39.9% male) completed the study. AR (positive AT and NAC), LAR (negative AT and positive NAC), DAR (positive AT and NAC for some allergens and negative AT and positive NAC for other allergens), and non‐allergic rhinitis (negative NAC) were diagnosed in 45.7%, 24.9%, 11.6%, and 17.9% of individuals, respectively. The clinical profile was comparable among allergic phenotypes, but allergic patients had a significantly earlier rhinitis onset, higher conjunctivitis prevalence, and more severe disease than NAR individuals. A diagnostic work‐up exclusively based on AT misclassified 37.6% of patients. Conclusions LAR and DAR represent relevant differential diagnosis in pediatric rhinitis. NAC increases the diagnostic accuracy of clinical algorithms for rhinitis in children and adolescents.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Systematic evaluation of allergic phenotypes of rhinitis in children and adolescents

Prieto

Rondón

Eguiluz‐Gracia

et al. 2021

Pediatric Allergy Immunology

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“…AR is a Th2-type inflammatory disease of the upper airways. 24,25 It is diagnosed on the basis of the pathogenesis, i.e, IgE antibody to an aeroallergen, IgE-mediated mast cell activation leading to mucosal symptoms such as rhinorrhea, nose itching, sneezing, blocked nose, and eosinophilic inflammation of the nasal mucosa leading to nasal hyper-reactivity. Positive findings for the "triad" of AR criteria, i.e., 1) "allergic" nasal symptoms, 2) aeroallergen sensitization and 3) nasal eosinophilia, can establish the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Multimorbidity is a characteristic feature of allergies in children. 25 The MeDALL (Mechanisms of the development of ALLergy) study, involving 12 cohort studies, reported that coexistence of asthma, rhinitis and eczema in the same child was more prevalent than would be expected by chance. 29 An important aspect of multimorbidity is development of asthma, because it places the largest burden on children.…”

Section: Discussionmentioning

confidence: 99%

Development of allergic rhinitis in early life: A prospective cohort study in high-risk infants

Masuda

Nagao

Usui

et al. 2021

Preprint

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Background: Allergic rhinitis (AR) is the most common allergic disease in children and is closely associated with asthma in the context of atopic march. The development process of AR in early childhood, however, is not well understood due to the absence of definitive diagnostic criteria. We prospectively investigated the process in regard to not only the nasal symptoms and sensitization, but also the nasal cytology, in relation to asthma in a high-risk cohort. Methods: Infants under 2 years of age with atopic dermatitis (AD) and/or food allergy (FA) without a diagnosis of asthma were recruited and followed prospectively for 2 years. The phenotype of perennial AR was classified based on the presence/absence of 1) persistent nasal symptoms, 2) nasal eosinophils and 3) HDM sensitization, the most common allergen for perennial AR in Japan. AR-like phenotypes were defined as positive for at least 2 of those 3 categories. Results: A total of 304 children were enrolled, and 242 subjects (80%) completed the 2-year observation. The prevalence of eosinophilia in nasal secretions increased from 18.5% to 69.9%, while HDM-specific IgE >0.35 kUA/L increased from 30.6% to 74.8%. AR-like phenotypes increased from 18.4% to 65.0%. The cumulative incidence of physician-diagnosed asthma during the 2-year follow-up was significantly higher in the subjects with an AR-like phenotype at 1 year than in those with a non-AR phenotypes. Conclusions: The prevalence of an HDM-related AR-like phenotype was markedly increased during infancy in high-risk infants with AD/FA and was associated with asthma.

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“…Previous publications highlighted that house dust mite (HDM) was the most common allergen in perennial AR in southern regions of China (4,5). As a common disease, AR is also prevalent in children and affects 10% to 30% of this population in the United States and other developed countries (6,7). Accordingly, AR was closely associated with asthma and allergic conjunctivitis and, carried a heavy disease burden for children including attention and memory deficits, fatigue, sleep-deprived and even depression (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Identification of Robust Biomarkers for Early Predicting Efficacy of Subcutaneous Immunotherapy in Children With House Dust Mite-Induced Allergic Rhinitis by Multiple Cytokine Profiling

et al. 2022

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BackgroundSubcutaneous immunotherapy (SCIT) is an effective treatment for children with allergic rhinitis (AR), but its efficacy fluctuates among patients. There are no reliable candidate biomarkers for monitoring and predicting the response to SCIT. The present study aims to identify novel biomarkers for early predicting the efficacy of SCIT in pediatric AR patients based on multiple cytokine profiling.MethodsWe prospectively recruited 72 children with house dust mite (HDM)-induced AR who were assigned to receive SCIT. The serum samples were collected and multiple cytokine profiling was conducted by Luminex assay at baseline. All patients were followed-up for 1 year and then categorized into effective and ineffective group based on their efficacy, and levels of 48 selected cytokines were tested and compared between the two groups. The potential cytokines were further validated by enzyme-linked immunosorbent assay (ELISA) in a cohort with 54 responders and 26 non-responders.ResultsSixty-nine of 72 children completed one-year follow-up schedule with 46 included in effective group and 23 in ineffective group. The results of multiple cytokine profiling showed that 15 cytokines (eotaxin, G-CSF, GM-CSF, IFN-γ, IL-12(p40), IL-13, IL-15, IL-16, IL-4, MIF, MIP-1α, RANTES, SCF, SDF-1α and VEGF) were dysregulated between effective and ineffective group (all P < 0.05). Unadjusted and adjusted multivariate analysis models highlighted that serum eotaxin, IFN-γ, IL-4 and MIF levels closely associated with the efficacy of SCIT in pediatric HDM-induced AR patients. In addition, receiver operating characteristic (ROC) curves revealed potential values of these four biomarkers in predicting the response to SCIT. Further ELISA validation results in the cohort of 80 pediatric patients demonstrated that serum eotaxin and IL-4 levels were elevated in responders while IFN-γ levels decreased in responders (all P < 0.05). ROC curves demonstrated that serum IL-4 exhibited more reliable accuracy in predicting SCIT efficacy than eotaxin and IFN-γ.ConclusionOur discover–validation study suggested that cytokines including IL-4, eotaxin and IFN- γ may serve as robust biomarkers for early predicting response of SCIT in children with HDM-induced AR. These results strengthen the evidence that cytokines were associated with the response of SCIT and contributed to understand its underlying therapeutic mechanisms.

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New concepts in pediatric rhinitis

Cited by 21 publications

References 131 publications

Systematic evaluation of allergic phenotypes of rhinitis in children and adolescents

Systematic evaluation of allergic phenotypes of rhinitis in children and adolescents

Development of allergic rhinitis in early life: A prospective cohort study in high-risk infants

Identification of Robust Biomarkers for Early Predicting Efficacy of Subcutaneous Immunotherapy in Children With House Dust Mite-Induced Allergic Rhinitis by Multiple Cytokine Profiling

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