The natural history of allergic rhinitis in childhood

Abstract

The distinction between 'seasonal' and 'perennial' allergic rhinitis (AR) is not always adequate. The 'Allergic Rhinitis and its Impact on Asthma' (ARIA) work group suggested a new classification for AR based on severity and duration of symptoms. Our primary aim was to describe the natural history and burden of AR according to the new ARIA criteria in a population-based birth cohort study of children up to 13 yr. We defined symptoms as 'severe' (impairment of daily activities) or 'mild' (no impairment) and 'persistent' (duration > 1 month) or 'intermittent' (<or=1 month) using annual questionnaires. Serum immunoglobulin E to five common aero-allergens was determined at six time points. We analyzed complete follow-up data from 467 children (54% boys). The 12-month prevalence of AR quadrupled from 6% (at age 3 yr) to 24% (at age 13 yr) in children with non-allergic parents and more than tripled from 13% (3 yr) to 44% (13 yr) in children with at least one allergic parent. Half or more of the children with AR had 'severe persistent' symptoms. At age 13, these children were significantly more often sensitized than those with 'mild persistent' disease: 91% vs. 70% (p = 0.015). Sensitization to aero-allergens (adjusted OR 18.9; 95%CI 9.3-38.4) and having 2 parents with allergy (3.1; 1.1-9.3) were significantly associated with AR. According to the ARIA criteria, the impact of AR seems to be substantial; the vast majority of affected children suffered persistently for periods of 2 months or more annually, and most of the children with persistent AR were impaired in their daily activities.

Natural course and comorbidities of allergic and nonallergic rhinitis in children

“…The proportion of children with allergic rhinitis increased from 5.4% to 14.0% from age 4 to 8 years; these findings are consistent with those from other longitudinal studies. 3,4 The proportion of children with nonallergic rhinitis decreased slightly, from 8.1% to 6.3%, during the same period. This should be considered in light of the fact that the prevalence of rhinitis, in general, increased from age 4 to 8 years, from 14% to 20%.…”

“…There is some evidence that the incidence of allergic rhinitis increases with age. [2][3][4] Allergic rhinitis has been defined as symptoms of sneezing and nasal itching, with obstruction and mucosal discharge, caused by an IgE-mediated reaction. 1 However, few longitudinal studies have used the combination of symptoms of rhinitis and an objective measure for IgE in the definition of pediatric allergic rhinitis.…”

Paediatric rhinitis: position paper of the European Academy of Allergy and Clinical Immunology

“…There was a male predominance of allergic rhinitis and female predominance of nonallergic rhinitis during adolescence. The MAS study followed up 467 children until 13 years and showed similar frequency of rhinitis (20). Allergic rhinitis, but not nonallergic rhinitis, in early childhood is a risk factor for developing asthma in later childhood (21) and adulthood (22).…”

Prediction of the incidence and persistence of allergic rhinitis in adolescence: A prospective cohort study

“…4,6 It typically begins in childhood or adolescence and mostly seems to affect children between 6 and 14 years of age 6 ; nevertheless, the prevalence in adulthood is high, ranging from 12% in Spain to 46% in Australia. 7 In Germany Keil et al 8 found the 12-month prevalence of AR at 6 years of age to be substantially lower (12%) than that at 13 years of age (30%) in the Multicentre Allergy Study birth cohort. The prevalence of ever having physician-diagnosed AR in 6-year-old schoolchildren has been increasing, from 1.3% to 3.2% in eastern Germany and from 2.5% to 3.2% in western Germany.…”