Analysis of Clinical Characteristics of a Paediatric Population with Rhinitis

Abstract

RATIONALE: Paediatric rhinitis phenotypes have been understudied. The aim was to analyze the clinical characteristics and the response to nasal allergen provocation test (NAPT) of a large paediatric population. METHODS: Patients aged 10-20 years were evaluated with detailed clinical history including severity, comorbidities, triggers and evolution. An initial allergological study (AE) including skin prick test (SPT), and specific IgE (sIgE) classified patients in AE+ or AE-. Afterward, NAPT classified patients in systemic allergic rhinitis (SAR5SPT/sIgE+, NAPT+), local allergic rhinitis (LAR5SPT/sIgE-, NAPT+), dual allergic rhinitis (DAR5SPT/sIgE+ to seasonal allergens, NAPT+ to perennial), and idiopathic rhinitis (IR5SPT/sIgE-, NAPT-). RESULTS: 134 subjects were included. The initial AE was negative in 45 (33.5 %) and positive in 89 (66.5 %). Pruritus was the differential symptom in AE+ vs. AE-(OR 6; IC 95%5 1,79-20,02; p5 0,003) and in LAR (p50.01, OR58.07). Severity was moderate-severe and perennial in AE+/ AE-, being milder in IR (27%, p50.04). In AE+ triggers were specific (allergens, p50.03), and in AE-non-specific (irritants, p50.011). Conjunctivitis and asthma were the main comorbidities. NAPT classified patients as SAR 56%, LAR 22.4%, DAR 10.4% and IR 11.2%. NAPT was positive in 30/45 subjects with AE-(misdiagnosis of 66.7% if only the initial study was performed). Pollen was the principal sensitizer by SPT/ sIgE, and D. pteronyssinus the main sensitizer in NAPT. CONCLUSIONS: Paediatric rhinitis is mostly allergic, perennial and moderate-severe, with conjunctivitis and asthma as main comorbidities. Pruritus is a distinctive symptom of SAR including LAR. NAPT correctly phenotypes rhinitis. DAR has been first described in children.