Prevalence and Clinical Characteristics of Local Allergic Rhinitis in Children Sensitized to House Dust Mites

Abstract

Objective: The prevalence of local allergic rhinitis (LAR) in nonatopic children remains unknown. This study aimed to determine the prevalence, clinical characteristics, and severity of LAR in children in comparison to classical allergic rhinitis (AR) and nonallergic rhinitis (NAR). Study Design: A total of 145 children (aged 1-18 years) were enrolled and classified into 3 groups (AR, NAR, and LAR) based on a skin prick test (SPT) and a nasal provocation test (NPT) with house dust mite, i.e., Dermatophagoides pteronyssinus. NPT positivity was defined as a symptom score ≥2 standard deviations (SDs) above the healthy control score. Results: Eighty-one children had AR (55.9%), and 64 (44.1%) had symptoms of rhinitis with negative SPT; 59 NAR (40.7%) and 5 LAR (3.4%) children were identified. The κ score for agreement between the SPT and the NPT results was 0.778 (95% CI 0.726-0.830, p < 0.001). A significant correlation was observed between wheal diameter and maximum nasal symptom score provoked by D.pteronyssinus (rho = 0.589, p < 0.001). Nasal severity according to the ARIA guideline did not show any differences in the 3 groups (p = 0.693). The AR group was older than the LAR and NAR groups (AR > LAR > NAR, p = 0.003). Conclusions: Despite the evidence to support the existence of LAR in pediatric populations, we found that its prevalence was relatively low, possibly due to the high rate of agreement between SPT and NPT. Further investigations are needed to identify immunological as well as clinical implications of LAR.

Detection of local allergic rhinitis in children with chronic, difficult‐to‐treat, non‐allergic rhinitis using multiple nasal provocation tests

“…We did not identify any particular clinical characteristics of the LAR children; there were no differences in terms of gender distribution, age of rhinitis onset, rhinitis duration, severity or impact on quality of life (Tables and ), which enhances what has been reported in the literature . Nasal blockage was the predominant symptom in all groups with the majority of children reported to be sleeping with an open mouth.…”

“…[8][9][10][11][12] In a recent review, 13 LAR prevalence in 17 adult studies ranged from 7.4% 14 to 69.6% 15 of the NAR participants, with some of the studies having thoroughly investigated patients for nasal reactivity to four common respiratory allergens. Only a few pediatric LAR studies have been conducted [16][17][18][19][20][21][22] ; most of them have investigated children with perennial symptoms only, while only three have had children challenged with three aeroallergens each. [18][19][20] Similar to adults, 13 the reported prevalence ranged from 3.7% 17 to 66.6%.…”

Bronchial asthma triggered by house dust mites in patients with local allergic rhinitis

“…Recent studies highlight that LAR is a common disease, affecting > 25% of nonatopic patients with rhinitis . The disease often starts during childhood and tends to worsen over time with association of comorbidities such as conjunctivitis and bronchial symptoms suggestive of asthma . To date, most studies on LAR have focused on the underlying mechanisms and the definition of the phenotype.…”

Shared and unique individual risk factors and clinical biomarkers in children with allergic rhinitis and obstructive sleep apnea syndrome

“…For example, male sex 6 and second-hand smoke (SHS) 7 increase the risk of OSAS and rhinitis. On the other hand, OSAS is associated with obesity, 6 familial history of OSAS, 8 and the presence of pharyngeal tonsils, 9 but allergic rhinitis is associated with exposure to allergens, 10 exposure to an environment that is "too clean" (according to the hygiene hypothesis), breast feeding (protective during specific age) and certain socioeconomic factors. 11 Although subjects with rhinitis and OSAS have shared risk factors, each modality may have distinct risk factors and clinical manifestations.…”