The Role of Nasal Nitric Oxide and Anterior Active Rhinomanometry in the Diagnosis of Allergic Rhinitis and Asthma: A Message for Pediatric Clinical Practice

Abstract

Background Allergic rhinitis (AR) and asthma are two common atopic diseases, often associated with a common ethiopathogenesis characterized by a Th2 inflammatory response with the release of many biomarkers, such as nitric oxide (NO). Purpose To evaluate and compare inflammatory (nFeNO and eFeNO) and functional (mNF and FEV1) parameters in AR children with or without asthma in comparison to controls. Secondly, we aimed to identify nFeNO cut-off values and verify their reliability to predict the presence of rhinitis or asthma alone or in combination. Patients and Methods We enrolled 160 children (6–12 years of age) with AR and/or asthma divided into four groups: controls, AR, asthma, and AR + asthma. All children underwent the following inflammatory and functional measurements: nFeNO, eFeNO, mNF and FEV1. Results We observed that levels of nFeNO were extremely higher in children with AR and even more in those with AR + asthma in respect to controls. Notably, all the pathological conditions, especially AR + asthma, showed significantly lower values of mNF compared to healthy children. A negative correlation linked mNF and nFeNO. Then, we found eFeNO values significantly higher in all the pathological groups compared to controls, with major values of this marker in patients affected by asthma and AR + asthma, as well as FEV1 values significantly lower in all the disease groups, especially in children with asthma and AR+ asthma. ROC curve analysis showed that nFeNO was a great predictor for rhinitis alone or with asthma, revealing an accurate cut-off of 662 ppb. Conclusion nFeNO measurement is non-invasive, easy to perform, economic and a valuable test in case of AR alone or in association with asthma. Thus, it should be used in patients with rhinitis, together with anterior active rhinomanometry (AAR) to diagnose and estimate the degree of nasal obstruction but also in children with asthma to assess their nasal involvement and improve the therapeutic management.

(R)Evolution in Allergic Rhinitis Add-On Therapy: From Probiotics to Postbiotics and Parabiotics

“…Allergic rhinitis, even if regarded as not a severe disease, accounts for a global burden in terms of its impact on children’s quality of life (sleep quality [ 53 ], cognitive function and school attendance [ 54 ], and behavioral impairment [ 55 ]) and social spending considering the bounded treatment options and the challenge of symptom control. Most of the current treatments are symptomatic (primarily antihistamines and intranasal corticosteroids) [ 56 ], except for allergen-specific immunotherapy, to date, the only disease-modifying treatment, even if it is burdened by limited patient compliance, duration, and costs [ 57 , 58 ].…”

The Functional Diversity of Nitric Oxide Synthase Isoforms in Human Nose and Paranasal Sinuses: Contrasting Pathophysiological Aspects in Nasal Allergy and Chronic Rhinosinusitis

“…The diagnostic values of nasal NO in allergic rhinitis were reported in various patient populations [35,58,60,73,[78][79][80]. Because the measurement of nasal NO is noninvasive, easy to perform, and economical, it has become a popular and valuable test for the diagnosis of AR even in children [81]. However, the measurement of nasal NO can be influenced by multiple external factors, including the ambient conditions, the time of day, the subject's past physical activity, the breathing method, and the analyzer models used [5,82,83].…”

High baseline prevalence of atopic comorbidities and medication use in children treated with allergy immunotherapy in the REAl-world effeCtiveness in allergy immunoTherapy (REACT) study

“…Despite this burden, AR is often underestimated in children and is trivialized as a disease of lesser importance. However, research into AR in children is increasing, i.e., non-invasive measures, such as rhinomanometry and the measurement of fractional excretion of nitric oxide (FeNO) are currently under evaluation to determine if they will prove useful in clinical decision making (21)(22)(23); modulation of the microbiome for AR prevention is also under investigation (24).…”