Underdiagnosed and Undertreated Allergic Rhinitis in Urban School-Aged Children with Asthma

Abstract

Allergic rhinitis (AR) is a risk factor for the development of asthma, and if poorly controlled, it may exacerbate asthma. We sought to describe AR symptoms and treatment in a larger study about asthma, sleep, and school performance. We examined the proportion (1) who met criteria for AR in an urban sample of school children with persistent asthma symptoms, (2) whose caregivers stated that they were not told of their child's allergies, (3) who had AR but were not treated or were undertreated for the disease, as well as (4) caregivers and healthcare providers' perceptions of the child's allergy status compared with study assessment, and (5) associations between self-report of asthma and AR control over a 4-week monitoring period. One hundred sixty-six children with persistent asthma participated in a clinical evaluation of asthma and rhinitis, including allergy testing. Self-report of asthma control and rhinitis control using the Childhood Asthma Control Test (C-ACT) and Rhinitis Control Assessment Test (RCAT) were measured 1 month after the study clinic session. Persistent rhinitis symptoms were reported by 72% of participants; 54% of rhinitis symptoms were moderate in severity, though only 33% of the sample received adequate treatment. AR was newly diagnosed for 53% during the clinic evaluation. Only 15% reported using intranasal steroids. Participants with poorly controlled AR had poorer asthma control compared with those with well-controlled AR. This sample of urban school-aged children with persistent asthma had underdiagnosed and undertreated AR. Healthcare providers and caregivers in urban settings need additional education about the role of allergies in asthma, recognition of AR symptoms, and AR's essential function in the comanagement of asthma. Barriers to linkages with allergy specialists need to be identified.

Mouse Sensitivity Is an Independent Risk Factor for Rhinitis in Children with Asthma

“…[2][3][4][5] Previous work has highlighted a similarly high prevalence of AR in the urban pediatric population, with underserved children at higher risk for undiagnosed AR 27 and up to two thirds of these children reportedly receiving inadequate or no treatment for AR. 28 Mouse and cockroach allergens have been previously reported to be the two most abundant aeroallergens in many urban communities 15 and our results here, identifying mouse sensitivity by serology as the dominant association with active rhinitis is also consistent with previous work reporting the dominance of mouse over cockroach allergy in asthma outcomes in a similar cohort of urban children. 17 The association between rhinitis and serologic mouse sensitivity was driven largely by children who were positive for mouse sensitivity by both serology and SPT.…”

Asthma-related lung function, sleep quality, and sleep duration in urban children

“…The study clinician used this query as background information to evaluate the child’s asthma and allergy status see below. 22,40 …”

Allergic rhinitis: the “Ghost Diagnosis” in patients with asthma

“…A study of allergic rhinitis symptoms in a diverse US urban population of 166 children with known asthma identified rhinitis symptoms in 72 % of subjects, with AR undiagnosed in 53 % [15]. A cross-sectional population-based study in six Colombian cities noted that the prevalence of subjects reporting current AR symptoms was 32 %, while the prevalence of physician diagnosed AR was lower at 14 % [16].…”