Fractional exhaled nitric oxide in Korean children with allergic rhinitis

Seung Hyun Moon; Hae Ji Jang; Yoon Sung Park; Woo Yeon Lee; Dae Hyun Lim; Jeong Hee Kim

doi:10.4168/aard.2015.3.6.439

Journal List > Allergy Asthma Respir Dis > v.3(6) > 1059144

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Moon, Jang, Park, Lee, Lim, and Kim: Fractional exhaled nitric oxide in Korean children with allergic rhinitis

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(6): 439-445.

Published online: 30 November 2015

DOI: https://doi.org/10.4168/aard.2015.3.6.439

Fractional exhaled nitric oxide in Korean children with allergic rhinitis

Seung Hyun Moon¹, Hae Ji Jang², Yoon Sung Park², Woo Yeon Lee², Dae Hyun Lim^1,², Jeong Hee Kim^1,²

¹Department of Pediatrics, Inha University School of Medicine, Incheon, Korea.

²Environmental Health Center for Allergic Rhinitis, Inha University Hospital, Incheon, Korea.

Correspondence to: Jeong Hee Kim. Department of Pediatrics, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea. Tel: +82-32-890-2843, Fax: +82-32-890-2844, kimjhmd@inha.ac.kr

Received 6 August 2015 Revised 22 September 2015 Accepted 6 October 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

Fractional exhaled nitric oxide (FeNO) is useful for the diagnosis of allergic rhinitis (AR) as well as bronchial asthma (BA). However, FeNO may differ according to race, age, and other determinants. There have been few studies about FeNO in Korean children with AR. The aims of this study were to evaluate the value of FeNO in AR and to compare FeNO, and determinants of FeNO levels between AR, BA, and combined AR and BA.

Methods

This study included 647 children aged 5 to 17. The children were classified into 5 groups after performing the skin test, FeNO measurement, the pulmonary function test, and the methacholine challenge test: those with nonallergic rhinitis (NAR), those with AR, those with BA, and those with combined AR and BA, and healthy controls,.

Results

The values of FEV₁ (forced expiratory volume in one second) %predicted were 94.4%±12.6%, 93.8%±20.7%, 90.0%±17.4% in AR, BA, and combined AR and BA, respectively. The values of FeNO in AR (32.3±25.0 ppb), BA (31.1±20.5 ppb), and combined AR and BA (34.5±30.4 ppb) were significantly higher compared to those of NAR (16.8±13.5 ppb) and controls (15.9±12.5 ppb). There was no significant difference in FeNO among AR, BA, and combined AR and BA. FeNO was significantly higher in patients with ≥4 positive results (36.6±29.2 ppb) than in those with <4 positive skin test results (27.6±20.7 ppb). When the receiver operating characteristic curve analysis for prediction of AR showed 0.756 of area under the curve, the cutoff level of FeNO was 16 ppb.

Conclusion

In this study, children with AR had increased levels of FeNO. It is suggested that AR may have eosinophilic bronchial inflammation without BHR or clinical asthma.

Keywords: Allergic rhinitis, Nonallergic rhinitis, FeNO, Eosinophilic inflammation

Figures and Tables

Fig. 1

Receiver operating characteristic curve analysis for prediction of allergic rhinitis among rhinitis patient. FeNO, fractional exhaled nitric oxide.

Table 1

Subject characteristics

Characteristic	Control (n = 345)	NAR (n = 83)	AR (n = 139)	Asthma (n = 18)	AR+asthma (n = 62)	P-value
Sex
Male:female	66:279	31:52	58:81	7:11	35:27
Age (yr)	12.8 ± 2.7	11.3 ± 2.9	11.4 ± 3.1	12.6 ± 3.1	11.2 ± 3.2
Height (cm)	151.4 ± 14.5	145.1 ± 13.8	146.5 ± 14.8	152.3 ± 15.8	146.2 ± 20.0
Weight (kg)	46.7 ± 13.1	41.7 ± 13.7	42.4 ± 13.3	49.1 ± 16.8	43.6 ± 17.6
Body mass index (kg/m²)	20.0 ± 3.3	19.4 ± 3.8	19.1 ± 3.9	20.6 ± 3.5	19.7 ± 3.6	0.211
Past history of AD						0.963
Yes	-	24	36	5	16
No	-	59	103	13	46
Past history of sinusitis						0.461
Yes		15	35	3	17
No		68	104	15	45
Pulmonary function test
FEV₁ %predicted	94.4 ± 12.5	93.0 ± 17.3	94.4 ± 12.6	93.8 ± 20.7	90.0 ± 17.4	0.418
FVC %predicted	94.3 ± 15.0	92.9 ± 15.7	92.6 ± 12.5	93.3 ± 18.8	88.6 ± 16.4	0.333
FEV₁/FVC (%)	101.6 ± 10.9	100.0 ± 11.3	102.6 ± 12.3	100.7 ± 10.2	101.4 ± 9.3	0.585
FEF_25%-75% (%)	82.0 ± 22.8	83.5 ± 25.3	88.3 ± 24.7	82.3 ± 27.2	79.4 ± 23.1	0.198
FeNO (ppb)	15.9 ± 12.5	16.8 ± 13.5	32.3 ± 25.0^*†	31.1 ± 20.5^*†	34.5 ± 30.4^*†

Values are presented as mean±standard deviation.

AR, allergic rhinitis; NAR, nonallergic rhinitis; AD, atopic dermatitis; FeNO, fractional exhaled nitric oxide.

^*P<0.05 vs. control. ^†P<0.05 vs. nonallergic rhinitis.

Table 2

FeNO values according to age and sex

Variable	Control (n = 345)		NAR (n = 83)		AR (n=139)		Asthma (n = 18)		AR+asthma (n = 62)
Variable	No.	FeNO (ppb)	No.	FeNO (ppb)	No.	FeNO (ppb)	No.	FeNO (ppb)	No.	FeNO (ppb)
Age (yr)
5-11	90	14.7 ± 9.6	46	16.7 ± 14.9	65	28.8 ± 24.2	5	22.4 ± 13.3	31	30.4 ± 25.1
12-14	135	16.0 ± 12.3	22	18.3 ± 12.4	42	36.8 ± 26.4	7	32.1 ± 23.2	19	36.3 ± 17.0
15-17	120	16.7 ± 14.6	15	14.9 ± 10.7	32	33.3 ± 24.6	6	37.0 ± 22.8	12	42.5 ± 52.9
P-value	0.544		0.756		0.269		0.520		0.488
Sex
Male	66	16.4±9.9	31	17.0±16.3	58	33.4±26.8	7	39.1±21.6	35	34.5±22.9
Female	279	15.8±13.1	52	16.7±11.7	81	31.5±23.8	11	25.9±18.9	27	34.6±38.4
P-value	0.709		0.903		0.662		0.189		0.989

Values are presented as mean±standard deviation. There was no significant difference in FeNO values according to age and sex.

FeNO, fractional exhaled nitric oxide; NAR, nonallergic rhinitis; AR, allergic rhinitis.

Table 3

FeNO values according to BHR in AR

	AR with BHR (n = 40)	AR without BHR (n = 99)	P-value
FeNO (ppb)	35.0 ± 30.9	31.2 ± 22.3	0.414

Values are presented as mean±standard deviation.

FeNO, fractional exhaled nitric oxide; BHR, bronchial hyperreactivity; AR, allergic rhinitis.

Table 4

FeNO values according to inhaled allergen in patient with atopy

	House dust mite^* (n = 204)	Mold (n = 42)	Pollen (n = 60)	Animal hair^† (n = 52)	P-value
FeNO (ppb)	33.4 ± 26.9	35.8 ± 27.5	32.7 ± 19.5	34.5 ± 31.2	0.932

Values are presented as mean±standard deviation. There was no significant difference in FeNO values according to inhaled allergen.

FeNO, fractional exhaled nitric oxide.

^*Dermatophagoides pteronyssinus, Dermatophagoides farina. ^†Dog hair, cat fur.

Table 5

FeNO values according to number of sensitization and FeNO value

	Nonsenstized (n = 428)	Mono-sensitized (n = 115)	Poly-sensitized (n = 104)
FeNO (ppb)	16.1 ± 12.7	31.0 ± 24.2	35.3 ± 28.6

Values are presented as mean±standard deviation. FeNO in nonsensitized group showed significant difference than that in mono- and poly-sensitized group (P<0.001).

FeNO, fractional exhaled nitric oxide.

Table 6

FeNO values according to wheal size and FeNO value

	Wheal size		P-value
	3+ (n = 93)	≥ 4+ (n = 129)	P-value
FeNO (ppb)	27.6 ± 20.7	36.6 ± 29.2	< 0.001

Values are presented as mean±standard deviation.

FeNO, fractional exhaled nitric oxide.

Table 7

Diagnosis validity of FeNO for prediction of AR among rhinitis patient

Cutoff value	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)
10	89.93	31.33	68.68	65.00
15	75.54	62.65	77.21	60.47
20	58.27	78.31	81.82	52.85
25	51.08	85.54	85.54	51.08

FeNO, fractional exhaled nitric oxide; AR, allergic rhinitis; PPV, positive predictive value; NPV, negative predictive value.

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ORCID iDs: Jeong Hee Kim
https://orcid.org/http://orcid.org/0000-0002-7054-8552
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