Association between the serum 25-hydroxyvitamin D level and allergic rhinitis in Korean children

Seo Hee Yoon; Jung Yoon Kim; Yoon Hee Kim; Young A Park; In Suk Sol; Min Jung Kim; Kyung Won Kim; Myung Hyun Sohn; Kyu-Earn Kim

doi:10.4168/aard.2016.4.6.423

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Yoon, Kim, Kim, Park, Sol, Kim, Kim, Sohn, and Kim: Association between the serum 25-hydroxyvitamin D level and allergic rhinitis in Korean children

Original Article

Allergy, Asthma & Respiratory Disease 2016; 4(6): 423-428.

Published online: 30 November 2016

DOI: https://doi.org/10.4168/aard.2016.4.6.423

Association between the serum 25-hydroxyvitamin D level and allergic rhinitis in Korean children

Seo Hee Yoon, Jung Yoon Kim, Yoon Hee Kim, Young A Park, In Suk Sol, Min Jung Kim, Kyung Won Kim, Myung Hyun Sohn

, Kyu-Earn Kim

Department of Pediatrics, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.

Correspondence to: Myung Hyun Sohn. Department of Pediatrics, Institute of Allergy, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-2050, Fax: +82-2-393-9118, MHSOHN@yuhs.ac

Received 10 June 2016 Revised 23 September 2016 Accepted 23 September 2016

(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/4.0/).

Abstract

Purpose

Vitamin D is known to play an important role in the regulation of the immune system and in the prevention of allergic disease. Herein, we examined the association between vitamin D and allergic rhinitis (AR) in children.

Methods

A total of 72 aeroallergen-proven AR and 57 healthy control subjects who visited Severance Children's Hospital between 2012 and 2014 were evaluated. The mean serum 25-hydroxyvitamin D (25(OH)D) level was measured in all subjects to evaluate their vitamin D status.

Results

The mean serum 25(OH)D levels was significantly lower in patients with AR than in controls (19.5±6.4 ng/mL vs. 22.3±5.8 ng/mL, P=0.013). The incidence of AR is higher in the 25(OH)D-insufficient group (15–20 ng/mL) and in the 25(OH)D-deficient group (≤15 ng/mL) compared with the 25(OH)D-sufficient group (>20 ng/mL) (40.3% vs. 84.4% vs. 22.2%, P<0.001). There was no significant difference in the serum 25(OH)D level between subgroups with mild and moderate-to-severe AR symptoms (19.8±6.5 vs. 19.0±6.3, P=0.596). After adjusting for confounding factors, the lower serum vitamin D level groups had increased odds of AR compared with the 25(OH)D-sufficient group (odds ration [95% confidence interval]; 3.67 [1.29–10.38] in the 25(OH)D-insufficient group; P=0.014 and 6.04 [1.49–24.51] in the 25(OH)D-deficient group; P=0.012).

Conclusion

The serum vitamin D levels were significantly lower in children with AR compared with healthy controls. Therefore, lower serum level of 25(OH)D may be associated with the development of AR.

Keywords: Allergic rhinitis, Vitamin D, Childhood

Figures and Tables

Fig. 1

Comparison of serum vitamin D levels according to the presence of allergic rhinitis (A) and the Allergic Rhinitis and its Impact on Asthma (ARIA) classification (B). (A) The box plots show the significant difference in the mean 25-hydroxyvitamin D (25(OH)D) levels between the allergic rhinitis and control group. (B) No significant differences were observed among the ARIA classification subgroups. Allergic rhinitis was classified on the basis of the ARIA 2008 guideline. Data are expressed as mean±standard deviation.

Table 1

Clinical and demographic characteristics of the allergic rhinitis and control groups

Characteristic	Allergic rhinitis (n = 72)	Control (n = 57)	P-value
Age (yr)	9.0 ± 3.2	8.4 ± 3.5	0.260
Male sex	46 (63.9)	34 (59.6)	0.622
BMI (kg/m²)	17.8 ± 6.4	15.9 ± 3.0	0.002
WBC (/µL)	7,084 ± 1,953	6,880 ± 1,805	0.547
TEC (/µL)	369 ± 250	210 ± 149	< 0.001
25(OH)D (ng/mL)	19.5 ± 6.4	22.3 ± 5.8	0.013
Serum vitamin D status
Sufficient (> 20 ng/mL)	16 (32.0)	34 (68.0)
Insufficient (15–20 ng/mL)	29 (61.7)	18 (38.3)	< 0.001
Deficient (≤ 15 ng/mL)	27 (84.4)	5 (15.6)

Values are presented as mean±standard deviation or number (%).

25(OH)D, 25-hydroxyvitamin D; BMI, body mass index; WBC, white blood cell; TEC, total eosinophil count.

Table 2

Comparison of vitamin D status according to the types of sensitized inhalation antigen

Factor	Inhalation antigen			P-value
Factor	Indoor^*	Outdoor^†	Both	P-value
No. of patients	48 (66.7)	4 (5.6)	20 (27.8)
25(OH)D (ng/mL)	19.5±6.1	14.9±2.9	20.6±7.4	0.188

Values are presented as number (%) or mean±standard deviation.

25(OH)D, 25-hydroxyvitamin D.

^*Indoor allergens include; house dust, Dermatophagoides pteronyssinus, Dermatophagoides farinae, cockroach, Aspergillus fumigatus, Alternaria alternata, cat fur, dog hair. ^†Outdoor allergens include; ragweed, mugwort, oak, birch, alder, hop Japanese, bermuda grass, grass mixture, tree pollen mixture.

Table 3

Correlation between 25(OH)D and other factors

Factor	25(OH) D
Factor	Correlation (r)	P-value
Age	–0.319	<0.001
Total eosinophil count	0.019	0.838
Total IgE	0.121	0.310
White blood cell	0.132	0.139
Body mass index	–0.101	0.260

25(OH)D, 25-hydroxyvitamin D.

Table 4

Risk of allergic rhinitis according to the vitamin D status

Characteristic	Allergic rhinitis
Characteristic	Unadjusted OR (95% CI)	P-value	Adjusted OR* (95% CI)	P-value
Serum vitamin D status
Sufficient (> 20 ng/mL)	1 (reference)		1 (reference)
Insufficient (15–19 ng/mL)	2.03 (0.93–4.41)	0.074	3.67 (1.29–10.38)	0.014
Deficient (≤ 15 ng/mL)	4.03 (1.31–12.40)	0.015	6.04 (1.49–24.51)	0.012

25(OH)D, 25-hydroxyvitamin D; OR, odds ratio; CI, confidence interval.

^*Adjusted for age, sex, seasons, total eosinophil count and body mass index.

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ORCID iDs: Myung Hyun Sohn
https://orcid.org/http://orcid.org/0000-0002-2478-487X
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