Journal List > Allergy Asthma Respir Dis > v.8(1) > 1141942

Won, Park, Ahn, Kim, Kwon, Seo, Song, and Yoo: Clinical characteristics of allergic rhinitis and nonallergic rhinitis in Korean children

Abstract

Purpose

Recently, the prevalence of allergic rhinitis (AR) in Korean children has been increased. The aim of this study was to investigate the clinical characteristics of rhinitis and to compare clinical parameters between AR and nonallergic rhinitis (NAR) in children.

Methods

We retrospectively reviewed the medical records of 1,034 children under 18 years of age who visited Korea University Anam Hospital for rhinitis symptoms from January 2008 to December 2017. Clinical data, including clinical features, comorbidities, blood test results, allergen sensitization profile, and pulmonary function test parameters, were collected.

Results

Among the 1,034 children with rhinitis, 737 (71.3%) were AR and 297 (28.7%) were NAR. The prevalence of AR gradually increased with age. The median levels of eosinophil count (4.1%), serum total IgE (204.4 IU/L), eosinophil cationic protein (ECP) concentration (17.9 µg/L), and fractional exhaled nitric oxide (FeNO) (22.0 ppb) were significantly higher in children with AR than in those with NAR. The sensitization rate to the inhalant allergens increased with age; however, food allergen sensitization rate tended to decrease. Median levels of eosinophil count, total IgE, ECP, and FeNO were significantly higher in the poly-sensitized group than in the mono-sensitized and nonsensitized groups.

Conclusion

More than 70% of Korean children who have rhinitis symptoms are AR. Children with AR more likely to have higher levels of FeNO and bronchial asthma. Poly-sensitized children showed increased rates of atopic dermatitis and bronchial asthma.

Figures and Tables

Fig. 1

Prevalence of allergic rhinitis (AR) and nonallergic rhinitis (NAR) at different ages.

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Fig. 2

Sensitization profiles in children with allergic rhinitis according to the age groups. HDM, house dust mite; CR, cockroach.

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Table 1

Demographics of study subjects

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Values are presented as median (interquartile range) or number (%).

AR, allergic rhinitis; AD, atopic dermatitis; WBC, white blood cell; ESR, erythrocyte sedimentation rate; IgE, immunoglobulin E; ECP, eosinophil cationic protein.

Table 2

Pulmonary function test results in subjects with AR and non-AR

aard-8-20-i002

Values are presented as median (interquartile range).

AR, allergic rhinitis; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; FEF25%–75%, forced expiratory flow between 25% and 75% of vital capacity; FeNO, fractional exhaled nitric oxide.

Table 3

Medication use in subjects with AR and non-AR

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Values are presented as number (%).

AR, allergic rhinitis; INS, intranasal steroid; LTRA, leukotriene receptor antagonist.

Table 4

Characteristics of study subjects according to the age groups

aard-8-20-i004

Values are presented as median (interquartile range) or number (%).

AR, allergic rhinitis; AD, atopic dermatitis.

*Linear-by-linear association test.

Table 5

Characteristics of study subjects according to the sensitization profile (total=1,034)

aard-8-20-i005

Values are presented as median (interquartile range) or number (%).

AR, allergic rhinitis; AD, atopic dermatitis; WBC, white blood cell; ESR, erythrocyte sedimentation rate; IgE, immunoglobulin E; ECP, eosinophil cationic protein; FEV1, forced expiratory volume in one second; FVC, forced vital capacity; FEF25%–75%, forced expiratory flow between 25% and 75% of vital capacity; FeNO, fractional exhaled nitric oxide.

*Linear-by-linear association or Jonckheere-Terpstra test.

References

1. Ahn JY, Kim JE, Choi BS. Symptomatic differences between allergic and nonallergic rhinitis in children. Allergy Asthma Respir Dis. 2015; 3:341–345.
crossref
2. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008; 63:8–160.
pmid
3. Health Insurance Review & Assessment Service. Disease and procedure statistics [Internet]. Seoul (Korea): Health Insurance Review & Assessment Service;c2018. cited 2019 Feb 7. Available from: https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020045030000&brdScnBltNo=4&brdBltNo=2371&pageIndex=3#none.
4. Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006; 368:733–743.
crossref pmid
5. Ahn K, Kim J, Kwon HJ, Chae Y, Hahm MI, Lee KJ, et al. The prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in Korean children: nationwide cross-sectional survey using complex sampling design. J Korean Med Assoc. 2011; 54:769–778.
crossref
6. Hong SJ, Ahn KM, Lee SY, Kim KE. The prevalences of asthma and allergic diseases in Korean children. Korean J Pediatr. 2008; 51:343–350.
crossref
7. Korea Centers for Disease Control and Prevention. Prevalence of allergic diseases in Korean children, 2010 [Internet]. Osong (Korea): Korea Centers for Disease Control & Prevention;cited 2019 Feb 7. Available from: http://www.cdc.go.kr/board.es?mid=a20602010000 &bid=0034&act=view&list_no=12633.
8. Kim JS, Kang HS, Jang HJ, Kim JH, Lim DH, Son BK. Clinical features of allergic rhinitis in Korean children. Allergy Asthma Respir Dis. 2015; 3:116–123.
crossref
9. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl (Stockh). 1980; 92:44–47.
10. Cockcroft DW. Bronchoprovocation methods: direct challenges. Clin Rev Allergy Immunol. 2003; 24:19–26.
crossref pmid
11. Slavin RG, Spector SL, Bernstein IL, Kaliner MA, Kennedy DW, Virant FS, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. 2005; 116:S13–S47.
crossref
12. Oh EM, Eun SH, Park SH, Seo YS, Kim J, Seo WH, et al. Sleep disturbance in children with allergic disease. Allergy Asthma Respir Dis. 2015; 3:70–76.
crossref
13. Rim JH, Park BG, Kim JH, Kim HS. Comparison and clinical utility evaluation of four multiple allergen simultaneous tests including two newly introduced fully automated analyzers. Pract Lab Med. 2016; 4:50–61.
crossref pmid pmc
14. Kang H, Yu J, Yoo Y, Kim DK, Koh YY. Coincidence of atopy profile in terms of monosensitization and polysensitization in children and their parents. Allergy. 2005; 60:1029–1033.
crossref pmid
15. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005; 26:319–338.
pmid
16. Park CH, Kim HB, Jung YH, Lee E, Yang SI, Seo JH, et al. Predicted normal values of pulmonary function tests in normal Korean children. Allergy Asthma Respir Dis. 2014; 2:187–193.
crossref
17. Futamura M, Ohya Y, Akashi M, Adachi Y, Odajima H, Akiyama K, et al. Age-related prevalence of allergic diseases in Tokyo schoolchildren. Allergol Int. 2011; 60:509–515.
crossref pmid
18. Osman M, Hansell AL, Simpson CR, Hollowell J, Helms PJ. Gender-specific presentations for asthma, allergic rhinitis and eczema in primary care. Prim Care Respir J. 2007; 16:28–35.
crossref pmid pmc
19. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004; 113:832–836.
crossref pmid
20. Grossman J. One airway, one disease. Chest. 1997; 111:11S–16S.
crossref pmid
21. Settipane RJ, Hagy GW, Settipane GA. Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students. Allergy Proc. 1994; 15:21–25.
crossref pmid
22. Choi SH, Yoo Y, Yu J, Rhee CS, Min YG, Koh YY. Bronchial hyperresponsiveness in young children with allergic rhinitis and its risk factors. Allergy. 2007; 62:1051–1056.
crossref pmid
23. Chung E, Park J, Lee SY, Choi YJ, Hong SJ, Park KS. Risk factors, lung function and bronchial hyperresponsiveness in current dust mite-induced allergic rhinitis. Allergy Asthma Respir Dis. 2016; 4:49–54.
crossref
24. Moon SH, Jang HJ, Park YS, Lee WY, Lim DH, Kim JH. Fractional exhaled nitric oxide in Korean children with allergic rhinitis. Allergy Asthma Respir Dis. 2015; 3:439–445.
crossref
25. Hur GY. Treatment of allergic rhinitis. Korean J Med. 2013; 85:463–468.
crossref
26. Arshad SH, Tariq SM, Matthews S, Hakim E. Sensitization to common allergens and its association with allergic disorders at age 4 years: a whole population birth cohort study. Pediatrics. 2001; 108:E33.
crossref
27. Kulig M, Bergmann R, Klettke U, Wahn V, Tacke U, Wahn U. Natural course of sensitization to food and inhalant allergens during the first 6 years of life. J Allergy Clin Immunol. 1999; 103:1173–1179.
crossref pmid
28. Park SH, Lim DH, Son BK, Kim JH, Song YE, Oh IB, et al. Sensitization rates of airborne pollen and mold in children. Korean J Pediatr. 2012; 55:322–329.
crossref pmid pmc
29. Yoon JW, Lee SM, Kim JH, Kim NY, Baek JH, Baek HS, et al. Sensitization patterns to common allergens in Korean children younger than 6 years of age presenting with typical symptoms or signs of allergic diseases: a single center study. Allergy Asthma Respir Dis. 2014; 2:272–276.
crossref
30. de Jong AB, Dikkeschei LD, Brand PL. Sensitization patterns to food and inhalant allergens in childhood: a comparison of non-sensitized, monosensitized, and polysensitized children. Pediatr Allergy Immunol. 2011; 22:166–171.
pmid
31. Ballardini N, Bergström A, Wahlgren CF, van Hage M, Hallner E, Kull I, et al. IgE antibodies in relation to prevalence and multimorbidity of eczema, asthma, and rhinitis from birth to adolescence. Allergy. 2016; 71:342–349.
crossref pmid
32. Kim DH, Lim DH, Samra M, Kim EH, Kim JH. How accurate are the ISAAC questions for diagnosis of allergic rhinitis in Korean children? Int J Environ Res Public Health. 2018; 15:1527.
crossref pmc
33. Mo JH. Clinical features of nonallergic rhinitis in children. Allergy Asthma Respir Dis. 2015; 3:311–312.
crossref
34. Chawes BL, Bønnelykke K, Kreiner-Møller E, Bisgaard H. Children with allergic and nonallergic rhinitis have a similar risk of asthma. J Allergy Clin Immunol. 2010; 126:567–573.
crossref pmid
35. Lin H, Lin R, Li N. Sensitization rates for various allergens in children with allergic rhinitis in Qingdao, China. Int J Environ Res Public Health. 2015; 12:10984–10994.
crossref pmid pmc
36. Pénard-Morand C, Raherison C, Kopferschmitt C, Caillaud D, Lavaud F, Charpin D, et al. Prevalence of food allergy and its relationship to asthma and allergic rhinitis in schoolchildren. Allergy. 2005; 60:1165–1171.
crossref pmid
37. Plunkett CH, Nagler CR. The influence of the microbiome on allergic sensitization to food. J Immunol. 2017; 198:581–589.
crossref pmid pmc
38. Bisgaard H, Li N, Bonnelykke K, Chawes BL, Skov T, Paludan-Müller G, et al. Reduced diversity of the intestinal microbiota during infancy is associated with increased risk of allergic disease at school age. J Allergy Clin Immunol. 2011; 128:646–652.
crossref pmid
39. Chiu CY, Chan YL, Tsai MH, Wang CJ, Chiang MH, Chiu CC. Gut microbial dysbiosis is associated with allergen-specific IgE responses in young children with airway allergies. World Allergy Organ J. 2019; 12:100021.
crossref
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Young Yoo
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