Investigating Rhinitis Phenotypes

Doctoral Dissertation uoadl:2880570 77 Read counter

Τομέας Υγείας - Μητέρας - Παιδιού
Library of the School of Health Sciences
Deposit date:
Tsilochristou Olympia
Dissertation committee:
Τσολιά Μαρία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Παπαδόπουλος Νικόλαος, Καθηγητής, ΕΚΠΑ, Επιβλέπων
Τυλιγάδα Αικατερίνη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Μαραγκουδάκης Παύλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ξεπαπαδάκη Παρασκευή, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σολδάτου Αλεξάνδρα, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σπυρίδης Νικόλαος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Διερεύνηση Φαινοτύπων Ρινίτιδας
Translated title:
Investigating Rhinitis Phenotypes
Background: There is little evidence on the incidence and characteristics of local
allergic rhinitis (LAR) in children. Out of the seven available studies, most have
included subjects with perennial rhinitis only and results are based on the investigation
of no more than three allergens per study. The aim of our study was to determine the
prevalence of LAR in children with chronic, difficult to treat, perennial or seasonal,
rhinitis but no evidence of sensitization to aeroallergens, or other alternative
diagnosis. We additionally aimed at undertaking detailed LAR prevalence investigation
through nasal specific provocation tests (NPT) to 4 locally relevant to Greece
aeroallergens. Our secondary objective was to identify whether children with LAR have
any distinct clinical characteristics that could help the clinician distinguish them from
children with non allergic non infectious rhinitis (NAR).
Methods: We prospectively performed multiple nasal provocation tests (M-NPT) with
four locally relevant aeroallergens (P. pratense, O. europea, A. alternata, D.
pteronyssinus) in children with absence of sensitization to aeroallergens, seen during
a calendar year in a specialized rhinitis clinic. We additionally performed single NPT to
children with allergic rhinitis (AR; positive control group). The result of the NPT was
based on symptoms and acoustic rhinometry. Identification of nasal hyper-reactivity
(NHR) triggers was through a questionnaire.
Results: LAR was confirmed in 29.2% (n=7/24) of the children that had negative skin
prick and blood testing to aeroallergens. All but one of the children reacted to one
allergen and one to two. Implementing the M-NPT protocol ensured a 69.8% (p<0.001)
significant decrease in the number of visits required for NPT in comparison to those
that would need to be performed if each child had 4 single NPT. All AR-children had
positive single NPT with results similar to the LAR. There were no differences in age at
examination and rhinitis onset, gender distribution, family atopy, and past or current
environment of residency while the prevalence of reported NHR-triggers was
comparable amongst the LAR, AR and NAR groups.
Conclusion: To the best of our knowledge, this is the first pediatric study where the
seasonal or perennial rhinitis population was thoroughly tested for LAR against four
aeroallergens. LAR was present in a considerable proportion of children with no
sensitization to aeroallergens and therefore, the performance of NPT, preferably to
more than one aeroallergens, should be strongly considered in these cases. There were no distinct clinical characteristics between LAR, AR and NAR in children.
Additionally, children with LAR clinically responded similarly to the eliciting
aeroallergen compared to children with AR. Implementing M-NPT rather than single
NPT is a time- and cost-efficient practice.
Rhinitis, Local allergic rhinitis, LAR, Allergic rhinitis, Non-allergic rhinitis, Pediatric rhinitis, Rhinitis phenotypes, Nasal hyperreactivity, Nasal provocation test, Multiple nasal provocation test
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