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Risk factors for allergic rhinitis in Costa Rican children with asthma
S Bunyavanich1, M E Soto-Quiros, L Avila
1Channing Laboratory, Boston, MA 02115, USA.
Insights
Identifying allergic rhinitis (AR) risk factors in children with asthma is crucial. Indoor allergens are linked to skin test-positive AR, while outdoor allergens and home conditions influence physician-diagnosed AR.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Environmental Health
Background:
- Allergic rhinitis (AR) and asthma often coexist in children.
- Risk factors for AR in asthmatic children may differ from those with AR or asthma alone.
- Accurate identification of AR in asthmatic children is essential for effective management.
Purpose of the Study:
- To identify clinical and environmental risk factors for allergic rhinitis (AR) in children with asthma.
- To differentiate risk factors based on AR definition: skin test-positive AR versus physician-diagnosed AR.
Main Methods:
- Cross-sectional study of 616 Costa Rican children (aged 6-14) with asthma.
- Data collected via questionnaires, spirometry, methacholine challenge, skin testing, and serology.
- Logistic regression used to analyze risk factors for two AR outcomes: skin test reaction (STR)-positive AR and physician-diagnosed AR.
Main Results:
- High prevalence (80%) of STR-positive AR; risk factors included indoor allergen sensitivity (dust mite, cockroach), parental AR history, older age at asthma onset, oral steroid use, and eosinophilia.
- Lower prevalence (27%) of physician-diagnosed AR; risk factors included pollen sensitivity, parental AR history, inhaled steroid/beta2-agonist use, household mold/mildew, and fewer siblings.
- Physician diagnosis sensitivity for STR-positive AR was low (29.5%).
Conclusions:
- AR risk factors in asthmatic children vary by AR definition.
- Indoor allergens are key drivers for STR-positive AR.
- Outdoor allergens and home environment impact physician-diagnosed AR, suggesting a need for targeted allergy testing in Latin American children with asthma to improve diagnosis.
Background:
Risk factors for allergic rhinitis (AR) in asthmatics are likely distinct from those for AR or asthma alone. We sought to identify clinical and environmental risk factors for AR in children with asthma.
Methods:
We performed a cross-sectional study of 616 Costa Rican children aged 6-14 years with asthma. Candidate risk factors were drawn from questionnaire data, spirometry, methacholine challenge testing, skin testing, and serology. Two outcome measures, skin test reaction (STR)-positive AR and physician-diagnosed AR, were examined by logistic regression.
Results:
STR-positive AR had high prevalence (80%) in Costa Rican children with asthma, and its independent risk factors were nasal symptoms after exposure to dust or mold, parental history of AR, older age at asthma onset, oral steroid use in the past year, eosinophilia, and positive IgEs to dust mite and cockroach. Physician-diagnosed AR had lower prevalence (27%), and its independent risk factors were nasal symptoms after pollen exposure, STR to tree pollens, a parental history of AR, inhaled steroid and short-acting beta2 agonist use in the past year, household mold/mildew, and fewer older siblings. A physician's diagnosis was only 29.5% sensitive for STR-positive AR.
Conclusions:
Risk factors for AR in children with asthma depend on the definition of AR. Indoor allergens drive risk for STR-positive AR. Outdoor allergens and home environmental conditions are risk factors for physician-diagnosed AR. We propose that children with asthma in Costa Rica and other Latin American nations undergo limited skin testing or specific IgE measurements to reduce the current under-diagnosis of AR.
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