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Published on: August 7, 2017
Epidemiological analysis of chronic rhinitis in pediatric patients
Elizabeth A Erwin1, Russell A Faust, Thomas A E Platts-Mills
1Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, Ohio 43205, USA. eae9m@virginia.edu
Insights
Distinguishing allergic and nonallergic rhinitis in children is challenging. Eye symptoms and specific questionnaire answers may indicate allergy, while physical obstruction and sinus issues don't strongly correlate with nasal congestion.
Area of Science:
- Pediatric Allergy and Immunology
- Otolaryngology
- Respiratory Medicine
Background:
- Nonallergic rhinitis presents diagnostic challenges, particularly in pediatric populations.
- Understanding distinct clinical features is crucial for accurate diagnosis and management.
Purpose of the Study:
- To identify clinical indicators differentiating allergic from nonallergic rhinitis phenotypes in children.
- To assess the diagnostic utility of current evaluation methods for pediatric rhinitis.
Main Methods:
- Retrospective review of 151 pediatric patients with perennial rhinitis.
- Comparison of data from medical history, Sinus and Nasal Quality of Life Survey (SN-5), allergy testing, acoustic rhinometry, and sinus CT scans.
Main Results:
- Nasal congestion was the most common symptom (62%).
- Positive allergy tests correlated with more frequent eye symptoms and higher SN-5 allergic domain scores.
- Sinus CT and acoustic rhinometry findings did not significantly correlate with symptom severity or differentiate between allergic and nonallergic groups.
Conclusions:
- Differentiating allergic and nonallergic rhinitis in perennial cases is difficult, but eye symptoms and questionnaire data are predictive.
- Acoustic rhinometry and sinus CT scans indicate that physical obstruction and sinus disease are not primary drivers of nasal symptoms, including congestion.
Background:
Nonallergic rhinitis is a poorly understood entity, especially among pediatric patients.
Objective:
The objective of this study was to identify clinical features that may distinguish phenotypes of allergic and nonallergic patients and to evaluate the usefulness of current diagnostic modalities.
Methods:
We reviewed medical records for 151 pediatric patients with perennial rhinitis, evaluated in a multidisciplinary allergy and otolaryngology clinic. Results obtained by standard history, validated sinus and Nasal Quality of Life Survey (SN-5), epicutaneous allergy testing, acoustic rhinometry, and sinus CT were compared.
Results:
Nasal congestion was the most frequent primary presenting complaint (62%). Among subjects having a positive allergy test, associated eye symptoms were more frequent (p = 0.01) and responses to the SN-5 allergic domain were higher (p = 0.02). Sinus CT scores were similar among allergic and nonallergic subjects (median 7 and 8, respectively) and did not correlate with symptom scores (p = 0.6). Among nonallergic subjects, quality of life ratings weakly correlated with sinus CT scores (r = 0.4; p = 0.05). By rhinometry, absolute mean cross-sectional area was similar among allergic (0.32 cm(2)) and nonallergic (0.36 cm(2)) subjects and did not correlate with symptom scores (p = 0.8 for allergic and p = 0.6 for nonallergic subjects). Distinct groups of nonallergic patients including those with prominent conjunctival pruritus (n = 24), frequent cold symptoms (n = 3), and chronic sinus disease (n = 2) were observed.
Conclusion:
It is difficult to distinguish allergic and nonallergic rhinitis in patients with perennial disease, but associated eye symptoms and questionnaire responses are predictive of allergy. Acoustic rhinometry and sinus CT suggest that physical obstruction and sinus disease are not related to nasal symptoms including, surprisingly, the sensation of congestion.
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