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Pollen-induced allergic rhinitis in 1360 Italian children: comorbidities and determinants of severity
Arianna Dondi1, Salvatore Tripodi, Valentina Panetta
1Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Pediatric Unit, Department for Mother and Child, Ramazzini Hospital, Carpi, Italy.
Insights
Pollen-induced allergic rhinoconjunctivitis (AR) is common in Italian children, with over half experiencing moderate to severe symptoms. Longer AR duration correlates with increased symptom severity and comorbidities like asthma.
Area of Science:
- Pediatric Allergy and Immunology
- Environmental Allergies
- Public Health
Background:
- Pollen-induced allergic rhinoconjunctivitis (AR) is a prevalent childhood condition.
- General practitioners may underestimate AR severity, delaying diagnosis and intervention.
- Early diagnosis and intervention are crucial for managing childhood AR.
Purpose of the Study:
- To assess the severity of pollen-induced AR in Italian children.
- To identify determinants of AR severity in this population.
- To evaluate children who have never received specific immunotherapy (SIT).
Main Methods:
- Recruited 1360 children (4-18 years) with pollen-induced AR across 14 Italian cities.
- Utilized standardized questionnaires and skin-prick tests (SPT) for allergen sensitization.
- Collected data on demographics, family history, and early-life environmental exposures via the AllergyCARD™ platform.
Main Results:
- 51% of children had moderate-to-severe AR; 39% had asthma, 23.9% had oral allergy syndrome (OAS).
- Average AR onset at 5.3 years, with a mean duration of 5.2 years.
- Longer AR duration was significantly linked to moderate-to-severe AR, asthma, and OAS (p < 0.001).
Conclusions:
- Highlights the significant severity of pollen-induced AR in Italian children.
- Emphasizes the association between AR duration and disease severity markers.
- Recommends nationwide initiatives for earlier diagnosis and intervention in pediatric AR.
Background:
Pollen-induced allergic rhinoconjunctivitis (AR) is highly prevalent and rapidly evolving during childhood. General practitioners may not be fully aware of the nature and severity of symptoms experienced by patients and might underestimate the prevalence of moderate or severe disease. Thus, the relevance of early diagnosis and intervention may be overlooked.
Objectives:
To investigate the severity of pollen-induced AR and its determinants in Italian children referred to allergy specialists and who had never received specific immunotherapy (SIT).
Methods:
Children (age 4-18 yr) affected by pollen-induced AR who had never undergone SIT were recruited between May 2009 and June 2011 in 16 pediatric outpatient clinics in 14 Italian cities. Recruited children's parents answered standardized questionnaires on atopic diseases (International Study of Allergy and Asthma in Childhood, Allergic Rhinitis and its Impact on Asthma, Global Initiative for Asthma). The children underwent skin-prick test (SPT) with several airborne allergens and six food allergens. Information on socio-demographic factors, parental history of allergic diseases, education, perinatal events, breastfeeding, nutrition and environmental exposure in early life was collected through an informatics platform shared by the whole network of clinical centers (AllergyCARD™).
Results:
Among the 1360 recruited patients (68% males, age 10.5 ± 3.4 yr), 695 (51%) had moderate-to-severe AR, 533 (39%) asthma, and 325 (23.9%) oral allergy syndrome (OAS). Reported onset of pollen-induced AR was on average at 5.3 ± 2.8 yr, and its mean duration from onset was 5.2 ± 3.3 yr. Only 6.2% of the patients were pollen-monosensitized, and 84.9% were sensitized to ≥3 pollens. A longer AR duration was significantly associated with moderate-to-severe AR symptoms (p 0.004), asthma (p 0.030), and OAS comorbidities (p < 0.001).
Conclusions:
This nationwide study may raise awareness of the severity of pollen-induced AR among Italian children who have never received pollen SIT. The strong association between pollen-induced AR duration and several markers of disease severity needs replication in longitudinal studies, while suggesting that countrywide initiatives for earlier diagnosis and intervention should be planned.
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