Related Experiment Video
Updated: Oct 10, 2025
A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects
Published on: May 4, 2021
Airway Nitric Oxide in Children with HDM-Induced Allergic Rhinitis
Woralak Sutiratanachai1, Watcharoot Kanchongkittiphon1, Natchanun Klangkalya1
1Faculty of Medicine Ramathibodi Hospital, 26687Mahidol University, Bangkok, Thailand.
Insights
Nasal nitric oxide (nNO) levels can help diagnose severe house dust mite (HDM)-induced allergic rhinitis in children. Higher nNO levels correlate with increased rhinitis severity, suggesting nNO as a potential diagnostic marker.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Biomarkers in Inflammation
Background:
- Allergic rhinitis is a prevalent condition in children.
- Airway nitric oxide (NO) has been investigated as a marker for eosinophilic inflammation.
Purpose of the Study:
- To assess airway nitric oxide (NO) levels in children diagnosed with house dust mite (HDM)-induced allergic rhinitis.
- To explore the correlation between NO levels and rhinitis severity.
Main Methods:
- Enrollment of children aged 5-18 with moderate-severe persistent rhinitis and positive HDM nasal provocation test (NPT).
- Assessment of nasal symptoms using Total Nasal Symptom Score (TNSS) and Visual Analog Scale (VAS).
- Measurement of fractional exhaled nitric oxide (FeNO), nasal nitric oxide (nNO), skin prick tests (SPT), and serum specific IgE (sIgE) to HDM.
Main Results:
- A significant correlation was found between nasal nitric oxide (nNO) levels and VAS scores (R=0.398, P=.005).
- Children with severe rhinitis exhibited significantly higher nNO levels compared to those with moderate rhinitis (1652.05 vs 941.30 ppb, P=.002).
- Fractional exhaled nitric oxide (FeNO) levels were higher in children with greater HDM sensitization (mean wheal diameter > 8 mm and sIgE > 0.35 KUA/L).
Conclusions:
- A proposed cut-off value for nNO (1350 ppb) can aid in diagnosing severe HDM-induced chronic rhinitis in children.
- Elevated FeNO levels are associated with a higher degree of HDM sensitization in children with allergic rhinitis.
Background:
Rhinitis is a common problem in children. Airway nitric oxide (NO) was proposed to represent eosinophilic inflammation.
Objectives:
To evaluate airway NO level in children with house dust mite (HDM)-induced allergic rhinitis.
Methods:
Children aged 5 to 18 years old with moderate-severe persistent rhinitis and positive result for the HDM nasal provocation test (NPT) was enrolled. The nasal symptoms evaluated by total nasal symptom score (TNSS) and visual analog scale (VAS) were recorded. Skin prick test (SPT) to common aeroallergens, fractional exhaled nitric oxide (FeNO), nasal nitric oxide (nNO), and blood test for specific IgE (sIgE) to HDM was measured. Rhinitis severity was categorized as severe if the VAS score > 7.
Results:
Forty-eight children with HDM-induced allergic rhinitis with the mean age of 9.3 ± 2.4 years were enrolled. nNO levels and VAS score were significantly correlated (R = 0.398, P = .005). Children with severe rhinitis had significantly higher nNO levels than moderate rhinitis (1652.05 vs 941.30 parts per billion [ppb], P = .002), while there was no difference in FeNO level. ROC curve analysis demonstrated the cut-off value of nNO at 1350 ppb (AUC 0.764, 95% CI: 0.616-0.911, P = .002) for detecting severe HDM-induced allergic rhinitis with the sensitivity of 78% and the specificity of 71%. The level of FeNO in children who had HDM mean wheal diameter (MWD) > 8 mm was significantly higher than those with HDM MWD of 3 to 8 mm and those with a negative test (39.7 vs 14.3 vs 14.4 ppb; P = .006, respectively). Children who had sIgE to HDM < 0.35 KUA/L had significantly lower FeNO than those with sIgE to HDM 0.35 to 50 KUA/L and >50 KUA/L (9.5 vs 19.7 vs 40.4 ppb; P = .029, respectively).
Conclusions:
Cut-off value for the diagnosis of severe HDM-induced chronic rhinitis was proposed. Rhinitis children who had a higher degree of HDM sensitization had a higher level of FeNO.
Related Concept Videos
01:28Nitric Oxide Signaling Pathway
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
01:24Antiasthma Drugs: Methylxanthines
Theophylline is thought to inhibit phosphodiesterase enzymes, increasing intracellular levels of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). This rise in cAMP and cGMP concentrations stimulates cardiac function,...
01:20Antiasthma Drugs: Muscarinic Receptor Antagonists
Antimuscarinic agents compete with ACh for the same binding site on the muscarinic receptors. By binding to these receptors, they inhibit the downstream effects of ACh and block the parasympathetic...
01:25Antiasthma Drugs: Mast Cell Stabilizers and Anti-IgE Drugs
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...
01:26Asthma-II: Pathophysiology and Classification
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include: