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Rhinoconjunctivitis symptoms in children and adolescents with asthma: Longitudinal clustering analysis
Alkis Togias1, Peter J Gergen1, Andrew H Liu2
1National Institute of Allergy and Infectious Diseases, Bethesda, Md.
The Journal of Allergy and Clinical Immunology
|January 4, 2025
Summary
This study identified new rhinoconjunctivitis phenotypes in children, revealing distinct symptom patterns beyond traditional allergy classifications. Further research is needed to explore factors beyond allergies in rhinoconjunctivitis pathobiology.
Area of Science:
- Allergy and Immunology
- Pediatric Respiratory Medicine
- Epidemiology
Background:
- Conventional rhinoconjunctivitis phenotypes rely on symptom severity, duration, seasonality, and allergen sensitization.
- Current classifications may not fully capture population-level symptom patterns.
Purpose of the Study:
- To identify unbiased rhinoconjunctivitis phenotypes based on symptom intensity and seasonality.
- To compare the characteristics of these identified phenotypes.
Main Methods:
- Prospective follow-up of 619 children with asthma in urban settings over 12 months.
- Utilized a rhinoconjunctivitis activity questionnaire and standardized management algorithms.
- Identified symptom trajectories and clusters, comparing them based on atopic characteristics.
Main Results:
- Five distinct symptom clusters were identified: two with high symptoms (differing seasonally), one with medium symptoms, one with medium nasal congestion only, and one with low symptoms.
- Low symptom clusters showed no seasonal variation and were further divided based on nasal corticosteroid use.
- High symptom clusters had more allergic sensitizations and family history of allergic disease, but allergy did not explain seasonality differences.
Conclusions:
- The study identified novel rhinoconjunctivitis phenotypes not previously reported.
- These phenotypes were not differentiated by demographics, atopy, or type 2 inflammation measures.
- Factors beyond allergies require investigation to understand rhinoconjunctivitis pathobiology.
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