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Mixed rhinitis: an underestimated diagnosis in children and adolescents?
I Burla Manhães1, F Y Matsumoto2, S Solé2
1Division of General and Community Pediatrics, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
Summary:
Background. Mixed rhinitis (MR) is a potential diagnosis for patients with allergic rhinitis (AR) who present symptoms following exposure to allergens yet also exhibit a significant burden of symptoms after exposure to non-specific irritants. MR is thought to be more prevalent than the isolated form of the disease (AR). However, there are still no established complementary tests or well-defined clinical criteria for diagnosing this phenotype in children and adolescents. This study aimed to propose and evaluate a questionnaire of triggers that could assist in clinically distinguishing patients with MR from those with AR and, through it, to estimate the prevalence of MR in a specialty center. Methods. This study focused on patients aged 8 to 18 years diagnosed with AR and under follow-up for at least six months. All patients completed the nasal irritant questionnaire (NIQ) with 18 items. The number of responses with a score ≥ 5 was used to define tertiles. The group from the 3rd tertile onwards was described as "high irritant burden" (MR), while the others were defined as "low irritant burden" (AR). Additionally, symptom control scores, allergic sensitization, atopic comorbidities, and indoor exposure to aeroallergens were considered. Results. By using the diagnostic criterion of MR, defined as at least eight positive responses on the NIQ in a patient with AR, it was possible to determine that the prevalence of MR was 42.9% (54/126), with a predominance of males and adolescents (median 13 years) and a mean duration of 3 years since symptom onset. This group also exhibited poorer symptom control. Considering the other evaluated variables, no significant differences were observed between the groups. Conclusions. The prevalence of MR is significant among children with AR, and individuals with MR exhibit poorer symptom control. At least eight positive responses with a score ≥ 5 in the NIQ were a practical cut-off point for differentiating between AR and MR phenotypes.
Insights
Mixed rhinitis (MR) affects nearly half of children with allergic rhinitis (AR). A new questionnaire helps distinguish MR, characterized by irritant triggers and poorer symptom control, from AR in pediatric patients.
Area of Science:
- Pediatric Allergy and Immunology
- Otorhinolaryngology
- Clinical Diagnostics
Background:
- Mixed rhinitis (MR) presents with symptoms from both allergens and non-specific irritants, often exceeding allergic rhinitis (AR) alone.
- Current diagnostic criteria and complementary tests for MR in pediatric populations are lacking.
- This study addresses the need for clinical tools to identify MR in children and adolescents.
Purpose of the Study:
- To propose and validate a questionnaire for distinguishing MR from AR in pediatric patients.
- To estimate the prevalence of MR within a pediatric specialty center.
- To identify clinical characteristics associated with MR.
Main Methods:
- A cohort of 8-18 year olds with AR completed an 18-item nasal irritant questionnaire (NIQ).
- MR was defined by a score of ≥5 on at least eight NIQ items, classifying patients as having a 'high irritant burden'.
- Symptom control, allergic sensitization, comorbidities, and indoor allergen exposure were assessed.
Main Results:
- The prevalence of MR was determined to be 42.9% (54/126) using the NIQ criterion.
- MR predominantly affected males and adolescents, with a median age of 13 years.
- Patients with MR reported poorer symptom control compared to those with AR.
Conclusions:
- Mixed rhinitis is a significant phenotype in children diagnosed with allergic rhinitis.
- The NIQ provides a practical tool for differentiating MR from AR, with a threshold of at least eight positive responses (score ≥5) being effective.
- Identifying MR is crucial as it is associated with diminished symptom control in pediatric patients.
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