Distinct Clinical and Cytokine Features of Moderate-Severe Persistent AR Phenotype by ARIA Classification: COCOA

Area of Science:

• Pediatric Allergy and Immunology
• Environmental Epidemiology
• Immunology

Background:

• Allergic rhinitis (AR) prevalence is rising globally.
• Understanding distinct AR phenotypes is crucial for effective management.
• The AR phenotype in the general pediatric population requires further exploration.

Purpose of the Study:

• To identify distinct allergic rhinitis (AR) phenotypes in Korean children using the Allergic Rhinitis and its Impact on Asthma (ARIA) classification.
• To investigate the prevalence of the moderate-to-severe persistent AR phenotype in a pediatric cohort.
• To explore risk factors and immunological markers associated with AR phenotypes.

Main Methods:

• A cohort of 1,113 Korean children aged 7 years was studied.
• Physician diagnosis of AR and ARIA classification were employed.
• Skin prick tests and cytokine assays (IL-4, IL-5, IL-17A) were performed at ages 3 and 7.

Main Results:

• The prevalence of AR at age 7 was 48.9%, with 4.4% exhibiting the moderate-to-severe persistent phenotype.
• Cesarean delivery linked to mild-intermittent AR; prenatal antibiotic use associated with moderate-to-severe persistent AR.
• Early sensitization (age 3) to specific allergens and later sensitization (age 7) increased risk for the severe AR phenotype. Elevated IL-4 at age 3 and IL-5/IL-17A at age 7 were observed in the severe phenotype group.

Conclusions:

• Approximately 4.4% of Korean children present with a moderate-to-severe persistent AR phenotype per ARIA criteria.
• Prenatal antibiotic exposure and early-life sensitization to common allergens are significant risk factors.
• The moderate-to-severe persistent AR phenotype involves both T helper 2 and T helper 17 immune responses, indicating complex inflammation patterns.