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Pandemic-Associated Sensitization Patterns and Burden in Chinese Children with Allergic Rhinitis: A Retrospective
Longli Huang1, Xinfeng Zhao1, Jun Zhou1
1Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou, Zhejiang, People's Republic of China.
Insights
The COVID-19 pandemic altered allergen sensitization in children with allergic rhinitis (AR). Post-pandemic, increased inhalant allergen sensitization and complexity were observed, impacting risk stratification for pediatric AR.
Area of Science:
- Pediatric Allergy and Immunology
- Environmental Health
- Epidemiology
Background:
- The COVID-19 pandemic and related interventions may have changed children's exposures.
- Limited data exist on how allergen sensitization patterns in pediatric allergic rhinitis (AR) changed during different pandemic phases.
Purpose of the Study:
- To evaluate phase-specific shifts in serum allergen-specific immunoglobulin E (sIgE) sensitization, intensity, co-sensitization, and burden among children with AR in Eastern China.
- To compare allergen sensitization patterns across pre-pandemic, lockdown, and post-lockdown periods.
Main Methods:
- Analysis of 12,702 children (0-18 years) with diagnosed AR undergoing sIgE testing for 19 allergens (2018-2024).
- Comparison of sensitization across pre-pandemic (2018-2019), lockdown (2020-2022), and post-lockdown (2023-2024) phases.
- Statistical analysis using Pearson's chi-squared test, Fisher's exact test, and multivariable logistic regression, adjusting for age, sex, and season.
Main Results:
- Divergent sensitization trajectories observed between pre-pandemic, lockdown, and post-lockdown phases.
- Increased sensitization to inhalant allergens and decreased sensitization to certain food allergens noted, with a rise in seafood allergens post-lockdown.
- Higher odds of sensitization to indoor, outdoor, and seafood allergens, alongside increased strong-positive responses and co-sensitization patterns post-lockdown.
Conclusions:
- Children with AR exhibited distinct inhalant and food allergen sensitization patterns across pandemic phases, with increased intensity and complexity post-lockdown.
- Findings suggest phase-specific environmental associations rather than direct pandemic causality.
- Results can inform post-pandemic risk stratification for pediatric AR, emphasizing inhalant allergen control and careful interpretation of food allergen sIgE results.
Background:
The coronavirus disease 2019 (COVID-19) pandemic and associated non-pharmaceutical interventions may have altered children's indoor, outdoor, and dietary exposures. However, phase-specific data on allergen sensitization patterns in pediatric allergic rhinitis (AR) remain limited.
Objective:
To assess phase-specific changes in serum allergen-specific immunoglobulin E (sIgE) sensitization patterns, intensity, co-sensitization, and burden in children with AR in Eastern China.
Methods:
We analyzed 12,702 children aged 0-18 years with clinically diagnosed AR who underwent sIgE testing for 19 inhalant and food allergens in Eastern China from 2018 to 2024. Sensitization was compared across pre-pandemic (2018-2019), lockdown (2020-2022), and post-lockdown (2023-2024) phases using Pearson's χ2 -test or Fisher's exact test and multivariable logistic regression adjusted for age group, sex, and season. Strong sensitization was defined as sIgE ≥3.51 IU/mL, and co-sensitization as concurrent sensitization to both allergens in a pair.
Results:
Compared with the pre-pandemic phase, the lockdown and post-lockdown phases showed divergent sensitization trajectories, with higher sensitization to several inhalant allergens and lower sensitization to selected food allergens, although selected seafood allergens increased in later phases. Post-lockdown, adjusted analyses showed higher odds for selected indoor, outdoor, and seafood allergens, while other allergens remained stable or showed non-monotonic patterns. Strong-positive responses, selected co-sensitization patterns, and ≥4 sensitizations were also more common post-lockdown.
Conclusion:
Across the pre-pandemic, lockdown, and post-lockdown periods, children with AR showed divergent trajectories of inhalant and food allergen sensitization, as well as greater post-lockdown sensitization intensity and complexity. These findings reflect phase-specific associations rather than direct causal effects of the pandemic. They may help inform post-pandemic risk stratification in pediatric AR, with greater attention to inhalant allergen control and more cautious interpretation of food sIgE positivity in clinical context.
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