Predicting the course of chronic rhinosinusitis in young children-5-year prospective study

Predicting the course of chronic rhinosinusitis (CRS) and assessing the clinical relevance of IgE-mediated sensitization to house dust mite (HDM) in preschool children remain challenging. We aimed to identify early clinical characteristics of HDM-induced allergic rhinitis (AR-HDM) in preschoolers and to determine predictors of CRS persistence.

We conducted a 5-year prospective follow-up of a well-defined multi-omics cohort of 133 children aged 4-8 years with CRS symptoms, with or without IgE-mediated sensitization to HDM. We developed a multivariate logistic regression model with clinical and multi-omics variables assessed at preschool age to predict CRS persistence and AR-HDM diagnosis at school age.

Among 117 children who completed the 5-year follow-up, CRS persisted in 35%. Higher baseline SN-5 (Sinus and Nasal Quality of Life Survey) scores (>3.6 points) significantly increased the risk of persistent CRS (OR = 3.41; 95% CI: 1.50-7.76; p = .003). ILC-2 cells were detected more frequently in nasal samples from preschool children with persistent CRS. Independent predictors of AR-HDM included a history of food allergy in infancy (OR = 3.87; 1.10-13.60; 0.034) and prominent allergic symptoms at baseline (allergy-related SN-5 domain ratio ≥21%), (OR = 3.96; 1.20-13.10; 0.025). The combined presence of these factors additionally improves the prediction of AR-HDM.

Higher SN-5 score and presence of ILC-2 in the nasal mucosa increase the risk of persistence of CRS. The co-occurrence of a relatively higher allergy domain of SN-5 score and a history of food allergy facilitates prediction of HDM allergy in preschoolers, enabling the timely initiation of allergen immunotherapy in allergic children.

ClinicalTrials.gov Identifier: NCT03011632.