Allergy Asthma Immunol Res.  2016 Jul;8(4):346-352. 10.4168/aair.2016.8.4.346.

Response to Nonallergenic Irritants in Children With Allergic and Nonallergic Rhinitis

Affiliations
  • 1Department of Pediatrics, College of Medicine, Hallym University, Hwaseong, Korea.
  • 2Department of Pediatrics, CHA University School of Medicine, Pocheon, Korea.
  • 3Department of Medicine, CHA University School of Medicine, Seongnam, Korea.
  • 4Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea. drmesh@gmail.com

Abstract

PURPOSE
Nonallergenic irritants can aggravate the symptoms of rhinitis. We investigated the clinical responses of children with allergic rhinitis (AR) and nonallergic rhinitis (NAR) to nonallergenic irritants, and identified factors associated with these responses.
METHODS
Children with chronic rhinitis (n=208) were classified as having AR or NAR based on the presence of aeroallergen-specific IgE. Healthy controls (n=24) were recruited for comparison. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines were used to classify patients, and their irritant score (0-21 points) and current symptom score (5-35 points) were measured. Subjects with irritant scores ≥3 and <3 were classified as having irritant and nonirritant rhinitis, respectively.
RESULTS
The mean age of enrolled subjects was 6.8 years (range: 1.8-16.0 years). The AR and NAR groups had similar irritant scores (P=0.394) and proportions of subjects with irritant scores ≥3 (P=0.105). Irritant score correlated positively with symptom score (P=0.005), and the proportion of subjects with irritant scores ≥3 was greater in children with moderate-severe rhinitis than in those with mild rhinitis (P=0.046). Multiple logistic regression analysis indicated that the presence of atopic eczema increased the risk for sensitivity to a nonallergenic irritant (aOR=2.928, 95% CI 1.567-5.473, P=0.001).
CONCLUSIONS
Response to a nonallergenic irritant was useful for gauging the severity of rhinitis, but not for differentiating AR from NAR. AR and NAR patients with atopic eczema may increase nasal sensitivity to nonallergenic irritants.

Keyword

Allergic rhinitis; nonallergic rhinitis; irritant; atopic trait

MeSH Terms

Asthma
Child*
Dermatitis, Atopic
Humans
Immunoglobulin E
Irritants*
Logistic Models
Rhinitis*
Immunoglobulin E
Irritants

Figure

  • Fig. 1 Age distribution of subjects with allergic rhinitis and nonallergic rhinitis (A) and irritant rhinitis and nonirritant rhinitis (B). The percentage of children with allergic rhinitis increased with age (P=0.001), but that of those with irritant rhinitis did not (P=0.358).

  • Fig. 2 (A-F) Total symptom scores (left column) and irritant scores (right column) in response to 21 different nonallergenic irritants in children with allergic rhinitis and nonallergic rhinitis (A and B), mild rhinitis and moderate-severe rhinitis (C and D), and intermittent rhinitis and persistent rhinitis (E and F).

  • Fig. 3 Receiver operating characteristics (ROC) curve obtained from the sum of scores in response to 21 different nonallergenic irritants in the control and rhinitis groups. An irritant score between 2.5 and 3.5 provided the best compromise between sensitivity and (1-specificity) (sensitivity 68.8% and 51.2%, specificity 64.7% and 82.4%, respectively). Specificity was 94.1% at 4.5 points.


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