Allergy Asthma Immunol Res.  2020 Jan;12(1):72-85. 10.4168/aair.2020.12.1.72.

Risk Factors and Comorbidities Associated With the Allergic Rhinitis Phenotype in Children According to the ARIA Classification

  • 1Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 2Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 3Department of Pediatrics, Mediplex Sejong Hospital, Incheon, Korea.
  • 4Department of Pediatrics, International St. Mary's Hospital, Catholic Kwandong University Hospital, Incheon, Korea.
  • 5Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
  • 6Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
  • 7Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 8Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Ilsan, Korea.
  • 9Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
  • 10Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, Korea.
  • 11Department of Pediatrics, The Catholic University of Korea College of Medicine, Daejeon, Korea.
  • 12Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea.
  • 13Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea.
  • 14Department of Pediatrics, Gwangju Veterans Hospital, Gwangju, Korea.
  • 15Department of Pediatrics, Catholic University of Daegu School of Medicine, Deagu, Korea.
  • 16Department of Pediatrics, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
  • 17Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea.
  • 18Department of Pediatrics, Health Science Institute, Gyeongsang National University College of Medicine, Jinju, Korea.
  • 19Division of Allergy and Chronic Respiratory Diseases, Center for Biomedical Sciences, Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea.
  • 20Korea Institute of Child Care and Education, Seoul, Korea.


Data are lacking on the association between the allergic rhinitis (AR) phenotype and sensitization to specific allergens or bronchial hyperresponsiveness (BHR) in children. We here investigated risk factors and comorbidities, including sensitization to specific allergens and BHR, for the AR phenotype by AR and its Impact on Asthma (ARIA) classification in a general population-based birth cohort study.
We enrolled 606 children aged 7 years from the Panel Study of Korean Children. The AR phenotype was assigned in accordance with the ARIA classification in children. Skin prick tests and Provocholine provocation test were performed. Risk factors and comorbidities for AR phenotypes were then analyzed.
The prevalence of mild and moderate to severe AR in our study cohort was 37.2% and 8.8%, respectively. Recent use of analgesics or antipyretics and current cat ownership were associated with the risk of mild persistent AR. Sensitizations to Dermatophagoides Pteronyssinus (Der p), Japanese hop and cat were associated with moderate to severe persistent AR. Children with moderate to severe AR had a higher risk of current asthma and BHR compared to mild AR cases (adjusted odds ratio [aOR], 5.26; 95% confidence interval [CI], 1.77-15.62). Moderate to severe AR with allergic sensitization was associated with the highest risk of BHR (aOR, 11.77; 95% CI, 3.40-40.74).
Moderate to severe-persistent AR is more closely related to respiratory comorbidities and sensitizations than mild AR. Stratifying the AR phenotype by ARIA classification may assist in disease management.


Allergic rhinitis; classification; risk factor; child; phenotype; bronchial hyperreactivity; cohort study; prevalence

MeSH Terms

Asian Continental Ancestry Group
Bronchial Hyperreactivity
Cohort Studies
Dermatophagoides pteronyssinus
Disease Management
Methacholine Chloride
Odds Ratio
Rhinitis, Allergic*
Risk Factors*
Methacholine Chloride


  • Fig. 1 Flow chart of the study subjects. PSKC, Panel Study on Korean Children; AR, allergic rhinitis; ARIA, Allergic Rhinitis and its Impact on Asthma.

  • Fig. 2 Prevalence of AR in 7-year-old children according to their Allergic Rhinitis and its Impact on Asthma classification. AR, allergic rhinitis.

  • Fig. 3 Adjusted odds ratio and 95% confidence intervals for the risk of bronchial hyperresponsiveness according to the AR phenotype by Allergic Rhinitis and its Impact on Asthma classification. AR, allergic rhinitis.


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