Allergy Asthma Immunol Res.  2017 Jan;9(1):70-78. 10.4168/aair.2017.9.1.70.

Comorbidities and Phenotypes of Rhinitis in Korean Children and Adolescents: A Cross-sectional, Multicenter Study

• Lee KS
• Yum HY
• Sheen YH
• Park YM
• Lee YJ
• Choi BS
• Jee HM
• Choi SH
• Kim HH
• Park Y
• Kim HB
• Rha YH
• Korean Academy of Pediatric Allergy and Respiratory Disease (KAPARD) Work Group on Rhinitis

• KMID: 2355896
• DOI: http://doi.org/10.4168/aair.2017.9.1.70

Abstract

PURPOSE
Rhinitis is a nasal inflammatory disease in children and adolescents. However, little is known about the phenotypes and characteristics of allergic rhinitis (AR) in Korean children and adolescents. The objective of this study was to analyze the symptoms and comorbidities of rhinitis, to compare AR to non-allergic rhinitis (NAR), and to reveal the phenotypes and features of AR in a Korean pediatric population.
METHODS
Patients under 18 years of age with rhinitis symptoms were recruited from January 2013 to January 2015 by pediatric allergists. We analyzed symptoms, phenotypes, comorbidities, and allergen sensitization in this cross-sectional, multicenter study.
RESULTS
Medical records were collected from 11 hospitals. The AR group has 641 (68.3%) patients, with 63.2% of boys and 7.5 (±3.4) years of mean age. The NAR group has 136 (14.5%) patients, with 55.1% of boys and 5.5 (±2.9) years of mean age. Moderate-severe persistent AR affected 41.2% of AR patients. Nasal obstruction was more common in NAR patients (P<0.050), whereas AR patients sneezed more (P<0.050) and more commonly had conjunctivitis, asthma, and otitis media (P<0.050). Sinusitis was the most common comorbidity in both groups. Allergen sensitization was caused by house dust mites (HDMs) (90.2%), pollen (38.7%), and animal dander (24.8%) in AR patients. Pollen and animal dander sensitization significantly increased age-dependently (P<0.050), but 91.9% of AR patients were already sensitized to HDMs before 5 years old.
CONCLUSIONS
Our study revealed that AR was more prevalent than NAR and that 41.2% of AR presented with moderate-severe disease in Korean pediatric populations. Sinusitis was the most common comorbidity, and sleep disturbance was associated with the severity of rhinitis. The majority of AR patients were sensitized to HDMs in preschool ages. Further studies, including nationwide and longitudinal data, will help understand the relationship between these diseases.

Keyword

Rhinitis; allergic rhinitis; children; comorbidity; phenotype

MeSH Terms

Adolescent*
Animals
Asthma
Child*
Comorbidity*
Conjunctivitis
Dander
Humans
Medical Records
Nasal Obstruction
Otitis Media
Phenotype*
Pollen
Pyroglyphidae
Rhinitis*
Rhinitis, Allergic
Sinusitis

Figure

• 

  Fig. 1 Frequency distribution of rhinitis in Korean children and adolescents. (A) The mean age of rhinitis patients is 6.7 (±3.4) at the time of presentation. The peak age is 5. The number of children who visit hospitals between ages 4 to 8 is higher than for other ages. (B) The number of patients with AR is higher than NAR at all ages. AR represents more than 70% of all cases ≥6 years. AR is also higher among those ≤1 year old. (C) Rhinitis patients visit mainly in the winter, and the peak month is January with fewer in the summer (June-August). (D) The percentage of patients with AR is higher than 50% regardless of season.

• 

  Fig. 2 Frequency of rhinitis symptoms. (A) Presence of all symptoms (rhinorrhea, sneezing, nasal obstruction, and nasal itching) is the most common pattern in children with AR (32.2%). Sneezing only is the least common AR patients' symptom (0.3%). (B) Presence of all symptoms (rhinorrhea, sneezing, nasal obstruction, and nasal itching) is also the most common pattern in children with NAR (36.4%). 4 AR and 4 NAR patients were excluded due to absence of symptoms' description.

• 

  Fig. 3 Frequency of allergen sensitization. Many allergic rhinitis patients have multiple allergen sensitizations. Some patients are sensitive to all kinds of allergens, which are house dust mites, animal dander, and pollen (9.0%). Sensitization to house dust mites only is the most common pattern (50.7%). The least is the co-occurrence of sensitization to animal dander and pollen (1.7%).

• 

  Fig. 4 Change of the prevalence of allergen sensitization in AR patients. (A) This graph contains all cases, including NAR and non-test groups. Types of sensitized allergens vary according to the ages of the children. For house dust mites, 64.1% of children ≤5 years old are sensitized and there is a plateau of the sensitized rate at 6-11 years old (P<0.05). The percentage sensitized to pollen rapidly increases in patients ≥12 years old (16.6% to 54.9%) (P<0.050). The number sensitive to animal dander gradually increases at 6-11 years old (P<0.05). There is an increase in the number of all-allergen sensitized patients from ≤5 years old to ≥12 years old (P<0.050). (B) This graph only includes the AR group. Types of sensitized allergens varies according to the ages of the children. For house dust mites, 91.9% of patients ≤5 years old are sensitized. The number then significantly decreases to 82.6% for patients ≥12 years old (P<0.050). The number of patients sensitized to pollen swiftly increases to 55.5% among those ≥12 years old (P<0.050). There is also an increase in numbers for sensitivity to animal dander, but the percentage reaches a plateau at 6-11 years old (P<0.05). The number of all-allergen sensitized patients increases from ≤5 years old to ≥12 years old (P<0.050). *P<0.005.

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