Advertisement

Natural course and comorbidities of allergic and nonallergic rhinitis in children

Published:November 07, 2011DOI:https://doi.org/10.1016/j.jaci.2011.09.036

      Background

      Not much data are available from large, unselected, birth cohort studies on the natural course and comorbidities of rhinitis in children.

      Objective

      To study phenotypes of rhinitis in relation to the natural course and comorbidities of allergic diseases in preschool-age and early school-age children.

      Methods

      We analyzed data from a birth cohort of 2024 children, for whom information on IgEs against 8 common inhaled allergens was available, collected at age 4 and 8 years. The children were assigned to groups of allergic rhinitis (rhinitis with sensitization to allergens), nonallergic rhinitis (rhinitis without sensitization), allergic sensitization but no rhinitis, or neither rhinitis nor sensitization.

      Results

      The proportion of children with allergic rhinitis increased from 5% to 14% from age 4 to 8 years, whereas the proportion of children with nonallergic rhinitis decreased slightly over the same period of development, from 8% to 6%. Of the children with allergic rhinitis when they were 4 years old, 12% underwent remission by the time they were 8 years old; of the children with nonallergic rhinitis, 73% underwent remission during this period of development. Among 4-year-olds without rhinitis who were sensitized to allergen, 56% had allergic rhinitis when they were 8 years old. Among 4- and 8-year-olds, allergic rhinitis and nonallergic rhinitis were associated with asthma, eczema, and food hypersensitivity. Twenty-five percent of 8-year-olds with allergic rhinitis also had oral allergy syndrome.

      Conclusions

      Fewer preschool-age children with allergic rhinitis undergo remission than do those with nonallergic rhinitis. Sensitization to inhaled allergens at an early age (4 years) precedes the development of allergic rhinitis, whereas symptoms of rhinitis do not. Oral allergy syndrome is common among 8-year-olds with allergic rhinitis.

      Key words

      Abbreviations used:

      BAMSE (Barn/Children, Allergy/Asthma, Milieu, Stockholm, Epidemiologic), ISAAC (International Study of Asthma and Allergy in Childhood), ISAAC-RC (Rhinoconjunctivitis according to the ISAAC definition), OAS (Oral allergy syndrome)
      To read this article in full you will need to make a payment

      References

        • Bousquet J.
        • Khaltaev N.
        • Cruz A.A.
        • Denburg J.
        • Fokkens W.J.
        • Togias A.
        • et al.
        Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen).
        Allergy. 2008; 63: 8-160
        • Asher M.I.
        • Montefort S.
        • Bjorksten B.
        • Lai C.K.
        • Strachan D.P.
        • Weiland S.K.
        • et al.
        Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC phases one and three repeat multicountry cross-sectional surveys.
        Lancet. 2006; 368: 733-743
        • Keil T.
        • Bockelbrink A.
        • Reich A.
        • Hoffmann U.
        • Kamin W.
        • Forster J.
        • et al.
        The natural history of allergic rhinitis in childhood.
        Pediatr Allergy Immunol. 2010; 21: 962-969
        • Kulig M.
        • Klettke U.
        • Wahn V.
        • Forster J.
        • Bauer C.P.
        • Wahn U.
        Development of seasonal allergic rhinitis during the first 7 years of life.
        J Allergy Clin Immunol. 2000; 106: 832-839
        • Bousquet J.
        • Fokkens W.
        • Burney P.
        • Durham S.R.
        • Bachert C.
        • Akdis C.A.
        • et al.
        Important research questions in allergy and related diseases: nonallergic rhinitis: a GA2LEN paper.
        Allergy. 2008; 63: 842-853
        • Canonica G.W.
        • Bousquet J.
        • Mullol J.
        • Scadding G.K.
        • Virchow J.C.
        A survey of the burden of allergic rhinitis in Europe.
        Allergy. 2007; 62: 17-25
        • Meltzer E.O.
        • Blaiss M.S.
        • Derebery M.J.
        • Mahr T.A.
        • Gordon B.R.
        • Sheth K.K.
        • et al.
        Burden of allergic rhinitis: results from the Pediatric Allergies in America survey.
        J Allergy Clin Immunol. 2009; 124: S43-S70
        • Bertelsen R.J.
        • Carlsen K.C.
        • Carlsen K.H.
        Rhinitis in children: co-morbidities and phenotypes.
        Pediatr Allergy Immunol. 2010; 21: 612-622
        • Bousquet J.
        • Van Cauwenberge P.
        • Khaltaev N.
        Allergic rhinitis and its impact on asthma.
        J Allergy Clin Immunol. 2001; 108: S147-S334
        • Chawes B.L.
        • Bonnelykke K.
        • Kreiner-Moller E.
        • Bisgaard H.
        Children with allergic and nonallergic rhinitis have a similar risk of asthma.
        J Allergy Clin Immunol. 2010; 126: 567-573.e8
        • Shaaban R.
        • Zureik M.
        • Soussan D.
        • Neukirch C.
        • Heinrich J.
        • Sunyer J.
        • et al.
        Rhinitis and onset of asthma: a longitudinal population-based study.
        Lancet. 2008; 372: 1049-1057
        • Bohle B.
        The impact of pollen-related food allergens on pollen allergy.
        Allergy. 2007; 62: 3-10
        • Eriksson N.E.
        • Formgren H.
        • Svenonius E.
        Food hypersensitivity in patients with pollen allergy.
        Allergy. 1982; 37: 437-443
        • Katelaris C.H.
        Food allergy and oral allergy or pollen-food syndrome.
        Curr Opin Allergy Clin Immunol. 2010; 10: 246-251
        • Vieths S.
        • Scheurer S.
        • Ballmer-Weber B.
        Current understanding of cross-reactivity of food allergens and pollen.
        Ann N Y Acad Sci. 2002; 964: 47-68
        • Wickman M.
        • Kull I.
        • Pershagen G.
        • Nordvall S.L.
        The BAMSE project: presentation of a prospective longitudinal birth cohort study.
        Pediatr Allergy Immunol. 2002; 13: 11-13
        • Wickman M.
        • Lilja G.
        • Soderstrom L.
        • van Hage-Hamsten M.
        • Ahlstedt S.
        Quantitative analysis of IgE antibodies to food and inhalant allergens in 4-year-old children reflects their likelihood of allergic disease.
        Allergy. 2005; 60: 650-657
        • Ostblom E.
        • Lilja G.
        • Ahlstedt S.
        • van Hage M.
        • Wickman M.
        Patterns of quantitative food-specific IgE-antibodies and reported food hypersensitivity in 4-year-old children.
        Allergy. 2008; 63: 418-424
        • Marinho S.
        • Simpson A.
        • Lowe L.
        • Kissen P.
        • Murray C.
        • Custovic A.
        Rhinoconjunctivitis in 5-year-old children: a population-based birth cohort study.
        Allergy. 2007; 62: 385-393
        • Bachert C.
        • van Cauwenberge P.
        • Olbrecht J.
        • van Schoor J.
        Prevalence, classification and perception of allergic and nonallergic rhinitis in Belgium.
        Allergy. 2006; 61: 693-698
        • Molgaard E.
        • Thomsen S.F.
        • Lund T.
        • Pedersen L.
        • Nolte H.
        • Backer V.
        Differences between allergic and nonallergic rhinitis in a large sample of adolescents and adults.
        Allergy. 2007; 62: 1033-1037
        • Settipane R.A.
        • Charnock D.R.
        Epidemiology of rhinitis: allergic and nonallergic.
        Clin Allergy Immunol. 2007; 19: 23-34
        • Bodtger U.
        • Poulsen L.K.
        • Linneberg A.
        Rhinitis symptoms and IgE sensitization as risk factors for development of later allergic rhinitis in adults.
        Allergy. 2006; 61: 712-716
        • Rondon C.
        • Dona I.
        • Torres M.J.
        • Campo P.
        • Blanca M.
        Evolution of patients with nonallergic rhinitis supports conversion to allergic rhinitis.
        J Allergy Clin Immunol. 2009; 123: 1098-1102
        • Huggins K.G.
        • Brostoff J.
        Local production of specific IgE antibodies in allergic-rhinitis patients with negative skin tests.
        Lancet. 1975; 2: 148-150
        • Powe D.G.
        • Bonnin A.J.
        • Jones N.S.
        “Entopy”: local allergy paradigm.
        Clin Exp Allergy. 2010; 40: 987-997
        • Rondon C.
        • Canto G.
        • Blanca M.
        Local allergic rhinitis: a new entity, characterization and further studies.
        Curr Opin Allergy Clin Immunol. 2010; 10: 1-7
        • Penard-Morand C.
        • Raherison C.
        • Kopferschmitt C.
        • Caillaud D.
        • Lavaud F.
        • Charpin D.
        • et al.
        Prevalence of food allergy and its relationship to asthma and allergic rhinitis in schoolchildren.
        Allergy. 2005; 60: 1165-1171
        • Guerra S.
        • Sherrill D.L.
        • Martinez F.D.
        • Barbee R.A.
        Rhinitis as an independent risk factor for adult-onset asthma.
        J Allergy Clin Immunol. 2002; 109: 419-425