Allergic Rhinitis May Be Important in Snoring Infants

Abstract

We read with interest the article by Kalra et al, 1 Kalra M LeMasters G Bernstein D et al. Atopy as a risk factor for habitual snoring at age 1 year. Chest. 2006; : 942-946 Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar who found that the prevalence of habitual snoring for 1-year-old children was 15% in a high-risk group for atopy,ie, children born to atopic parents. This prevalence was significantly higher than that reported in older children, 10.9% in 6- to 12-year-old children in Hong Kong, 2 Ng DK Kwok KL Cheung JM et al. Prevalence of sleep problems in Hong Kong primary school children: a community-based telephone survey. Chest. 2005; 128: 1315-1323 Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar and 10 to 14% in < 6-year-olds in Europe and the United States. 3 Young T Peppard PE Gottlieb DJ Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002; 162: 1217-1239 Crossref Scopus (3328) Google Scholar This higher prevalence is most likely due to the fact that 29% of this group of infants were atopic, and it is not surprising that Kalra et al 1 Kalra M LeMasters G Bernstein D et al. Atopy as a risk factor for habitual snoring at age 1 year. Chest. 2006; : 942-946 Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar found that the presence of atopy increased the risk of habitual snoring (odds ratio, 2.0; 95% confidence interval, 1.2 to 3.0), a common symptom of obstructive sleep apnea syndrome (OSAS). 4 Chau KW Ng DKK Kwok CKL et al. Clinical risk factors for obstructive sleep apnea in children. Singapore Med J. 2003; 44: 570-577 PubMed Google Scholar This was similar to previous findings in Hong Kong, 2 Ng DK Kwok KL Cheung JM et al. Prevalence of sleep problems in Hong Kong primary school children: a community-based telephone survey. Chest. 2005; 128: 1315-1323 Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar when we found allergic rhinitis to be a significant risk factor for witnessed apnea with an adjusted odds ratio of 2.19, another symptom of OSAS as well as in the United States. 5 McColley SA Carroll JL Curtis S et al. High prevalence of allergic sensitization in children with habitual snoring and obstructive apnea. Chest. 1997; 111: 170-173 Abstract Full Text Full Text PDF PubMed Scopus (172) Google Scholar It is unfortunate that Kalra et al 1 Kalra M LeMasters G Bernstein D et al. Atopy as a risk factor for habitual snoring at age 1 year. Chest. 2006; : 942-946 Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar did not report the prevalence of nasal symptoms in their cohort, as the data would have shed light on the mechanisms that link habitual snoring and atopic status, possibly allergic rhinitis. Other important data that were not reported were the parts played by individual allergens, especially the airborne allergens vs food allergen. These data would help determine whether the inhaled route or the ingested route is important in the habitual snoring infants. In the study of Kalra et al, 1 Kalra M LeMasters G Bernstein D et al. Atopy as a risk factor for habitual snoring at age 1 year. Chest. 2006; : 942-946 Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar the definition of positive atopic status for egg white and whole milk was wheal ≥ 3 cm than the negative control, and this would be associated with a high false-positive rate. 6 Sporik R Hill DJ Hosking CS Specificity of allergen skin testing in predicting open food challenges to milk, egg and peanut in children. Clin Exp Allergy. 2000; 30: 1495-1498 Crossref PubMed Scopus (472) Google Scholar ResponseCHESTVol. 131Issue 1PreviewWe thank Ng et al for their interest in our article.1They raise concern about lack of data on nasal symptoms and our definition for positive skin-prick test results. Using the rhinitis definition of a positive parent report to the question “In the past 12 months, has your child ever had a problem with sneezing, or a runny, or a blocked nose when he/she did not have a cold or flu?” we found a strong association between rhinitis and habitual snoring (p < 0.001) in our cohort of 681 infants. In multivariate logistic regression model with habitual snoring as the dependent variable, the adjusted odds ratio for rhinitis was 2.5 (confidence interval, 1.7 to 4.0) and atopy (defined as positive skin-prick test result to an aeroallergen or food allergen was 1.9 (confidence interval, 1.2 to 2.9). Full-Text PDF