Abstract
BackgroundSeasonal Allergic Rhinitis (SAR) is a heterogeneous inflammatory disease. We hypothesized that a cluster analysis based on the evaluation of cytokines in nasal lavage (NL) could characterize distinctive SAR endotypes in children.MethodsThis cross-sectional study enrolled 88 children with SAR. Detailed medical history was obtained by well-trained physicians. Quality of life and sleep quality were assessed through standardized questionnaires [Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and Pittsburgh Sleep Quality Index (PSQI) respectively]. Children were grouped through K-means clustering using Interleukin (IL)-5, IL-17, IL-23, and Interferon (INF)-γ in NL.ResultsOut of the 88 patients enrolled, 80 were included in the cluster analysis, which revealed three SAR endotypes. Cluster 1 showed lower levels of IL-5 and IL-17 and intermediate levels of IL-23 and IFN-γ; Cluster 2 had higher levels of IL-5 and intermediate levels of IL-17, IL-23, and IFN-γ; Cluster 3 showed higher levels of IL-17, IL-23, and IFN-γ and intermediate levels of IL-5. Cluster 1 showed intermediate values of nasal pH and nasal nitric oxide (nNO), and a lower percentage of neutrophils at nasal cytology than Clusters 2 and 3. Cluster 2 had a lower level of nasal pH, a higher nNO, higher scores in the ocular domain of PRQLQ, and worse sleep quality than Clusters 1 and 3. Cluster 3 showed a higher percentage of neutrophils at nasal cytology than Clusters 1 and 2.ConclusionsOur study identified three endotypes based on the evaluation of cytokines in NL, highlighting that childhood SAR is characterized by heterogeneous inflammatory cytokines.
Highlights
The diversity of cytokines in nasal lavage (NL) fluid offers the opportunity of assessing the underpinning immune-inflammatory network of allergic rhinitis (AR) [1]
We show the results of the first phase of a cross-sectional study approved by the local Institutional Ethics Committee (Palermo 1, Italy, Approval Number: 10/2017)
Our findings highlight that childhood seasonal AR (SAR) is characterized by heterogeneous inflammatory cytokines
Summary
The diversity of cytokines in nasal lavage (NL) fluid offers the opportunity of assessing the underpinning immune-inflammatory network of allergic rhinitis (AR) [1] Measuring such mediators in NL may contribute to describing the mucosal activity profile [2] and gaining insight into the pathophysiologic processes [3]. Low levels of IFN-γ have been described in NL from children with SAR, indicating that the Th1 immune response in the nasal mucosa is reduced in these patients [8]. Overall, these data suggest that allergic inflammation is characterized by the activation of a complex immunological network, including a heterogeneous range of mediators. We hypothesized that a cluster analysis based on the evaluation of cytokines in nasal lavage (NL) could characterize distinctive SAR endotypes in children
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