Rhinitis Phenotypes Research Articles

Investigation of the diagnostic accuracy of basophil activation test for allergic phenotypes of rhinitis.

Basophil activation test (BAT) might be an alternative to nasal allergen challenge (NAC) to identify the allergic etiology in rhinitis patients. Here, we investigate the diagnostic performance of BAT for allergic phenotypes of rhinitis. Rhinitis patients and healthy controls were subjected to NAC with Dermatophagoides pteronyssinus (DP), Alternaria alternata (AA), grass (GP) and olive (OP) pollens. Rhinitis subjects also underwent skin prick test (SPT) with relevant allergens. Patients were classified into allergic rhinitis (AR, positive NAC and SPT), local allergic rhinitis (LAR, positive NAC and negative SPT), dual allergic rhinitis (DAR, defined as AR for ≥1 allergen and LAR for ≥1 allergen), and non-allergic rhinitis (NAR, negative NAC and SPT) phenotypes. BAT with DP, AA, GP and OP was conducted in study individuals and compared with NAC results. A total of 47 AR, 31 DAR, 26 LAR, 12 NAR and 21 control subjects were recruited. The best positivity cut-offs of BAT for DP-, AA-, GP- and OP-driven allergy (all phenotypes) were a %CD63 cells of 8.650, 14.250, 26.200, and 12.780, respectively (AUC 0.851, 0.701, 0.887, and 0.921, respectively). Sensitivity, specificity, negative and positive predictive values of BAT (all phenotypes) ranged 43.5%(AA)-83.3%(OP), 88.9%(GP)-100%(AA), 87%(GP)-100%(AA), and 61.1%(DP)-80.0%(pollens), respectively. BAT identified 79%-100% of SPT-positive allergies (AR and DAR), and 25%-75% of SPT-negative allergies (LAR and DAR), while ≤10% of NAR/HC subjects tested positive. BAT positivity correlated with rhinitis severity in LAR patients (p = 0.018), and associated with conjunctivitis (p = 0.015) in allergic subjects. BAT can replace NAC for AR confirmation, and limit the number of NAC required for LAR and DAR diagnosis. BAT can demonstrate sIgE in SPT-negative allergies.

Analyzing Phenotypes Post-Exposure in Allergic Rhinitis (APPEAR) in the Environmental Exposure Unit (EEU).

Previous studies have defined clinical phenotypes of allergic rhinitis (AR) after allergen exposure using the time course of the total nasal symptom score (TNSS). We aimed to validate previously proposed AR phenotypes across different allergens (birch, grass, ragweed, house dust mite) following exposure in the Environmental Exposure Unit (EEU). The Analyzing Phenotypes Post-Exposure in Allergic Rhinitis (APPEAR) database comprises 153 participants from EEU studies conducted between 2010-2021 by Kingston Allergy Research. TNSS, nasal congestion symptom scores, and percent change in peak nasal inspiratory flow from baseline (%ΔPB) were recorded for each participant. Participants were phenotyped using previously described criteria RESULTS: 65 participants (42.5%) were classified as Early-phase Responders (EPR), 58 (37.9%) as Protracted Early-phase Responders (pEPR), 13 (8.5%) as Dual Responders (DR), and 17 (11.1%) as Low Responders (LoR). Significant negative correlations exist between TNSS and %ΔPB (r = -0.99, p<0.0001), and nasal congestion symptom score and %ΔPB (r = -0.99, p<0.0001). At the beginning of the late-phase AR response (6 to 7 hours), pEPRs had significantly higher TNSS compared to EPRs, DRs, and LoRs (p<0.0001). By the end of the study (up to 12 hours), DRs and pEPRs had significantly higher TNSS compared to EPRs and LoRs (p<0.0001). Visible and statistical validity between the phenotypes were also confirmed by assessing participants' mean TNSS and mean %ΔPB over time when grouping by phenotype. This study confirms distinct phenotypes exist in the late-phase AR response amongst different allergens and in a greater sample size than described previously, which could provide clinical benefit.

Clinical and molecular analysis of longitudinal rhinitis phenotypes in an urban birth cohort

BackgroundChronic rhinitis symptoms cause significant health burden among children and can have a heterogeneous presentation. Defining phenotypes of childhood chronic rhinitis and associated pathobiology may lead to prevention or improved treatments. ObjectivesTo identify longitudinal patterns of rhinitis symptoms in childhood and determine their associations with early life risk factors, allergic comorbidities, and nasal epithelial cell gene expression. MethodsChronic rhinitis symptoms were evaluated from ages 1 through 11 years in 485 urban children at high risk for allergic disease in the Urban Environment and Childhood Asthma (URECA) birth cohort. We identified longitudinal rhinitis phenotypes and their relationships to early life exposures, atopic comorbidities, and patterns of nasal epithelial gene expression at age 11 years. ResultsChronic rhinitis symptoms started early in many children and were a risk factor for developing aeroallergen sensitization. We identified four longitudinal rhinitis phenotypes: low/minimal disease, persistent, persistent decreasing, and late increasing. Persistent rhinitis was most closely linked to allergic sensitization and asthma. Risk factors for persistent rhinitis included frequent colds (p<0.001), antibiotic use (p<0.001), and reduced exposure to common indoor aeroallergens (p=0.003). Compared to low/minimal disease, rhinitis phenotypes were associated with increased expression of canonical Type 2 genes and decreased expression of immune response genes. ConclusionsIn urban children, rhinitis symptoms often precede aeroallergen sensitization. Rhinitis phenotypes based on symptoms had distinct risk factors and nasal transcriptome. These results suggest that focusing on early life risk factors and distinct immune mechanisms may be a target to preventing chronic rhinitis in childhood.

ОЦЕНКА ИНТЕРЛЕЙКИНОВОГО ПРОФИЛЯ В НАЗАЛЬНЫХ СМЫВАХ У ДЕТЕЙ С АЛЛЕРГИЧЕСКИМ РИНИТОМ

Allergic rhinitis is one of the most urgent problems of allergology and immunology, since, despite the improvement of therapeutic and diagnostic approaches, the number of patients remains very significant. Allergic pathologies of various types occur in 25-30% of children. Allergic rhinitis is based on a multifactorial chronic inflammatory process of the nasal mucosa, which causes the presence of constant persistent inflammation and the progression of the disease, especially in childhood. Biological inflammatory mediators in nasal flushes help to determine the pathophysiological phenotypes of allergic rhinitis, which is of undoubted interest. The work carried out the determination of the level of cytokines: IL 1b, IL 4, IL 6, IL 10 and interferon gamma in nasal flushes in patients with allergic rhinitis, depending on the presence or absence of changes in the nasal mucosa based on rhinoscopy during diagnosis verification. Changes in the nasal mucosa directly depend on the production of cytokines, which form individual phenotypes of the disease. According to the results of the analysis, the data obtained are associated with the presence of persistent allergic inflammation, neurohumoral and anti-infectious, which make a significant contribution to the clinical manifestations of the disease. The study of the role and significance of the proliferation of major cytokines in the nasal secretion will help the practitioner in determining treatment tactics, duration of therapeutic and preventive measures and further marching of the patient.

Dependence of hematological parameters on the microbiota of the nasal mucosa in chronic rhinitis

Relevance. Chronic rhinitis is one of the most common otorhinolaryngological diseases. We assume that dysbiosis of the nasal mucosa depends on the phenotype of chronic rhinitis and affects hematological characteristics.&#x0D; Aim. Study of the hematological parameters dependence from the microbiota of the nasal mucosa in patients with various forms of chronic rhinitis.&#x0D; Material and methods. The examination groups included 45 patients with chronic allergic rhinitis (CAlR), 49 patients with chronic vasomotor rhinitis (CVR), 32 patients with chronic atrophic rhinitis (CAR), 39 patients with chronic infectious rhinitis (CIR) and 40 people from the control group. The subjects with chronic rhinitis, as well as the control group, underwent bacteriological examination of the nasal mucosa and assessment of hematological parameters. Statistical analysis was carried out using the Statistica 10 package.&#x0D; Results. The microbiome of the nasal mucosa is characterized by 100% infection with infectious agents in CIR, while fungal flora was detected in 1/3 of cases. The microbiological features of the nasal mucosa in CVR corresponded to the control, in CAR rhinitis - predominantly the growth of Klebsiella spp., in CIR - Staphylococcus spp., Streptococcus spp., Neisseriae spp., Escherichia spp. Hematological features manifested themselves depending on the form of chronic rhinitis. The greatest number of changes in blood parameters is found in CIR and CAR, less in CAlR, no changes were detected in CVR. The greatest dysbiosis of the nasal mucosa in CIR, the abundant growth of microorganisms of the genus Klebsiella spp in CAR corresponds to the largest number of changes in hematological parameters, and CVR is characterized by the absence of changes in hematological parameters, despite the fact that the microbiological characteristics of the nasal mucosa corresponded to the control.&#x0D; Conclusion. The microbiota of the nasal mucosa in healthy people and patients from the groups with CAlR, CVR and CAR is represented by a combination of coccal and rod-shaped flora, with the exception of CIR, in which representatives of the fungal flora are identified. Pathogenetically significant is the identification of representatives of Staphylococcus spp., Streptococcus spp., Neisseriae spp., Escherichia spp. in CIR, and Klebsiella spp. in CAR. Most hematological changes are detected in chronic atrophic and infectious rhinitis.

Rhinitis Phenotypes Based on Multimorbidities

Chronic allergic and nonallergic rhinitis are common phenotypes of a highly prevalent disorder of the upper airways, often associated with asthma.1 Clinical data, epidemiologic studies, and mHealth-based and genomic approaches indicate the existence of 2 distinct diseases: rhinitis alone and rhinitis+ asthma, which may be allergic or less often nonallergic. Both disease phenotypes need to be further characterized, because allergic conjunctivitis, food allergy, and atopic dermatitis, often present in patients with allergic rhinitis, may be considered as independent multimorbidities. Thus, the concept "multimorbid allergic disease" is more appropriate than "one-airway-one-disease." In a meta-analysis, atopic dermatitis was strongly associated with allergic and nonallergic rhinitis, but not with rhinitis and asthma.2 Asthma alone may also be associated with non-type 2 mechanisms.3 The distinction between rhinitis alone and rhinitis and asthma was found in all the 12 countries studied using an mHealth app (MASK-air) in Europe and Latin America. These data indicate that the distinction between the 2 diseases is independent of allergen exposure.4.

Allergic rhinitis phenotypes with distinct transcriptome profiles in children: A birth cohort

Allergic rhinitis (AR) phenotypes in childhood are unclear. This study sought to determine AR phenotypes and investigate their natural course and clinical and transcriptomic characteristics. Latent class trajectory analysis was used for phenotyping AR in 1050 children from birth through 12 years using a birth cohort study. Blood transcriptome analyses were performed to define the underlying mechanisms of each phenotype. Five AR phenotypes were identified: early onset (n= 88, 8.4%), intermediate transient (n= 110, 10.5%), late onset (n= 209, 19.9%), very late onset (n=187, 17.8%), and never/infrequent (n= 456, 43.4%). Children with early-onset AR were associated with higher AR severity and sensitizations to foods at age 1 year and inhalants at age 3 years and asthma symptoms, but not with bronchial hyperresponsiveness (BHR). Children with late-onset AR phenotype associated with sensitizations to various foods at age 1 year but not from age 3 years, and to inhalants from age 7 years and with asthma with BHR. Children with very late-onset AR phenotype associated with sensitizations to foods throughout preschool age and to inhalants at ages 7 and 9 years and with asthma with BHR. Transcriptome analysis showed that early-onset AR was associated with viral/bacterial infection-related defense response, whereas late-onset AR was associated with T cell-related immune response. Early-onset AR phenotype was associated with sensitization to foods and inhalants at an early age and asthma symptoms, but not with BHR, whereas very late- and late-onset AR phenotypes were positively associated with sensitization to inhalants and asthma with BHR. Transcriptomic analyses indicated that early- and late-onset AR phenotypes had distinct underlying mechanisms related to AR as well.

Markers of eosinophilic airway inflammation in patients with asthma and allergic rhinitis.

Background: Measurement of airway inflammation is an important step to determine phenotype of asthma and allergic rhinitis (AR). Objective: To assess the level of nitric oxide in exhaled air (FeNO), nasal fraction of nitric oxide (nasal NO), their relationship with clinical control and blood eosinophils in patients with steroid-naive mild and moderate asthma and AR. Methods: One hundred forty-seven patients (65 men), ages 26-49.5 years (mean age, 32 years) with AR (n = 81) or AR and concomitant asthma (n = 46) and 20 healthy subjects were included in a single-center cohort study. All the patients underwent spirometry with reversibility test. Control of asthma and AR was assessed by using the Asthma Control Questionnaire and the visual analog scale, respectively. Levels of FeNO and nasal NO were measured by chemiluminescent analyzer, peripheral blood eosinophils were counted by automatic analyzer. Results: The FeNO level was significantly elevated in the patients with asthma and concomitant AR compared with the healthy subjects and was associated with control of both asthma and AR. There was no correlation between nasal NO and control of AR. Receiver operating characteristic analysis revealed that the level of eosinophils of 150 cells/μL may be a cutoff for lower airway eosinophilic inflammation. Blood eosinophils count was unable to distinguish eosinophilic and non-eosinophilic upper airway inflammation. Conclusion: We confirm that FeNO but not nasal NO is a marker of eosinophilic airway inflammation in patients with mild-moderate steroid-naive AR and concomitant asthma. A blood eosinophil level of ≥150 cells/µL may be a simple marker of eosinophilic airway inflammation in patients with asthma. However, its low specificity requires repeated measurements and use in combination with other biomarkers.

Trajectory analysis of rhinitis in a birth cohort from lower-income New York City neighborhoods

Rhinitis is a prevalent, chronic nasal condition associated with asthma. However, its developmental trajectories remain poorly characterized. We sought to describe the course of rhinitis from infancy to adolescence and the association between identified phenotypes, asthma-related symptoms, and physician-diagnosed asthma. We collected rhinitis data from questionnaires repeated across 22 time points among 688 children from infancy to age 11 years and used latent class mixed modeling (LCMM) to identify phenotypes. Once children were between ages 5 and 12, a study physician determined asthma diagnosis. We collected information on the following asthma symptoms: any wheeze, exercise-induced wheeze, nighttime coughing, and emergency department visits. For each, we used LCMM to identify symptom phenotypes. Using logistic regression, we described the association between rhinitis phenotype and asthma diagnosis and each symptom overall and stratified by atopic predisposition and sex. LCMM identified 5 rhinitis trajectory groups: never/infrequent; transient; late onset, infrequent; late onset, frequent; and persistent. LCMM identified 2 trajectories for each symptom, classified as frequent and never/infrequent. Participants with persistent and late onset, frequent phenotypes were more likely to be diagnosed with asthma and to have the frequent phenotype for all symptoms (P< .01). We identified interaction between seroatopy and rhinitis phenotype for physician-diagnosed asthma (P= .04) and exercise-induced wheeze (P= .08). Severe seroatopy was more common among children with late onset, frequent and persistent rhinitis, with nearly 25% of these 2 groups exhibiting sensitivity to 4 or 5 of the 5 allergens tested. In this prospective, population-based birth cohort, persistent and late onset, frequent rhinitis phenotypes were associated with increased risk of asthma diagnosis and symptoms during adolescence.

Exploring the latest understanding on the role of immune mediators, genetic and environmental factors in pathogenesis of allergic rhinitis: a systematic review.

Despite well-defined clinical phenotypes of chronic rhinitis, the underlying in-depth pathophysiological mechanism, particularly with reference to the involvement of immune mediators, genetic, and environmental factors, are still not fully understood. Therefore, our aim was to give updated information on the pathogenesis of allergic rhinitis (AR), with an emphasis on the role of cytokines in adults aged 18 years and above. Additionally, we investigated the impact of genetic and environmental factors in the pathogenesis of AR. A search in various databases identified 1,178 records, and 18 studies were ultimately selected from January 2018 to April 2023. The total sample size in our studies was 4,317, with 2,186 in the experimental and 2,131 in control groups, respectively. The mean age was 33.4 years, with 43% were male, while 57% were female. According to the selected studies, various factors, including immune mediators, particularly cytokines, genetic, and environmental factors, were identified in the development of AR. The selected studies presented findings on different factors and sub-factors in the pathogenesis of AR, making it a challenge for us to compare their results. However, based on our findings, researchers can link our identified factors to potential therapies for AR.

Distinction between rhinitis alone and rhinitis with asthma using interactomics

The concept of “one-airway-one-disease”, coined over 20 years ago, may be an over-simplification of the links between allergic diseases. Genomic studies suggest that rhinitis alone and rhinitis with asthma are operated by distinct pathways. In this MeDALL (Mechanisms of the Development of Allergy) study, we leveraged the information of the human interactome to distinguish the molecular mechanisms associated with two phenotypes of allergic rhinitis: rhinitis alone and rhinitis in multimorbidity with asthma. We observed significant differences in the topology of the interactomes and in the pathways associated to each phenotype. In rhinitis alone, identified pathways included cell cycle, cytokine signalling, developmental biology, immune system, metabolism of proteins and signal transduction. In rhinitis and asthma multimorbidity, most pathways were related to signal transduction. The remaining few were related to cytokine signalling, immune system or developmental biology. Toll-like receptors and IL-17-mediated signalling were identified in rhinitis alone, while IL-33 was identified in rhinitis in multimorbidity. On the other hand, few pathways were associated with both phenotypes, most being associated with signal transduction pathways including estrogen-stimulated signalling. The only immune system pathway was FceRI-mediated MAPK activation. In conclusion, our findings suggest that rhinitis alone and rhinitis and asthma multimorbidity should be considered as two distinct diseases.

Comparative characteristics of nasal mucosa microflora in various forms of chronic rhinitis

Dysbiosis of the nasal mucosa contributes to the development of secondary immune disorders, maladjustment and contributes to the development of pathological processes, regardless of the phenotype of chronic rhinitis. The aim of our work was to comparatively assess microbial species and quantitative composition as well as frequency of its occurrence in patients with various forms of chronic rhinitis. We present the results of a laboratory examination of patients with chronic rhinitis (79 subjects aged 18 to 70 years), including 20 patients with chronic allergic,20 with chronic vasomotor,18 with chronic atrophic,21 with chronic infectious rhinitis. The control group consisted of 40 apparently healthy donors. All patients underwent nasal mucosa bacteriological examination. Statistical analysis of the obtained results was carried out using the Statistica for Windows 8.0 software package (StatSoft Inc., USA,2008). Nonparametric KruskalWallis, MannWhitney, and Wilcoxon tests were used to assess differences in groups. The critical level of statistical significance in testing scientific hypotheses was considered equal to p 0.05. In the control group, microorganisms of the genera Staphylococcus, Streptococcus, Neisseria, Acinetobacter, Klebsiella, Proteus are detected in the microflora of the nasal mucosa, which do not cause pathological changes. An interesting fact is the detection of Proteus mirabilis and Acinetobacter baumannii in healthy volunteers in the absence of clinical manifestations of infection, which proves the possibility of coexistence with opportunistic flora while maintaining the immune system functionining. In chronic allergic rhinitis, microorganisms of the genera Staphylococcus, Streptococcus, Neisseria, Enterobacter, Сorynebacterium are detected. In chronic vasomotor rhinitis, representatives of the genera Staphylococcus, Streptococcus, Neisseria, Klebsiella are detected. In chronic atrophic rhinitis, representatives of the genera Staphylococcus, Streptococcus, Neisseria, Acinetobacter are detected, with a predominance of Klebsiella bacteria. In chronic infectious rhinitis, representatives of the genera Staphylococcus, Streptococcus, Neisseria, Acinetobacter, Escherichia, Enterobacter, Corynebacterium, Pseudomonas, Proteus, Candida are detected. The absence and/or decrease in the number of representatives of the normoflora was found identifying pathogenic and opportunistic bacteria. With inflammation in the mucous membrane of the nasal cavity, regardless of its etiology, there is a change in the microflora quantitative and species composition. The most pronounced dysbiosis of the nasal mucosa microflora was found in chronic infectious rhinitis.

Nasal allergen challenge (NAC): Practical aspects and applications from an EU/US perspective—a Work Group Report of the AAAAI Rhinitis, Rhinosinusitis and Ocular Allergy Committee

Nasal allergen challenge (NAC) is applied in a variety of settings (research centres, specialty clinics and hospitals) as a useful diagnostic and research tool. NAC is indicated for diagnosis of seasonal and perennial allergic rhinitis, local allergic rhinitis, occupational rhinitis, to design the composition of allergen immunotherapy in polysensitized patients and to investigate the physio-pathological mechanisms of nasal diseases. NAC is currently a safe and reproducible technique, although it is time and resource consuming. NAC can be performed by a variety of methods, but the lack of a uniform technique for performing and recording the outcomes, represents a challenge for those considering NAC as a clinical tool in the office. The availability of standardized allergens for NAC is also different in each country. The objective of this workgroup report is to review the current information about NAC, focusing on the practical aspects and application for diagnosis of difficult rhinitis phenotypes (e.g. local allergic rhinitis, occupational rhinitis), taking into account the particular context of practice in the United States and the European Union.

Comparison of Rhinitis Phenotypes with the Development of Asthma by Age 10 in an Urban Birth Cohort

The relationship between allergic rhinitis and asthma is well established. However, it is unclear how rhinitis phenotypes are related to asthma. This study examined the association between longitudinal patterns of childhood rhinitis and diagnosis of asthma in an urban birth cohort.

The Indispensable Nasal Decongestant: Patients’ Views and Perspectives on Nasal Decongestant Overuse

Rhinitis medicamentosa (RM) is a type of nonallergic rhinitis caused by prolonged use of nasal decongestants (NDs). Although it is a preventable phenotype of rhinitis, little is known about patients dealing with this condition. To gain a better understanding of patients' views and experiences of ND overuse, and potential facilitators and barriers to discontinue the overuse. We performed a qualitative study using in-depth semistructured interviews with 22 patients who have been using an ND on an almost daily basis for at least 6 months. The interviews were conducted face-to-face, audio-recorded, and transcribed verbatim. Data analysis followed the grounded theory approach. Interviewees described the large impact of nasal congestion on their daily lives. Despite efforts to try other treatment options, the ND was considered the only effective aid to resolve the troublesome symptom. Most participants were aware that the prolonged use was problematic, sometimes leading to hiding behavior in order to avoid criticism by others including their health professionals. Many participants expressed a strong will to discontinue. However, multiple barriers to withdrawal were identified including fear of surgery or the impact of withdrawal on sleep, lack of good alternatives, and negative experiences with past withdrawal attempts. Patients thus face a dilemma in which the barriers to withdrawal currently outweigh the possible benefits. The use of NDs is considered indispensable by many chronic users. The facilitators and barriers identified in this study provide opportunities to reduce the use of NDs and the prevalence of RM in the future.

Сlinical and allergological characteristics of chronic inflammatory diseases of the nose in patients with severe bronchial asthma receiving immunobiological therapy in the Sverdlovsk region

Introduction. Allergic rhinitis, chronic rhinosinusitis (with/without polyps) are chronic inflammatory diseases of the nose and often accompany asthma, aggravating its severity.Aim of the study. Тo determine the phenotypes, spectrum of sensitization and severity of chronic inflammatory diseases of the nose in patients with severe bronchial asthma receiving immunobiological therapy in the Sverdlovsk region.Materials and methods. The territorial register of adult patients with severe bronchial asthma (n = 85) who received immunobiological therapy in the Sverdlovsk region in October 2021 was analyzed. When diagnosing chronic inflammatory diseases of the nose, an examination by an otorhinolaryngologist and computed tomography of the paranasal sinuses were performed; were determined: the absolute number of blood eosinophils, specific IgE to inhaled allergens, including the FadiatopTM method; skin tests were performed; assessment of the severity of nasal symptoms was determined using the SNOT-22, VAS.Results. Chronic inflammatory diseases of the nose were reported in 89.4% of patients. Allergic rhinitis occurred in 54.1% of cases (n = 46). 54.3% (n = 25) were dominated by patients with a moderate course; severe course was observed in 28.3% of cases (n = 13). Allergic rhinitis in 92.3% of cases (n = 36) was accompanied by allergic asthma and in 71.4% (n = 10) – mixed. Sensitization to household allergens was more common, from seasonal allergens to tree pollen. Phadiatop was positive in all patients with allergic rhinitis and negative in patients with chronic rhinosinusitis with/without nasal polyps. Patients with chronic rhinosinusitis occurred in 35.3% of cases (n=30); nasal polyps were in 23.5% (n = 20). The highest rates of blood eosinophilia were in patients with concomitant chronic rhinosinusitis with nasal polyps – 920 cells/µl. This phenotype in 95% of cases was accompanied by non-allergic (eosinophilic) asthma.Conclusion. Severe bronchial asthma is almost always accompanied by chronic inflammatory diseases of the nose. Phadiatop shows its high informativeness in determining the phenotype of allergic rhinitis.

Rhinitis phenotypes and multimorbidities in the general population: the CONSTANCES cohort.

Scarce epidemiological studies have characterised allergic rhinitis (AR) and non-allergic rhinitis (NAR) in adults. In a population-based cohort, our aims were to 1) describe rhinitis, AR and NAR, and 2) explore how asthma and conjunctivitis may lead to the identification of novel rhinitis phenotypes. In this cross-sectional analysis, current rhinitis was defined as present in the last 12 months using a questionnaire from the French CONSTANCES cohort. Participants with current rhinitis reporting nasal allergies were considered as AR, otherwise as NAR. We described AR and NAR phenotypes, and their phenotypes including co-occurrence with ever-asthma and ever-conjunctivitis. Among the 20 772 participants included in this analysis (mean±sd age 52.6±12.6 years; 55.2% female), crude prevalences of AR and NAR were 28.0% and 10.9%. AR participants more frequently reported persistent rhinitis (31.6% versus 25.1%) and moderate-to-severe rhinitis (40.1% versus 24.2%) than NAR participants. Among AR or NAR participants, those with ever-asthma reported more moderate-to-severe rhinitis. Participants with AR, ever-asthma and ever-conjunctivitis had an earlier age of rhinitis onset, more severe rhinitis and higher eosinophil counts than participants in other groups. Results were replicated in another cohort. In this large population-based cohort, 40% reported current rhinitis, with a lower prevalence of moderate-to-severe rhinitis than in clinical practice. For the first time in a general adult population, we showed that AR and NAR alone or in combination with asthma or in combination with asthma and conjunctivitis are different phenotypes. These results provide new insights on how best to manage rhinitis and its multimorbidities.

Local allergic rhinitis in children: A systematic review.

Local allergic rhinitis (LAR) is a well-defined and reported phenotype in adults, but data is scarce for children and adolescents, and it is probably an undiagnosed and highly underestimated condition in childhood. The objectives of this systematic review were to identify original observational studies published on LAR in children and adolescents and to describe the prevalence and characteristics of this phenotype in the pediatric age group. A systematic search was performed in PubMed and EMBASE databases. The search was limited to publications on humans, written in English, published between January 1, 2000 and September 20, 2021. Participants had to be under 18 years old and with a diagnosis of LAR confirmed by nasal allergen provocation test (NAPT). Ten articles were identified. Despite the wide variability of protocols, prevalence rates ranged from 3.7 to 83.3% among children previously diagnosed as having nonallergic rhinitis, being markedly lower in Eastern countries (3.7-16.6%) when compared to Western countries (22.3-83.3%). To date, no relevant clinical characteristics capable of differentiating LAR patients from other childhood rhinitis phenotypes have been identified. LAR is an allergic rhinitis phenotype also found in children. Population and regional differences and differences in NAPT protocols may explain the heterogeneity in LAR prevalence rates observed in different parts of the world. In addition to clarifying this large discrepancy, longitudinal studies are also needed to assess the clinical characteristics of the LAR phenotype in the pediatric age group, and its stability into adulthood must be confirmed.

The prevalence of non‐allergic rhinitis phenotypes in the general population: A cross‐sectional study

BackgroundNon‐allergic rhinitis (NAR) can be subdivided into several phenotypes: rhinorrhea of the elderly, rhinitis medicamentosa, smokers', occupational, hormonal, drug‐induced, gustatory, and idiopathic rhinitis. There are two pathophysiological endotypes of NAR: inflammatory and neurogenic. Phenotypes may serve as an indicator of an underlying endotype and, therefore, help to guide the treatment. The prevalence of each phenotype in the general population is currently unknown.Methodology/PrincipalCross‐sectional questionnaire‐based study in the general population of the Netherlands.ResultsThe prevalence of chronic rhinitis in the general population was 40% (N = 558, of those, 65% had NAR and 28% AR, in 7% allergy status is unknown). Individuals with NAR (N = 363) had significantly more complaints in October–February. Those with AR (N = 159) had significantly more complaints in April–August. The most common NAR phenotypes were idiopathic (39%) and rhinitis medicamentosa (14%), followed by occupational (8%), smokers' (6%), hormonal (4%), gustatory (4%), and rhinorrhea of the elderly (4%). The least prevalent phenotype was drug induced (1%). Nineteen percent of the NAR group could not be classified into any of the phenotypes.ConclusionsThis is the first study to describe the prevalences of NAR phenotypes in the general population. AR and NAR have a distinct seasonality pattern with NAR being more prevalent in autumn/winter and AR in spring/summer. Our data on the prevalence of phenotypes may help clinicians to anticipate the type of patients at their clinic and help guide a tailored treatment approach. The high prevalence of rhinitis medicamentosa is alarming, since this is a potentially preventable phenotype.

Endotyping allergic rhinitis in children: A machine learning approach.

IntroductionThe diversity of allergic rhinitis (AR) phenotypes is particularly evident in childhood, suggesting the need to analyze and identify new approaches to capture such clinical heterogeneity. Nasal cytology (NC) is a very useful diagnostic tool for identifying and quantifying nasal inflammation. Data‐driven approaches such as latent class analysis (LCA) assign subjects to classes based on their characteristics. We hypothesized that LCA based on NC, including the assessment of neutrophils, eosinophils, and mast cells, may be helpful for identifying AR endotypes in children.MethodsA total of 168 children were enrolled. Sociodemographic characteristics and detailed medical history were obtained from their parents. All children performed NC and skin prick tests. LCA was applied for identifying AR endotypes based on NC, using the R package poLCA. All the statistical analyses were performed using R 4.0.5 software. Statistical significance was set at p ≤ .05.ResultsLCA identified two classes: Class 1 (n = 126, 75%): higher frequency of children with moderate/large number of neutrophils (31.45%); almost all the children in this class had no mast cells (91.27%) and Class 2 (n = 42, 25%): higher frequency of children with moderate/large number of eosinophils (45.24%) and moderate/large number of mast cells (50%).ConclusionsThe present study used a machine learning approach for endotyping childhood AR, which may contribute to improve the diagnostic accuracy and to deliver personalized health care in the context of precision medicine.