Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
Am J Rhinol Allergy. 2011 Sep-Oct;25(5):327-32. doi: 10.2500/ajra.2011.25.3640.
Nonallergic rhinitis is a poorly understood entity, especially among pediatric patients.
The objective of this study was to identify clinical features that may distinguish phenotypes of allergic and nonallergic patients and to evaluate the usefulness of current diagnostic modalities.
We reviewed medical records for 151 pediatric patients with perennial rhinitis, evaluated in a multidisciplinary allergy and otolaryngology clinic. Results obtained by standard history, validated sinus and Nasal Quality of Life Survey (SN-5), epicutaneous allergy testing, acoustic rhinometry, and sinus CT were compared.
Nasal congestion was the most frequent primary presenting complaint (62%). Among subjects having a positive allergy test, associated eye symptoms were more frequent (p = 0.01) and responses to the SN-5 allergic domain were higher (p = 0.02). Sinus CT scores were similar among allergic and nonallergic subjects (median 7 and 8, respectively) and did not correlate with symptom scores (p = 0.6). Among nonallergic subjects, quality of life ratings weakly correlated with sinus CT scores (r = 0.4; p = 0.05). By rhinometry, absolute mean cross-sectional area was similar among allergic (0.32 cm(2)) and nonallergic (0.36 cm(2)) subjects and did not correlate with symptom scores (p = 0.8 for allergic and p = 0.6 for nonallergic subjects). Distinct groups of nonallergic patients including those with prominent conjunctival pruritus (n = 24), frequent cold symptoms (n = 3), and chronic sinus disease (n = 2) were observed.
It is difficult to distinguish allergic and nonallergic rhinitis in patients with perennial disease, but associated eye symptoms and questionnaire responses are predictive of allergy. Acoustic rhinometry and sinus CT suggest that physical obstruction and sinus disease are not related to nasal symptoms including, surprisingly, the sensation of congestion.
非过敏性鼻炎是一种尚未被充分认识的病症，尤其是在儿科患者中。
本研究旨在确定可能区分过敏性和非过敏性患者表型的临床特征，并评估当前诊断方法的有效性。
我们回顾了在多学科过敏和耳鼻喉科诊所就诊的 151 例常年性鼻炎儿科患者的病历。比较了标准病史、经验证的鼻窦和鼻生活质量调查（SN-5）、皮内过敏试验、声鼻反射测量和鼻窦 CT 获得的结果。
鼻塞是最常见的主要首发症状（62%）。在过敏检测阳性的患者中，伴有眼部症状更为常见（p = 0.01），且对 SN-5 过敏域的反应更高（p = 0.02）。过敏性和非过敏性患者的鼻窦 CT 评分相似（中位数分别为 7 分和 8 分），且与症状评分无相关性（p = 0.6）。在非过敏性患者中，生活质量评分与鼻窦 CT 评分呈弱相关（r = 0.4；p = 0.05）。通过鼻反射测量，过敏性（0.32cm²）和非过敏性（0.36cm²）患者的平均横截面积绝对值相似，且与症状评分无相关性（过敏性患者 p = 0.8，非过敏性患者 p = 0.6）。观察到非过敏性患者存在不同的亚组，包括伴有明显结膜瘙痒（n = 24）、频繁感冒症状（n = 3）和慢性鼻窦疾病（n = 2）的患者。
在患有常年性疾病的患者中，很难区分过敏性和非过敏性鼻炎，但相关的眼部症状和问卷调查反应可预测过敏。声鼻反射测量和鼻窦 CT 表明，物理阻塞和鼻窦疾病与包括鼻塞在内的鼻部症状无关，这令人惊讶。
