La Mantia Ignazio, Andaloro Claudio
Department of Medical Sciences, Surgical and Advanced Technologies, GF Ingrassia, University of Catania - ENT Unit, Santa Marta e Santa Venera Hospital, Acireale, Catania, Italy.
Department of Medical Sciences, Surgical and Advanced Technologies, GF Ingrassia, University of Catania, Italy.
Int J Pediatr Otorhinolaryngol. 2017 Jul;98:103-109. doi: 10.1016/j.ijporl.2017.04.044. Epub 2017 May 4.
Chronic rhinitis (CR) is one of the most common causes accounting for lost-school days, absenteeism and resource utilization in pediatric patients. Distinction between common causes of CR, allergic (AR)and non-allergic rhinitis (NAR), based upon clinical features is critical, especially in primary care settings or facilities with lack of allergen sensitivity testing, as management strategies differ considerably. The current study elucidates clinical factors, particularly facial features associated with AR and NAR using a large cohort.
In a retrospective cohort analysis of pediatric patients aged 6-18 years, we assessed patient demographics, clinical symptoms, and signs associated with allergic rhinitis using multivariable regression techniques.
Overall, 1490 patients (mean age: 10.11 ± 3.31 years; 48% female; 69% AR and 31% NAR) were included in the study. In multivariable regression analysis, major clinical features associated with AR were: sneezing (OR: 3.53; 95% CI: 2.35-5.32; p < 0.001), rhinorrhea (OR: 1.77; 95% CI: 1.18-2.66; p = 0.006), nasal itching (OR: 17.88; 95% CI: 11.92-26.83; p < 0.001), horizontal nasal crease (OR: 5.09; 95% CI: 1.29-20.01; p = 0.020) and conjunctivitis (OR: 4.66; 95% CI: 3.28-6.62; p < 0.001). On the contrary, we noted presence of Dennie-Morgan fold (OR: 1.67; 95% CI: 1.11-2.56; p = 0.014), moderate to severe persistent or intermittent symptoms to be likely associated with NAR than AR.
In pediatric patients presenting with symptoms of rhinitis, facial hallmarks serve as an adjunct to sensitivity testing in establishing a diagnosis as well as differentiating between NAR from AR, albeit individualized upon patient history and clinical features.
慢性鼻炎（CR）是导致儿科患者缺课、缺勤和资源利用的最常见原因之一。根据临床特征区分CR的常见病因，即变应性鼻炎（AR）和非变应性鼻炎（NAR）至关重要，尤其是在基层医疗环境或缺乏变应原敏感性检测的机构中，因为管理策略差异很大。本研究使用一个大型队列阐明了临床因素，特别是与AR和NAR相关的面部特征。
在一项对6至18岁儿科患者的回顾性队列分析中，我们使用多变量回归技术评估了患者的人口统计学特征、临床症状以及与变应性鼻炎相关的体征。
总体而言，1490名患者（平均年龄：10.11±3.31岁；48%为女性；69%为AR，31%为NAR）纳入了研究。在多变量回归分析中，与AR相关的主要临床特征为：打喷嚏（比值比：3.53；95%置信区间：2.35 - 5.32；p<0.001）、流涕（比值比：1.77；95%置信区间：1.18 - 2.66；p = 0.006）、鼻痒（比值比：17.88；95%置信区间：11.92 - 26.83；p<0.001）、鼻横纹（比值比：5.09；95%置信区间：1.29 - 20.01；p = 0.020）和结膜炎（比值比：4.66；95%置信区间：3.28 - 6.62；p<0.001）。相反，我们注意到存在Dennie-Morgan皱襞（比值比：1.67；95%置信区间：1.11 - 2.56；p = 0.014），与AR相比，中度至重度持续性或间歇性症状可能与NAR相关。
在出现鼻炎症状的儿科患者中，面部特征可作为敏感性检测的辅助手段，用于诊断以及区分NAR和AR，尽管需根据患者病史和临床特征进行个体化判断。
