Pediatric Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
Department of Pediatrics, University of L'Aquila, L'Aquila, Italy.
J Paediatr Child Health. 2021 Dec;57(12):1955-1959. doi: 10.1111/jpc.15626. Epub 2021 Jun 29.
Asthma and allergic rhinitis share common pathophysiological mechanisms. However, while asthma phenotypes and endotypes are defined basing on both clinical and immunological features, rhinitis classification is still based on severity and frequency of symptoms. Recently, fractional exhaled nitric oxide (FeNO) has been suggested as a possible biomarker of rhinitis to asthma development. The aim of our study was to define the prevalence of a high FeNO allergic rhinitis endotype in a paediatric population of children with allergic rhinitis in order to quantify the impact of such patients in general practice.
A total of 159 children (aged 7-16 years) with allergic rhinitis and no asthmatic symptoms were enrolled in our study. Severity assessment of rhinitis and asthma was evaluated in accordance with ARIA and GINA guidelines. All patients performed the following assessments: skin prick test (SPT), spirometry and FeNO measurement.
FeNO was increased in 54 (33.9%) of 159 patients. No significant correlation with age, severity and frequency of rhinitis was evidenced. Positive SPT for house dust mites was related with a higher prevalence of high FeNO (P = 0.04), with no significant correlation with other sensitisations. All patients showed normal spirometric values.
A possible new endotype of allergic rhinitis and lower airways inflammation showed to be significantly present in our population. The lack of correlation with allergic rhinitis severity assessment suggests that FeNO could be considered as an independent variable, possibly linked to a higher risk of asthma development in children with no lower airways symptoms and normal spirometry.
哮喘和变应性鼻炎具有共同的病理生理机制。然而，虽然哮喘表型和内型是基于临床和免疫特征来定义的，但鼻炎的分类仍然基于症状的严重程度和频率。最近，呼出气一氧化氮分数（FeNO）被认为是变应性鼻炎发展为哮喘的一种潜在生物标志物。本研究的目的是在患有变应性鼻炎的儿童人群中确定高 FeNO 变应性鼻炎内型的患病率，以量化此类患者在一般实践中的影响。
共纳入 159 例（年龄 7-16 岁）无哮喘症状的变应性鼻炎患儿。根据 ARIA 和 GINA 指南评估鼻炎和哮喘的严重程度。所有患者均进行以下评估：皮肤点刺试验（SPT）、肺功能检查和 FeNO 测量。
159 例患者中，FeNO 升高者 54 例（33.9%）。未发现 FeNO 与年龄、鼻炎严重程度和频率之间存在显著相关性。屋尘螨 SPT 阳性与高 FeNO 患病率显著相关（P=0.04），与其他致敏原无显著相关性。所有患者的肺功能检查值均正常。
我们的人群中可能存在一种新的变应性鼻炎内型和下气道炎症。FeNO 与变应性鼻炎严重程度评估无相关性，表明 FeNO 可能被视为一个独立变量，可能与无下气道症状和正常肺功能的儿童哮喘发展风险增加有关。
