Department of Pediatric Allergy, Children's Hospital, University of Bonn, Bonn, Germany.
Department of Bioengineering, Izmir Institute of Technology, Izmir, Turkey.
Pediatr Allergy Immunol. 2021 Nov;32(8):1691-1699. doi: 10.1111/pai.13605. Epub 2021 Aug 5.
Childhood allergic rhinitis (AR) is clinically heterogenous. We aimed to identify distinct phenotypes among children with AR using data-driven techniques and to ascertain their association with patterns of symptoms, allergic sensitization, and comorbidities.
We recruited 510 children with physician-diagnosed AR, of whom 205 (40%) had asthma. Latent class analysis (LCA) was performed to identify latent structure within the data set using 17 variables (allergic conjunctivitis, eczema, asthma, family history of asthma, family history of allergic rhinitis, skin sensitization to 8 common allergens, tonsillectomy, adenoidectomy).
A four-class solution was selected as the optimal model based on statistical fit. We labeled latent classes as: (1) AR with grass mono-sensitization and conjunctivitis (n = 361, 70.8%); (2) AR with house dust mite sensitization and asthma (n = 75, 14.7%); (3) AR with pet and grass polysensitization and conjunctivitis (n = 35, 6.9%); and (4) AR among children with tonsils and adenoids removed (n = 39, 7.6%). Perennial AR was significantly more common among children in Class 2 (OR 5.83, 95% CI 3.42-9.94, p < .001) and Class 3 (OR 2.88, 95% CI 1.36-6.13, p = .006). Mild and intermittent AR symptoms were significantly more common in children in Class 2 compared to those in Class 1. AR was more severe in Class 1 compared to other 3 classes, indicating that upper respiratory symptoms are more severe among children with isolated seasonal rhinitis, than in those with rhinitis and coexisting asthma.
We have identified 4 phenotypes in school-age children with AR, which were associated with different patterns of clinical symptoms and comorbidities.
儿童变应性鼻炎（AR）在临床上表现多样。本研究旨在使用数据驱动技术确定 AR 患儿的不同表型，并确定其与症状模式、过敏致敏和合并症的相关性。
我们招募了 510 名经医生诊断为 AR 的患儿，其中 205 名（40%）患有哮喘。采用潜在类别分析（LCA）方法，使用 17 个变量（过敏性结膜炎、湿疹、哮喘、哮喘家族史、变应性鼻炎家族史、对 8 种常见过敏原的皮肤致敏、扁桃体切除术、腺样体切除术）对数据集进行潜在结构分析。
基于统计拟合，选择了四分类模型作为最佳模型。我们将潜在类别标记为：（1）草单一致敏和结膜炎的 AR（n=361，70.8%）；（2）屋尘螨致敏和哮喘的 AR（n=75，14.7%）；（3）宠物和草双重致敏和结膜炎的 AR（n=35，6.9%）；（4）切除扁桃体和腺样体的 AR（n=39，7.6%）。与 Class 1 相比，Class 2（OR 5.83，95%CI 3.42-9.94，p<0.001）和 Class 3（OR 2.88，95%CI 1.36-6.13，p=0.006）的儿童中，常年性 AR 更为常见。与 Class 1 相比，Class 2 中儿童的轻中度间歇性 AR 症状更为常见。Class 1 中 AR 比其他 3 个类别的 AR 更为严重，表明与孤立性季节性鼻炎相比，上呼吸道症状在仅有鼻炎的儿童中更为严重，而在同时患有鼻炎和哮喘的儿童中则不那么严重。
我们在患有 AR 的学龄儿童中确定了 4 种表型，这些表型与不同的临床症状和合并症模式相关。
