Teo Wan-Yee, Wong Hwee-Bee, Hwarng Gwen Yung Hsin, Tan Henry K K
Division of Medicine, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore.
Cancer and Stem Cell Biology Program, Duke-NUS Medical School, 100 Bukit Timah Road, Singapore, Singapore.
Eur J Pediatr. 2023 Mar;182(3):1127-1135. doi: 10.1007/s00431-022-04701-7. Epub 2023 Jan 3.
The purpose of this study is to (1) to determine if treatment of underlying allergic rhinitis (AR) in children will affect epistaxis outcome, (2) to compare efficacy of three outpatient AR treatment regimens in epistaxis outcomes, and (3) to investigate potential factors in the pathogenesis of epistaxis with underlying AR. A single-blind randomized-controlled study was conducted in the Otolaryngology clinic in KK Women's and Children's Hospital. Sixty children aged below 18 years with underlying untreated AR, with first presentation of epistaxis, were randomized to three different AR treatments: treatment 1, antihistamine (20 patients); treatment 2, nasal steroid spray (20 patients); and treatment 3, both antihistamine and nasal steroid spray (20 patients). Epistaxis severity and frequency were assessed. Pre-treatment, 95% of patients within each of the three treatment groups described epistaxis symptoms. Post-treatment, there was improvement in epistaxis outcome (resolution of epistaxis) with 20% (4/20), 40% (8/20), and 60% (12/20) of patients in treatment groups 1 (antihistamine), 2 (nasal steroid spray), and 3 (combined therapy) respectively, who reported resolution of epistaxis. Treatment regimens containing nasal steroid spray resulted in greater improvement of epistaxis severity and frequency. Combined therapy (treatment 3) resulted in the best epistaxis outcome at 1-month follow-up. Majority (90%) reported nose-picking/rubbing behavior.
Intranasal corticosteroids are superior to oral antihistamines in relieving itch or rhinorrhea in AR. Intranasal corticosteroids may be important in treating epistaxis with underlying AR, because digital trauma from itch/rhinorrhea-related nose-picking/rubbing frequently leads to epistaxis. Results from this study will be important to primary and emergency physicians, community pediatricians, and pediatric allergists and otolaryngologists.
• Childhood epistaxis commonly co-exists with allergic rhinitis (AR), causing significant symptoms and distress to patients. • There are currently no studies reporti ng on epistaxis outcome aft er treatment of underlying AR.
• This is a single-blind randomized-controlled study of 60 children aged below 18 years with underlying untreated AR, with first presentation of epistaxis to a children's hospital in Singapore Patients were randomized to three different regimens to treat AR: treatment 1, antihistamine; treatment 2, nasal steroid spray; and treatment 3, both antihistamine and nasal steroid spray. • Treatment regimens containing nasal steroid spray improved epistaxis outcomes, with combined therapy of antihistamine and nasal steroid spray resulting in the best outcome for resolution of epistaxis among the three treatment regimens.
本研究的目的是：（1）确定治疗儿童潜在性变应性鼻炎（AR）是否会影响鼻出血的治疗效果；（2）比较三种门诊AR治疗方案对鼻出血治疗效果的疗效；（3）研究伴有潜在性AR的鼻出血发病机制中的潜在因素。在KK妇女儿童医院耳鼻喉科门诊进行了一项单盲随机对照研究。60名年龄在18岁以下、患有未经治疗的潜在性AR且首次出现鼻出血的儿童被随机分为三种不同的AR治疗组：治疗组1，使用抗组胺药（20例患者）；治疗组2，使用鼻用类固醇喷雾剂（20例患者）；治疗组3，同时使用抗组胺药和鼻用类固醇喷雾剂（20例患者）。评估鼻出血的严重程度和频率。治疗前，三个治疗组中95%的患者描述有鼻出血症状。治疗后，治疗组1（抗组胺药）、2（鼻用类固醇喷雾剂）和3（联合治疗）中分别有20%（4/20）、40%（8/20）和60%（12/20）的患者鼻出血症状得到缓解（鼻出血停止）。包含鼻用类固醇喷雾剂的治疗方案能使鼻出血的严重程度和频率有更大改善。联合治疗（治疗组3）在1个月随访时鼻出血治疗效果最佳。大多数（90%）患者报告有挖鼻/揉鼻行为。
鼻内皮质类固醇在缓解AR的瘙痒或鼻漏方面优于口服抗组胺药。鼻内皮质类固醇在治疗伴有潜在性AR的鼻出血中可能很重要，因为与瘙痒/鼻漏相关的挖鼻/揉鼻引起的手指创伤常导致鼻出血。本研究结果对初级和急诊医生、社区儿科医生、儿科过敏症专科医生以及耳鼻喉科医生具有重要意义。
• 儿童鼻出血常与变应性鼻炎（AR）共存，给患者带来显著症状和困扰。• 目前尚无关于治疗潜在性AR后鼻出血治疗效果的研究报告。
• 这是一项对60名年龄在18岁以下、患有未经治疗的潜在性AR且首次到新加坡一家儿童医院就诊鼻出血的儿童进行的单盲随机对照研究。患者被随机分为三种不同的AR治疗方案：治疗组1，使用抗组胺药；治疗组2，使用鼻用类固醇喷雾剂；治疗组3，同时使用抗组胺药和鼻用类固醇喷雾剂。• 包含鼻用类固醇喷雾剂的治疗方案改善了鼻出血的治疗效果，抗组胺药和鼻用类固醇喷雾剂联合治疗在三种治疗方案中鼻出血缓解效果最佳。
