Gu Zheng, Wei Ping, Kou Wei, Tang Xin-Ye, Yao Hong-Bing, Liu En-Mei
Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China,
Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China.
Int Arch Allergy Immunol. 2023;184(9):882-892. doi: 10.1159/000530842. Epub 2023 Jun 8.
Allergic rhinitis (AR) in children is associated with various comorbidities, posing challenges for treatment and management. There have been few investigations of these multimorbidities in Chinese children with AR. Here, we investigated the prevalence of multimorbidities in children with moderate to severe AR and analyzed the influencing factors using real-world data.
In total, 600 children who visited the outpatient clinic of our hospital and were diagnosed with moderate-severe AR were prospectively enrolled. All children underwent allergen detection and electronic nasopharyngoscopy. Parents or guardians completed a questionnaire that included age, sex, mode of delivery, feeding pattern, and familial history of allergy. The multimorbidities investigated included atopic dermatitis (AD), asthma, allergic conjunctivitis (AC), chronic rhinosinusitis (CRS), adenoid hypertrophy (AH), tonsil hypertrophy (TH), recurrent epistaxis, and recurrent respiratory tract infections (RRTIs).
The AR multimorbidities reported in children were as follows: recurrent epistaxis (46.5%), AC (46.3%), AD (40.7%), asthma (22.5%), RRIs (21.3%), CRS (20.5%), AH (19.7%), and TH (12.5%). In univariate logistic regression analysis, age (<6 years), birth mode, familial history of allergy, and single dust mite allergy were associated with AR multimorbidity (p < 0.05). Multivariate logistic regression revealed that a familial history of allergy was an independent risk factor for AC (odds ratio [OR] = 1.539, 95% confidence interval [CI]: 1.104-2.145) and AH (OR = 1.506, 95% CI: 1.000-2.267) (p < 0.05). Age (<6 years) was independently associated with the risk of AD (OR = 1.405, 95% CI: 1.003-1.969) and RRTIs (OR = 1.869, 95% CI: 1.250-2.793) (p < 0.05), cesarean section with AR and CRS risk (OR = 1.678, 95% CI: 1.100-2.561), and single dust mite allergy with asthma (OR = 1.590, 95% CI: 1.040-2.432) and CRS (OR = 1.600, 95% CI: 1.018-2.515) risk (p < 0.05). Further, non-dust mite allergy was independently associated with AR and CRS (OR = 2.056, 95% CI: 1.084-3.899).
AR was found to be accompanied by different comorbidities, including both allergic and non-allergic comorbidities, complicating disease treatment. These findings demonstrated that age (<6 years), familial history of allergy, types of allergens, and cesarean section were risk factors for different multimorbidities associated with AR.
儿童过敏性鼻炎（AR）与多种合并症相关，给治疗和管理带来挑战。目前针对中国AR儿童的这些多种合并症的研究较少。在此，我们利用真实世界数据调查了中重度AR儿童多种合并症的患病率，并分析了影响因素。
前瞻性纳入我院门诊就诊且被诊断为中重度AR的600名儿童。所有儿童均接受过敏原检测和电子鼻咽镜检查。父母或监护人完成一份问卷，内容包括年龄、性别、分娩方式、喂养方式和过敏家族史。所调查的多种合并症包括特应性皮炎（AD）、哮喘、过敏性结膜炎（AC）、慢性鼻-鼻窦炎（CRS）、腺样体肥大（AH）、扁桃体肥大（TH）、反复鼻出血和反复呼吸道感染（RRTIs）。
儿童中报告的AR合并症如下：反复鼻出血（46.5%）、AC（46.3%）、AD（40.7%）、哮喘（22.5%）、RRIs（21.3%）、CRS（20.5%）、AH（19.7%）和TH（12.5%）。单因素逻辑回归分析显示，年龄（<6岁）、分娩方式、过敏家族史和单一尘螨过敏与AR合并症相关（p<0.05）。多因素逻辑回归显示，过敏家族史是AC（比值比[OR]=1.539，95%置信区间[CI]：1.104-2.145）和AH（OR=1.506，95%CI：1.000-2.267）的独立危险因素（p<0.05）。年龄（<6岁）与AD风险（OR=1.405，95%CI：1.003-1.969）和RRTIs风险（OR=1.869，95%CI：1.250-2.793）独立相关（p<0.05），剖宫产与AR和CRS风险相关（OR=1.678，95%CI：1.100-2.561），单一尘螨过敏与哮喘风险（OR=1.590，95%CI：1.040-2.432）和CRS风险（OR=1.600，95%CI：1.018-2.515）相关（p<0.05）。此外，非尘螨过敏与AR和CRS独立相关（OR=2.056，95%CI：1.084-3.899）。
发现AR伴有不同的合并症，包括过敏性和非过敏性合并症，使疾病治疗复杂化。这些发现表明，年龄（<6岁）、过敏家族史、过敏原类型和剖宫产是与AR相关的不同多种合并症的危险因素。
