Konstantina Chrysouli1, Anastasia Gounari1, Evmorfia Koulou1, Veronika Astraka1, Elina Hatzaki1, George Kokolakis1, Eleni Damaskopoulou2, Margarita Nikolaou2, Efstathia Staikou2 , Aris Papapetropoulos1, Petros Vrettakos1
1Department of Otorhinolaryngology, Head and Neck Surgery, Penteli Children Hospital, Greece
2Department of Microbiology, Head and Neck Surgery, Penteli Children Hospital, Athens, Greece
Introduction: Allergic rhinitis affects a significant proportion of the population. This study aimed at determining the prevalence, sociodemographic features, clinical manifestations, diagnostic approach, comorbid illnesses, complications and quality of life in children referred to the outpatient clinic of ''Allergic Rhinitis'' in Penteli Children Hospital, Athens, Greece.
Patients and Methods: We analyzed 469 pediatric patients referred to the outpatient clinic of ''Allergic Rhinitis'' in Penteli Children Hospital, Athens, Greece from 26/01/2012 to 20/11/2020. The diagnostic procedure included the same questionnaire used at the time of diagnosis, endoscopy with rigid fiberoptic endoscope 2 mm, 7 mm, 0° and 30° field of view, Skin Prick Test, measurement
of total blood serum IgE levels and eosinophils from nasal secretions and Radioallergosorbent Test (RAST), a blood test using radioimmunoassay test to detect serum specific IgE antibodies, to determine the substances a child is allergic to in some only non-diagnostic cases. Results: A total of 469 pediatric patients were examined of which 337 were children diagnosed with allergic rhinitis. Children with allergic rhinitis represented 72% of all examined pediatric patients. Allergic rhinitis was recorded as the one and only allergic disease in 59% of the children diagnosed with allergic rhinitis, concomitant asthma in 16% of them; atopic dermatitis in 8%and allergic conjunctivitis in 5%. Chronic urticaria was documented in 12% of the children diagnosed with allergic rhinitis. There were 60% males and 40% female among the children with allergic rhinitis with male to female ratio of approximately 3:2. Allergic rhinitis affected all pediatric age group and was peaked at the age group 11 to 14 years and 5 to 7 years accounted for 35% and 32% respectively. There was positive family history of allergy in 54% of children with allergic rhinitis. A total of 68% children with allergic rhinitis were living in urban setting while 32% of them were from rural setting. We received equal randomized samples from each group of children (urban group and rural group) in order to measure the real prevalence of allergic rhinitis in each group. The prevalence of urban population was 15%, with the prevalence of rural population was 11%, and the difference wasn’t statistically significant between urban and rural residents. Perennial allergic rhinitis was recorded in 64% of children with allergic rhinitis while seasonal allergic rhinitis was recorded in 36%. Skin tests were important diagnostic tools, not being necessary the measurement of total IgE in plasma. Total blood serum IgE were measured in cases of non-diagnostic/negative skin test. Immunotherapy was effective in 100% of the patients. The most frequent aeroallergen sensitization that resulted in positive skin prick test was trees; Plantain, Arizona cypress, Olive Tree 50% followed by Grass Mixture 32%, mites; Dermatophagoides Farina, Acarus siro 31%; Dermatophagoides pteronyssinus 33%; other grass pollen, weeds and flowers; Bermuda grass 23%; Timothy grass 15%; Cereal Mixture 15%; Pellitory 8%; Parietariasp. 6%; Mugwort 5%; Groosefoot 5%; Rye 2%; fungi's ( molds); Penicillium notatum 4%; Candida albicans 2%; Cladosporium herbarum 1%; Alternaria alternata 1% and Animal Dander (cat 12%; dog 8%). Measurement of total blood serum IgE levels, eosinophils from nasal secretions and Radioallergosorbent Test (RAST) were performed in cases of non-diagnostic/or negative Skin Test (in 32% of the examined children). Total blood serum IgE levels were increased in 29% of the children with non-diagnostic or negative Skin test. Eosinophils from nasal secretions were increased in 22% of the children with non diagnostic or negative Skin test and thus in these cases the diagnosis was local allergic rhinitis. Radioallergosorbent Test (RAST) was diagnostic to the specific allergens a child is allergic to in 36% of the children with non diagnostic or negative Skin test. In 59% of children with chronic urticaria demonstrated positive skin prick test to common aeroallergens. Clinical presentations of allergic rhinitis in this study were mainly 78% nasal blockage, 67% runny nose, 15% recurrent sneezing and 14% nasal itching. The most common complication was acute or chronic sinusitis 35%. Other common complications of allergic rhinitis were otitis media or Eustachian tube dysfunction 33%, 16% asthma, 10% sleep disturbance or apnea and 6% dental problems. Major associated comorbid illnesses among the children were tonsils hypertrophy, adenoid hypertrophy and inferior turbinate hypertrophy which accounted for 58%, 49% and 52% respectively. 54% of asthmatic children were diagnosed allergic rhinitis, while 16% of allergic rhinitis children were diagnosed asthma. The Odds Ratio (OR) for the Factor Structure of the Strengths’ and Difficulties (SDQ) questionnaire was 1, 15. The Odds Ratio (OR) for the Pittsburg Sleep Quality Index (PSQI) questionnaire was 6. Treatment of allergic rhinitis leads to improvement on the clinical features in 91% patients. No significant improvements in clinical features were noticed in 9% patients. None of the studied patients reported worse clinical condition after treatment of allergic rhinitis. No mortality was recorded from allergic rhinitis in our study. Conclusion: Allergic rhinitis was reported in 72% of studied children and was frequently characterized by significant morbidity. Allergic rhinitis affected all pediatric age group and was peaked at age group 11 to 14 years and 5 to 7 years. There were associated epidemiological features, clinical manifestations, comorbid illnesses, complications and affectation of the quality of life in children. Early referral is highly recommended to the specialist to avoid further complications. Further studies on the general population should be carried out in order to understand the pathophysiologic mechanisms of allergic rhinitis more comprehensively.
Allergens; Allergic rhinitis; Epidemiology; Narrative study
Chrysouli K, Gounari A, Koulou E, Astraka V, Hatzaki E, Kokolakis G, et al. Epidemiological Features, Clinical Manifestations, Diagnostic Approach and Quality of Life of Pediatric Patients with Allergic Rhinitis: A Narrative Study in a Children Hospital. Am J Otolaryngol Head Neck Surg. 2021; 4(2): 1122..