PURPOSE OF THE STUDY.
To investigate the risk factors for rhinitis in school-age children and whether there are differences in risk factors between allergic and nonallergic rhinitis. Among children with asthma, the authors also investigated the association between rhinitis and asthma severity.
Nine hundred and six children participating in a birth cohort study were reviewed at age 8 years.
Subjects were recruited antenatally and followed prospectively. Participants attended follow-up at age 8 years, and a validated International Study of Asthma and Allergies in Childhood questionnaire was administered to collect information on parentally reported symptoms, doctor diagnoses, and environmental exposures. Skin prick tests were performed to common inhalant allergens in 815 of the 906 participants. Data were extracted between January 2006 and February 2008 from electronic and paper-based primary care medical records, including prescriptions of inhaled and intranasal corticosteroids. Specific airway resistance was measured by using plethysmography. Spirometry was used to measure forced expiratory volume in 1 second and forced vital capacity. Airway hyperreactivity was assessed by using methacholine challenge. Fractional exhaled nitric oxide was measured as an indicator of airway inflammation.
School-age children with rhinitis (allergic and nonallergic) had higher airway reactivity than those without rhinitis. Children with asthma and rhinitis were more likely to have doctor visits and missed school days. Children with asthma and allergic rhinitis had more wheezing attacks than children with asthma who had no sensitization to inhalant allergens. Intranasal corticosteroid use improved asthma control independent of lower airway inhaled corticosteroid treatment and oral antihistamines.
The findings in this longitudinal cohort study confirm previous observations that appropriate treatment of rhinitis in children with asthma reduced the risk of asthma severity. However, this study showed a small but consistent reduction in risk with intranasal corticosteroid use. This article also confirmed the presence of distinct rhinitis phenotypes in early childhood.
This study highlights the importance of appropriate longitudinal surveillance and consistent intranasal corticosteroid rhinitis treatment in school-age children with persistent wheezing. This large investigation of school-age children adds to data from previously published studies by showing an increased risk of missed school among children with rhinitis and asthma compared with asthma alone.
- Copyright © 2015 by the American Academy of Pediatrics