Clinical Relevance of Rhinitis Classification in Children With Asthma

Rhinitis is found in approximately 88% of children with asthma, and seasonal exacerbation of allergic rhinitis due to poly allergy is common, mostly severe, and often associated with asthma that is difficult to control, according to a study published in Annals of Allergy, Asthma & Immunology.

Numerous studies have been devoted to evaluating the reciprocal impact of asthma and rhinitis, which may share pathogenic mechanisms. This study evaluated the prevalence and effects of rhinitis on asthma outcomes in children from the “ControL’Asma” study group recently established by The Italian Society of Paediatric Allergy and Immunology. Clinical and patient information was gathered on 333 children enrolled from 10 pediatric allergy centers in Italy. The participants were stratified using 2 rhinitis classifications: traditional (based on seasonality of symptoms such as seasonal, perennial, or mixed) and the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines.

The results indicated that 88% of children with asthma have comorbid rhinitis. No rhinitis was seen in 53.85% of children with well-controlled asthma, whereas 66.67% of participants with poorly controlled asthma had nonallergic rhinitis, and 34.2% of children had perennial allergic rhinitis with seasonal exacerbation due to poly allergy.

The 2 rhinitis classifications had significant subgroup differences in asthma duration, age, asthma severity, asthma duration, asthma control, body mass index, past year use of oral corticosteroids, dosage of inhaled corticosteroids, FEF 25-75, and c-ACT. There was no concordance between the classifications because overlapping between the 2 was only seen with a significant difference. ARIA provided clear indications about the impact of rhinitis phenotyping on asthma severity. Conventional classification provided indications about the impact of rhinitis phenotypes on functional and clinical variables in children with asthma. Because each classification provided different information that could be clinically relevant and useful to asthma management, the investigators indicated that using both classifications for rhinitis in practice would be more helpful than relying on just one.

The study investigators stated that the main study limitation is the cross-sectional design, although follow-up is ongoing. They concluded that “rhinitis is frequently associated with asthma in children, rhinitis phenotyping should be performed using both conventional and ARIA classification, and rhinitis phenotyping allows clinicians to diagnose and treat the asthma properly.”

Reference

Tosca MA, Duse M, Marseglia G, Ciprandi G; “ControL’Asma Study Group” members. The practical clinical relevance of rhinitis classification in asthmatic children: outcomes of the “ControL’Asma” study [published online August 8, 2019]. Ann Allergy Asthma Immunol. doi: 10.1016/j.anai.2019.08.003