New concepts in pediatric rhinitis

Rhinitis—and especially allergic rhinitis (AR)—remains the most frequent hypersensitivity condition, affecting up to a quarter of the population and impacting the quality of life of individual patients and the health economy. Data, especially with respect to underlying pathophysiologic mechanisms, mainly derive from studies on adults and are subsequently extrapolated to the pediatric population. Therapeutic algorithms for children with rhinitis are long based on the same principles as in adults. We explore and describe novel aspects of rhinitis, ranging from mechanisms to disease classification, phenotypes, diagnostic and monitoring tools, and the use of treatments, with a focus on the traits of pediatric age groups.     

Allergic rhinitis in children

Allergic rhinitis affects up to 40% of children but is commonly undiagnosed. Careful assessment of nasal symptoms allows for the most appropriate therapeutic options to be chosen. Allergen avoidance is often difficult in practice. Antihistamines are of limited benefit in allergic rhinitis caused by house dust mite and other perennial allergens, where symptoms, predominantly nasal obstruction, are not histamine mediated. In contrast, symptoms triggered by pollen, such as nasal itch, rhinorrhoea and sneezing, are relieved by antihistamines. Intranasal steroids are the treatment of choice for persistent moderate–severe allergic rhinitis and are more effective than antihistamines for relief of nasal obstruction. Failure to respond to intranasal medications is often caused by poor compliance or inefficient use of nasal sprays. Immunotherapy may be a useful, if expensive, option, particularly where symptoms are because of a specific pollen. The benefits of immunotherapy in house dust mite‐induced rhinitis and asthma remain controversial.     

Prevalence of allergic rhinitis and nasal smear eosinophilia in 11- to 15 yr-old children in Shiraz

Allergic rhinitis (AR) is a common condition among schoolchildren. The prevalence rate of AR differs among countries and even among regions within the same country. The objective of this study was to determine the prevalence of nasal symptoms and signs of AR and nasal smear eosinophilia in 11- to 15-yr-old children in Shiraz. A total of 4584 children aged 11-15 yr of both sexes were surveyed from May 1995 to April 1996, and nasal symptoms and signs of AR (sneezing, rhinorrhea, nasal blockage, itching, color change, mucosal swelling, nasal wetness, and nasal crease), based on questionnaire and ear, nose and throat (ENT) examination were recorded. In addition, smears were taken from nasal secretions and stained. The results compared with nasal smears related to 340 healthy children. 1008 (22%) schoolchildren had nasal symptoms of AR (based on the questionnaire), 445 (9.7%) were identified as having nasal symptoms and signs of AR (based on the questionnaire and ENT specialist examination), and 226 (5.8%) had nasal symptoms and signs of AR associated with nasal eosinophilia (based on the questionnaire, ENT specialist examination and positive nasal smear for eosinophilia). Nasal eosinophilia was present in 274 (62%) children with nasal symptoms and signs of AR. This survey showed that prevalence of nasal symptoms and signs of AR was high in schoolchildren in Shiraz. Nasal smear eosinophilia had a diagnostic specificity of 96% and sensitivity of 62% and seems to be a potentially valuable test for AR.     

上海不同地区变应性哮喘及变应性鼻炎患儿的变应原分析

目的分析上海不同地区变应性哮喘和变应性鼻炎患儿的变应原分布特点及意义,为防治儿童变应性呼吸道疾病提供理论依据。方法对2005年9月-2006年12月上海3家医院收治的502例变应性哮喘和变应性鼻炎患儿以及375例成人患者,采用12种德国Allergopharma变应原点刺液进行变应原皮肤点刺试验(SPT)。结果1.儿童组SPT阳性率80.9%,显著低于成人组的98.9%(χ2=69.278P=0.001),<7岁儿童组SPT阳性率低于≥7岁儿童组。2.SPT阳性患儿阳性率最高的变应原为粉尘螨,其次为猫上皮和狗上皮,阳性率分别为92.9%、35.7%和19.0%。3.儿童组中单纯哮喘患儿SPT阳性率的(67.7%),显著低于单纯鼻炎患儿(81.5%)和鼻炎并哮喘患儿(86.5%)(P=0.039,0.001)。4.上海市区患儿SPT阳性率(82.7%),显著高于上海郊区患儿阳性率(72.0%)(χ2=7.443P=0.006)。结论保持居住环境、家居用品清洁,减少尘螨接触,不养猫、狗等宠物,对减少儿童变应性哮喘和变应性鼻炎发病有很大帮助;儿童SPT阳性率受年龄影响;变应性鼻炎患儿在诊断治疗中较哮喘更应警惕变应原的检测和回避。     

儿童过敏性鼻炎的流行病学

过敏性鼻炎（allergic rhinitis，AR）是儿童常见的慢性疾病之一。经全球流行病学调查，不同年龄段、不同地区之间的儿童AR患病率都有差异，AR患病率整体呈现缓慢增加的趋势。但不同地区过敏原种类分布不一，在欧美及我国新疆地区，以植物类为主要过敏原；我国其他地区则以螨类为主要过敏原。     

Nonspecific bronchial hyperresponsiveness and development of asthma in children with hay fever

It has been suggested that patients with allergic rhinitis who present nonspecific bronchial hyperresponsiveness (BHR) are those most likely to develop asthma. Therefore, a study was conducted in children with rhinoconjunctivitis to ascertain whether BHR to methacholine might predict the development of asthma in these patients. Fifteen patients with hay fever and no previous symptoms of asthma were selected. All underwent clinical symptom tests and methacholine tests, during the pollen season in the 4 consecutive years following the start of the study. At the end of this period, 5 patients had developed asthma. It may thus be affirmed that, in this group, neither the presence nor the degree of previous BHR was useful for predicting which patients would later develop asthma.     

自然杀伤细胞在儿童过敏性哮喘和(或)鼻炎中的变化

目的探讨自然杀伤细胞(nature killer cells,NK)在过敏性哮喘和(或)鼻炎患儿中的变化。方法选择2009年8月—2010年12月在儿科门诊和病房诊断明确、3～14岁过敏性哮喘和(或)变应性鼻炎发作且未用药物治疗的患儿45例,正常对照儿童30例,采用乳酸脱氢酶释放法检测外周血NK细胞杀伤活性,流式细胞技术测定外周血NK细胞数量,应用免疫磁珠分选技术纯化NK细胞,分别采用标准刺激剂(离子霉素+佛波酯)和尘螨试剂刺激NK细胞,流式细胞技术检测NK细胞内γ-干扰素(IFN-γ)和白介素(IL-4)的表达情况。结果过敏性哮喘和(或)鼻炎患儿与对照组比较,NK细胞数量减少,差异有统计学意义(P=0.015);NK细胞活性下降,差异有统计学意义(P=0.023)。在尘螨刺激下,NK细胞内IFN-γ和IL-4表达均升高,但IL-4升高幅度较IFN-γ强,导致IFN-γ/IL-4比值显著降低,差异有统计学意义(P<0.05)。结论在过敏性哮喘和(或)鼻炎发作患儿中,NK细胞数量与活性均下降;在尘螨刺激下,NK细胞内IFN-γ/IL-4比值升高,导致NK细胞向NKⅡ型细胞方向失衡。推测NK细胞的数量、功能变化及...     

Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC)

Background: As part of the International Study of Asthma and Allergies in CHITdFood (ISAAC), prevalence surveys were conducted among representative samples of school children from locations in Europe, Asia. Africa. Australasia. North and South America.
Subjects: 257.800 children aged 6-7 years from 91 centres in 38 countries, and 463,801 children aged 13-14 years from 155 centres in 56 countries. Methods: Written symptom questionnaires were translated from Fnglish into the local language for self-completion hy the 13-14-year-olds and completion by the parent.s of the 6-7-year-olds. Rhinitis was described as a problem with sneezing, or a runny, or blocked nose when you (your child) DID NOT have a cold or the flu. Additional questions were asked about rhinitis associated with itchy-watery eyes, interference with activities and a history of hay fever ever.
Results: The prevalenee of rhinitis with itchy-watery eyes ("rhinoeonjunc-tivitis") in the past year varied across centres from 0.8%(to 14.9%c in the 6-7-year-olds and from 1.4% to 39.7% in the 13-14-year-olds. Within each age group, the global pattem was broadly consistent across each of the symptom categories. In centres of higher prevalence there was great variability in the proportion of rhinoconjunctivitis labelled as hay fever. The lowest prevalences of rhinoconjunctivitis were found in parts of eastern Furope. south and central Asia. High prevalences were reported from cen-tres in several regions.
Conclusion: These results suggest substantial worldwide variations in the prevalence and labelling of symptoms of allergic rhinoconjunctivitis which rcqtiirc further study. These differences, if real, may offer important clues t o environmental influences on ullergy.     

复旦大学附属儿科医院2413例过敏性鼻炎患儿过敏原筛查结果分析

目的　了解过敏性鼻炎（allergic rhinitis,AR）患儿的过敏原,为儿童AR的预防和治疗提供依据。方法　采用免疫印迹法对2013年1月至2018年7月就诊于复旦大学附属儿科医院耳鼻咽喉头颈外科的2413例AR患儿进行过敏原检测并进行分析。结果　吸入性过敏原前4位分别为户尘螨（49.52%）、混合霉菌（23.62%）、狗毛（17.99%）、屋尘（15.54%）。食入性过敏原前4位分别为牛奶（46.54%）、鸡蛋（22.92%）、腰果（19.10%）、螃蟹（9.45%）。部分AR患儿（46.33%）同时存在吸入性及食入性过敏。男女患儿过敏原阳性率比较差异有统计学意义（P＜0.05）。随着年龄增长,儿童的吸入性过敏原阳性率逐渐增加,食入性过敏原阳性率逐渐降低。结论　儿童吸入性过敏原以尘螨及混合霉菌为主,食入性过敏原以牛奶及鸡蛋为主,过敏原检测有助于了解患儿的过敏状态。     

Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: A randomized study

Recent evidence suggests that nasal irrigation with hypertonic saline may be useful as an adjunctive treatment modality in the management of many sinonasal diseases. However, no previous studies have investigated the efficacy of this regimen in the prevention of seasonal allergic rhinitis-related symptoms in the pediatric patient. Twenty children with seasonal allergic rhinitis to Parietaria were enrolled in the study. Ten children were randomized to receive three-times daily nasal irrigation with hypertonic saline for the entire pollen season, which had lasted 6 weeks. Ten patients were allocated to receive no nasal irrigation and were used as controls. A mean daily rhinitis score based on the presence of nasal itching, rhinorrea, nasal obstruction and sneezing was calculated for each week of the pollen season. Moreover, patients were allowed to use oral antihistamines when required and the mean number of drug assumption per week was also calculated. In patients allocated to nasal irrigation, the mean daily rhinitis score was reduced during 5 weeks of the study period. This reduction was statistically significantly different in the 3th, 4th and 5th week of therapy. Moreover, a decreased consumption of oral antihistamines was observed in these patients. This effect became evident after the second week of treatment and resulted in statistically significant differences during the 3th, 4th and 6th week. This study supports the use of nasal irrigation with hypertonic saline in the pediatric patient with seasonal allergic rhinitis during the pollen season. This treatment was tolerable, inexpensive and effective.     

过敏性鼻炎的诊断与治疗新进展

介绍过敏性鼻炎（AR）的诊治新进展。遗传和环境因素被认为是AR的病因学因素,AR与哮喘常相伴发生。1999年世界卫生组织出台的“过敏性鼻炎及其对哮喘的影响”指南（ARIA）及过敏症报告,提供了规范的诊断方法及治疗指南,强调了AR对哮喘的影响,并对AR进行了新的分类。最常用的诊断试验包括皮肤试验及检测特异性血清lgE抗体（放射性过敏原吸附试验）。而标准化的鼻部激发试验（nasal provocation testing,NPT）在鉴别AR与非AR应用中,是一个十分有效且安全的方法。AR的治疗一般包括避免接触变庙原、药物治疔、侍疫疗法及手术疗法等。     

北京地区学龄儿童变应性鼻炎相关因素分析

目的 了解北京城区学龄儿童变应性鼻炎的主要变应原、伴发结膜炎的情况及其与气道高反应的关系.方法 2006年和2007年8-9月在首都儿科研究所耳鼻喉科门诊就诊的100例6～14岁的变应性鼻炎患儿为病例组,小学健康儿童(无变态反应性疾病)30名为正常对照组,进行问卷调查及吸入变应原皮肤点刺试验(skin prick test,SPT);随机选取病例组中53例鼻炎患儿和对照组30名儿童做乙酰甲胆碱气道激发试验(methacholine bronchial provocation test,Mth BPT).结果 ①变应性鼻炎组中螨、霉菌、艾蒿、猫狗毛、夏秋季花粉、葎草SPT阳性率较高,分别为55%、39%、36%、34%、31%、27%、22%.②变应性鼻炎组中各年龄组螨SPT阳性率差异无统计学意义,而艾蒿和夏秋季花粉随年龄增加SPT阳性率明显增JJ玎(x2=7.51,6.29,P均＜0.05).③变应性鼻炎合并结膜炎患儿为65%.合并结膜炎组患儿变应原阳性数量高于单纯变应件鼻炎组,差异有统计学意义(t=3.06,P＜0.05).④变应性鼻炎症状越重,变应原阳性数幂越多(r=0.21,P=0.04),越可能合并变应件结膜炎(r=0.31,P=0.002).⑤变应性鼻炎组53例患儿乙酰甲且日碱气道激发试验阳性率为77%,正常对照组儿童为16.7%,两组差异有统计学意义(x2=28.56,P＜0.0001).变应性鼻炎组激发试验阳性的发生概率是正常对照组的17.08倍(95%可信区间5.38～54.26).结论 北京城区儿童8-9月变应性鼻炎就诊高峰和花粉变应原有关,其中艾蒿、夏秋季花粉和年龄有相关性.变应性鼻炎合并结膜炎发病率高,应注重结膜炎的诊断和治疗.变应性鼻炎儿童气道反应性增加,应对其积极治疗,减缓和预防哮喘的发生.