The natural history of childhood-onset nonallergic rhinitis; a long-term follow-up study

Kantima Kanchanapoomi, Witchaya Srisuwatchari, Punchama Pacharn, Nualanong Visitsunthorn, Orathai Jirapongsananuruk

Affiliation:
Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

Abstract

Background: Non-allergic rhinitis (NAR) is characterized by symptoms of nasal inflammation without allergic sensitization. The long-term outcome of NAR in children is poorly defined.
Objective: To determine the natural history of childhood-onset NAR and the development of allergic rhinitis (AR) in these children.
Methods: NAR patients who were followed for more than 10 years were evaluated at 3-5 years (E2) and 9-12 years (E3) after the first evaluation (E1). Nasal symptoms, disease severity, comorbidities, medication used, and aeroallergen sensitization were assessed.
Results: Eighty-two NAR patients (58.5% male) completed all 3 evaluations. The age at onset was 2.0 (range 2.0-4.0) years. The follow-up period was 13.6 (range 12.3-14.3) years. At E2, 37.8% of patients developed AR. At E3, the patients were classified into four groups based on results of skin prick tests in E2 and E3 (group I: NAR→NAR→NAR, 39.0%, group II: NAR→NAR→AR, 23.2%, group III: NAR→AR→NAR, 12.2% and group IV: NAR→AR→AR, 25.6%). The most common aeroallergen sensitization was house dust mite. The family history of atopy, asthma and allergic rhinitis were higher in group III and IV than other groups (p < 0.05). The atopic dermatitis, obstructive sleep apnea and adenotonsillar hypertrophy at E1 and E2 were predominantly found in group IV (p < 0.05). At E2, group III and IV patients had higher proportion of exposure to house dust, animal dander and smoking compared to other groups (p < 0.05). The overall remission rate was 14.6%.
Conclusion: Children with NAR should be reevaluated periodically to determine aeroallergen sensitization for the appropriate diagnosis and management.
Key words: allergic rhinitis, childhood-onset nonallergic rhinitis, children, natural history, nonallergic rhinitis, sensitization