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Phenotypical Features of Obstructive Sleep Apnea (OSA) in Children with Chronic Rhinitis
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Phenotypical Features of Obstructive Sleep Apnea (OSA) in Children with Chronic Rhinitis Maria J. Gutierrez, MD1, Carlos Rodriguez-Martinez, MD2, Cesar Nino, PhD3, Anjani Ravindra, MD4, Gustavo Nino, MD5; 1Division of Pulmonary, Allergy & Immunology and Critical Care Medicine, Pennsylvania State University College of Medicine, Hershey, PA; Division of Pediatric Rheumatology, Pennsylvania State University College of Medicine, Hershey, PA, 2Division of Pediatric Pulmonology, National University of Colombia, Bogota, Colombia, 3Department of Electronics Engineering, Javeriana University, Bogota, Colombia, 4Department of Pediatrics, Division of Pediatric Pulmonology, Hershey, PA, 5Penn State Sleep Research and Treatment Center, Pennsylvania State University College of Medicine, Hershey, PA; Department of Pediatrics, Division of Pediatric Pulmonology, Pennsylvania State University College of Medicine. RATIONALE: Chronic rhinitis and obstructive sleep apnea (OSA) often coexist during childhood. To delineate this clinical association, we investigated the severity and phenotypical features of OSA in children with chronic rhinitis. Specifically, we hypothesized that children with rhinitis have a distinct OSA phenotype that involves a higher prevalence of Rapid-Eye-Movement (REM)-related breathing abnormalities. METHODS: We conducted a retrospective cross-sectional analysis of 146 children aged 2-12 years with OSA diagnosed by polysomnography (PSG) in our sleep center. Outcomes included PSG parameters and obstructive apnea hypopnea index (OAHI) during REM and non-REM sleep. Linear model or logistic regression model was built to study the joint effect of rhinitis and OSA parameters with control for potential confounders (significance level p<0.05). RESULTS: Chronic rhinitis was present in 43% of children with OSA (n563) but overall OAHI severity was unaffected by the presence of rhinitis in children with OSA. In contrast, OAHI severity during REM sleep in children with moderate-severe OSA was significantly increased in subjects with rhinitis and OSA (44.1/h SE56.4) compared to those with OSA alone (28.2/hr; SE53.8) Multivariate analysis revealed that the association between rhinitis and REM-related OSA parameters is independent of obesity, age, gender and ethnicity. CONCLUSIONS: These results demonstrate that rhinitis is an important comorbidity in children with OSA. Although OSA is not more severe in children with rhinitis, they do have a distinct OSA phenotype characterized by more REM-related OSA.
150
Skin Prick Test and Serum Specific IgE May Not Be Sufficient for the Diagnosis of Perennial Allergic Rhinitis in Atopic Patients Miguel Blanca, MD, PhD1, Carmen Rondon, MD, PhD2, Paloma Campo, MD, PhD2, Francisca Gomez, MD, PhD3, Rosa Garcıa Mendoza2, Maria Isabel Sanchez Rivas2, Lidia Melendez, Lab. Tech.4, Tahıa Fernandez, PhD3, Marıa Jose Torres, MD, PhD1; 1Allergy Service, Carlos Haya Hospital, Malaga, Spain, 2Allergy Service Carlos Haya Hospital, Malaga, Spain, 3IMABIS Foundation, Malaga, Spain, 4Research Laboratory, Hospital Carlos Haya, Malaga, Spain. RATIONALE: The aim of this study was to evaluate the usefulness of nasal allergen provocation test (NAPT) in the detection of non-seasonal clinically relevant aeroallergens in atopic perennial rhinitis patients with skin prick test (SPT) positivity to seasonal pollens. METHODS: A total of 19 perennial rhinitis patients with clinical history of more than 2 years of evolution and positive SPT to seasonal pollens were included. Clinical questionnaire, SPT, serum determination of total and specific IgE to aeroallergens, and NAPT were carried out in all subjects. Response to NAPT was assessed by appearance of nasal-ocular symptoms, changes in nasal patency evaluated by acoustic rhinometry, and determination of specific IgE, and inflammatory mediators (tryptase and ECP) in nasal secretions. RESULTS: Clinical data showed a mean evolution of 7,6 years in these patients, with a worsening of symptoms during spring in 26% and after natural exposure to house dust in 52,6% of cases. SPT was positive to olive
and/or grass pollen in 68% and 37% of patients respectively. SPT and serum specific IgE were negative to perennial allergens (house dust mite, molds, and dander epithelia) in all cases. However NAPT induced a nasal allergic response to D. Pteroyssinus in 94.7%, and to Alternaria alternata in 63.2% of patients. CONCLUSIONS: According to these data SPT and serum specific IgE can be not sufficient to detect relevant aeroallergens implicated in perennial allergic rhinitis in spite of evidence of positive response to seasonal aeroallergens.
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Underutilization of Rhinolaryngoscopy in Allergy Practices: Results of National Survey of Allergists and Fellows in Training (FITs) Puneet Bajaj, MD1, Timothy J. Craig, DO FAAAAI1,2,3; 1Hershey Medical Center, Hershey, PA, 2Penn State University College of Medicine, Hershey, PA, 3Penn State University. RATIONALE: Rhinolaryngoscopy is a valuable diagnostic tool for examination of nasal passages and adjoining upper airway. As specialists dealing with nose and upper airways, allergists are expected to have expertise in performing rhinolaryngoscopy. A review of literature did not reveal any published studies on utilization of rhinolaryngoscopy in allergy practices. METHODS: A survey of practicing allergists and FITs was conducted by circulating an internet based questionnaire to members of AAAAI in JuneJuly 2012 to determine their experience with performing rhinolaryngoscopy. Information was collected regarding the type of practice, level of experience, amount of endoscopic training received, and potential barriers for performing rhinolaryngoscopy. RESULTS: A total of 592 responses were received from 4,632 survey recipients with a response rate of 12.78%, which is a higher than average response rate. The majority of allergists (68.5%) do not perform rhinolaryngoscopies. Only 24% of allergists working in academics reported performing this procedure compared to 34% in nonacademic settings. Out of 38 FITs who responded, only 29% reported performing this procedure during training. Limited rhinolaryngoscopy training during fellowship was reported as the main barrier by majority of the allergists (51.4%). Others barriers reported were limited time during busy practice (47%), concerns about missing pathology (45%), lack of knowledge of anatomy (27.2%), and endoscopic equipment (26.5%). Majority of the allergists (51.6%) reported not being comfortable with documenting, coding and billing for rhinolaryngoscopy. CONCLUSIONS: Rhinolaryngoscopy is poorly utilized by the majority of practicing allergists. A structured approach for teaching rhinolaryngoscopy is needed during fellowship training to improve its utilization.
SATURDAY
Abstracts AB41
J ALLERGY CLIN IMMUNOL VOLUME 131, NUMBER 2
Phenotypical Features of Obstructive Sleep Apnea (OSA) in Children with Chronic Rhinitis Maria J. Gutierrez, MD1, Carlos Rodriguez-Martinez, MD2, Cesar Nino, PhD3, Anjani Ravindra, MD4, Gustavo Nino, MD5; 1Division of Pulmonary, Allergy & Immunology and Critical Care Medicine, Pennsylvania State University College of Medicine, Hershey, PA; Division of Pediatric Rheumatology, Pennsylvania State University College of Medicine, Hershey, PA, 2Division of Pediatric Pulmonology, National University of Colombia, Bogota, Colombia, 3Department of Electronics Engineering, Javeriana University, Bogota, Colombia, 4Department of Pediatrics, Division of Pediatric Pulmonology, Hershey, PA, 5Penn State Sleep Research and Treatment Center, Pennsylvania State University College of Medicine, Hershey, PA; Department of Pediatrics, Division of Pediatric Pulmonology, Pennsylvania State University College of Medicine. RATIONALE: Chronic rhinitis and obstructive sleep apnea (OSA) often coexist during childhood. To delineate this clinical association, we investigated the severity and phenotypical features of OSA in children with chronic rhinitis. Specifically, we hypothesized that children with rhinitis have a distinct OSA phenotype that involves a higher prevalence of Rapid-Eye-Movement (REM)-related breathing abnormalities. METHODS: We conducted a retrospective cross-sectional analysis of 146 children aged 2-12 years with OSA diagnosed by polysomnography (PSG) in our sleep center. Outcomes included PSG parameters and obstructive apnea hypopnea index (OAHI) during REM and non-REM sleep. Linear model or logistic regression model was built to study the joint effect of rhinitis and OSA parameters with control for potential confounders (significance level p<0.05). RESULTS: Chronic rhinitis was present in 43% of children with OSA (n563) but overall OAHI severity was unaffected by the presence of rhinitis in children with OSA. In contrast, OAHI severity during REM sleep in children with moderate-severe OSA was significantly increased in subjects with rhinitis and OSA (44.1/h SE56.4) compared to those with OSA alone (28.2/hr; SE53.8) Multivariate analysis revealed that the association between rhinitis and REM-related OSA parameters is independent of obesity, age, gender and ethnicity. CONCLUSIONS: These results demonstrate that rhinitis is an important comorbidity in children with OSA. Although OSA is not more severe in children with rhinitis, they do have a distinct OSA phenotype characterized by more REM-related OSA.
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Skin Prick Test and Serum Specific IgE May Not Be Sufficient for the Diagnosis of Perennial Allergic Rhinitis in Atopic Patients Miguel Blanca, MD, PhD1, Carmen Rondon, MD, PhD2, Paloma Campo, MD, PhD2, Francisca Gomez, MD, PhD3, Rosa Garcıa Mendoza2, Maria Isabel Sanchez Rivas2, Lidia Melendez, Lab. Tech.4, Tahıa Fernandez, PhD3, Marıa Jose Torres, MD, PhD1; 1Allergy Service, Carlos Haya Hospital, Malaga, Spain, 2Allergy Service Carlos Haya Hospital, Malaga, Spain, 3IMABIS Foundation, Malaga, Spain, 4Research Laboratory, Hospital Carlos Haya, Malaga, Spain. RATIONALE: The aim of this study was to evaluate the usefulness of nasal allergen provocation test (NAPT) in the detection of non-seasonal clinically relevant aeroallergens in atopic perennial rhinitis patients with skin prick test (SPT) positivity to seasonal pollens. METHODS: A total of 19 perennial rhinitis patients with clinical history of more than 2 years of evolution and positive SPT to seasonal pollens were included. Clinical questionnaire, SPT, serum determination of total and specific IgE to aeroallergens, and NAPT were carried out in all subjects. Response to NAPT was assessed by appearance of nasal-ocular symptoms, changes in nasal patency evaluated by acoustic rhinometry, and determination of specific IgE, and inflammatory mediators (tryptase and ECP) in nasal secretions. RESULTS: Clinical data showed a mean evolution of 7,6 years in these patients, with a worsening of symptoms during spring in 26% and after natural exposure to house dust in 52,6% of cases. SPT was positive to olive
and/or grass pollen in 68% and 37% of patients respectively. SPT and serum specific IgE were negative to perennial allergens (house dust mite, molds, and dander epithelia) in all cases. However NAPT induced a nasal allergic response to D. Pteroyssinus in 94.7%, and to Alternaria alternata in 63.2% of patients. CONCLUSIONS: According to these data SPT and serum specific IgE can be not sufficient to detect relevant aeroallergens implicated in perennial allergic rhinitis in spite of evidence of positive response to seasonal aeroallergens.
151
Underutilization of Rhinolaryngoscopy in Allergy Practices: Results of National Survey of Allergists and Fellows in Training (FITs) Puneet Bajaj, MD1, Timothy J. Craig, DO FAAAAI1,2,3; 1Hershey Medical Center, Hershey, PA, 2Penn State University College of Medicine, Hershey, PA, 3Penn State University. RATIONALE: Rhinolaryngoscopy is a valuable diagnostic tool for examination of nasal passages and adjoining upper airway. As specialists dealing with nose and upper airways, allergists are expected to have expertise in performing rhinolaryngoscopy. A review of literature did not reveal any published studies on utilization of rhinolaryngoscopy in allergy practices. METHODS: A survey of practicing allergists and FITs was conducted by circulating an internet based questionnaire to members of AAAAI in JuneJuly 2012 to determine their experience with performing rhinolaryngoscopy. Information was collected regarding the type of practice, level of experience, amount of endoscopic training received, and potential barriers for performing rhinolaryngoscopy. RESULTS: A total of 592 responses were received from 4,632 survey recipients with a response rate of 12.78%, which is a higher than average response rate. The majority of allergists (68.5%) do not perform rhinolaryngoscopies. Only 24% of allergists working in academics reported performing this procedure compared to 34% in nonacademic settings. Out of 38 FITs who responded, only 29% reported performing this procedure during training. Limited rhinolaryngoscopy training during fellowship was reported as the main barrier by majority of the allergists (51.4%). Others barriers reported were limited time during busy practice (47%), concerns about missing pathology (45%), lack of knowledge of anatomy (27.2%), and endoscopic equipment (26.5%). Majority of the allergists (51.6%) reported not being comfortable with documenting, coding and billing for rhinolaryngoscopy. CONCLUSIONS: Rhinolaryngoscopy is poorly utilized by the majority of practicing allergists. A structured approach for teaching rhinolaryngoscopy is needed during fellowship training to improve its utilization.
SATURDAY
Abstracts AB41
J ALLERGY CLIN IMMUNOL VOLUME 131, NUMBER 2