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Prevalence of rhinitis among teenagers
Abstracts S199
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2
794
Hayfever Symptoms and Medication Use in UK Teenagers
S. M. Walker1, S. Khan-Wasti1, M. Fletcher1, A. Sheikh2; 1National Respiratory Training Centre, Warwick, UNITED KINGDOM, 2Division of Community Health Sciences: GP Section, University of Edinburgh, Edinburgh, UNITED KINGDOM. RATIONALE: Hayfever is a common condition which reaches peak prevalence in adolescence. Symptoms are often trivialised by patients and health professionals, although symptoms and some treatments (sedating anti-histamines) have been shown to affect learning and concentration. The aim of this study was to investigate hayfever symptoms and use of allergy medication in UK secondary school children. METHODS: All students aged 15/16 (n=3286) in 14 schools in the West Midlands area of the UK were invited to participate in the study via parental letter and consent. A pre-piloted questionnaire asking about respiratory health, smoking, and hayfever treatment was developed (using, where appropriate, validated questions from the ISAAC study) and piloted among a group of 16y olds. The questionnaire was distributed to all year 11 (15/16 yr old) students in April 2004. RESULTS: 3189/3286 (97%) students agreed to participate in the study, and questionnaires were completed and returned by 2282 (72%). 51% (1153) students reported symptoms indicative of hayfever although only 21% (485) reported a diagnosis of hayfever by their nurse or doctor. 25% (570) reported a diagnosis of asthma and 20% (461) smoked cigarettes. 22% (502) reported taking medication for their hayfever. The most commonly used treatments were non-sedating anti-histamines (49%), followed by nasal steroids (23%) and sedating anti-histamines (22%).
CONCLUSIONS: Of responders, 51% of UK 15/16 y olds report symptoms indicative of hayfever, although only 21% reported having had a clinical diagnosis of hayfever. Sedating anti-histamines are commonly prescribed despite the availability of effective alternatives. Funding: Schering-Plough UK Ltd
795
Prevalence of Rhinitis Among Teenagers
A. Teijeiro; Faculty of Medicine, Catholic University of Cordoba, Cordoba, ARGENTINA. RATIONALE: ISAAC (International Study of Asthma and Allergies in Childhood) provides, a unique opportunity for a worldwide comparison of the prevalence and severity of symptoms of rhinitis in adolescents. METHODS: A standardized, self-administered, written questionnaire was used in the randomized study sample of 13-14 years old teenagers attending 20 public and private secondary schools in Cordoba, Argentina as a part of the ISAAC phase III performed in 2002/2003. RESULTS: 3,445 children completed the questionnaire. Nose symptoms ever were found in 1,699 children (49.5%); nose symptoms in the last 12 months were found in 1,379 children (40%). 587 teenagers presented nose and eyes symptoms during the last 12 months (17%). 22% of children having symptoms of rhinitis have limited their daily activity. Physiciandiagnosis of allergic rhinitis was found in 12.7%. A great seasonal variation was found. The major burden of rhinitis was during winter time, 16% in June, 13.6% in August, and 13.9% in September, being the lowest at the beginning of summer (4.1% in December). CONCLUSIONS: This study shows that the prevalence and severity of rhinitis is highly prevalent in teenagers also affecting their quality of life. This study suggests that rhinitis is underdiagnosed. Rhinitis is an important public health problem in Cordoba, Argentina. Funding: INTERASMA Nasopharyngeal Lymphoma Presenting as Intractable Nasal Congestion in a Patient With Allergic Rhinitis S. Cherian1, S. Narula2, A. Apter2; 1Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, 2Allergy and Clinical Immunology, Hospital of the University of Pennsylvania, Philadelphia, PA. RATIONALE: Non-Hodgkin’s Lymphoma (NHL) of the nasal cavity and paranasal sinuses can present with similar symptoms as allergic rhinitis, and can be mistaken for persistent allergic rhinitis. METHODS: The case history of a patient with long-standing allergic rhinitis and breast cancer is reviewed. RESULTS: A 65 year old woman who lived in the Northeastern United States presented to her allergist in late February for persistent nasal congestion. She had a history of allergic rhinitis, GERD, and breast cancer. She continued to experience bilateral nasal congestion despite several months of combination antihistamines, nasal steroid sprays, and oral decongestants. Radiographic imaging later revealed prominent enlargement of lymphoid tissue in the nasopharynx without nasal polyps. CT of the abdomen and pelvis also revealed diffuse lymphadenopathy. Biopsy of the nasopharyngeal tissue showed a predominance of large transformed malignant lymphocytes, consistent with diffuse large B-cell lymphoma, a type of NHL. CONCLUSIONS: In older patients with intractable nasal congestion despite optimal medical therapy for allergic rhinitis, a thorough examination should be undertaken and alternative diagnoses considered. An otorhinolaryngological evaluation and imaging studies should look for an anatomical obstruction such as a malignant mass. In NHL of the nasal cavity, most patients are symptomatic for months prior to diagnosis. B symptoms are present only in the minority of patients. Recognition and early diagnosis is vital to ensure appropriate therapy.
796
MONDAY
Risk Factors of Airway Hyperresponsiveness in Childhood Allergic Rhinitis Without Asthma S. Satitpimpa, C. Direkwattanachai, S. Benjaponpitak, J. Sasisakulporn, S. Tongpradit; Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, THAILAND. RATIONAL: Allergic rhinitis patients who have bronchial hyperresponsiveness (BHR) are those who are more likely to develop asthma . The purposes of this study were to evaluate the prevalence of BHR in nonasthmatic children with allergic rhinitis by measuring the methacholine (Mch) reactivity and to evaluate the demographic data associated with BHR. METHODS: The study is a cross-sectional evaluation of BHR in 59 allergic rhinitis children (age range 6-18 years ) without asthmatic symptom and FEV1 > 80% predicted. All subjects were evaluated for their associated history of atopy and underwent the diagnostic evaluation including: skin prick test for common aeroallergens, pulmonary function test, peak expiratory flow rate variability (PEFv) and Mch bronchial challenge test. RESULTS: Eight of 59 patients had Mch positive (PD20< 80 breath units). The median PEFv was 5.92% (range 1-27) in Mch positive group and 4.33% (range 1-19.2) in Mch negative group, the difference being not significant (p=0.129, Mann-Whitney U-test). Comparing the risk factors between Mch positive and Mch negative group included criteria : birth weight, duration of breast feeding, cat or dog ownership, passive smoke exposure, pattern and number of skin prick test reactivity, day care attendance, history of eczema, and familial atopic disease. Statistically, however, there was no difference between the two groups. CONCLUSIONS: The prevalence of BHR in allergic rhinitis children was 13.56%. Only one case in Mch positive group had PEFv > 20% . This study revealed that there is no definite link between the studied risk factors and BHR in allergic rhinitis children. Funding: Faculty of Medicine , Ramathibodi Hospital ,THAILAND
793
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2
794
Hayfever Symptoms and Medication Use in UK Teenagers
S. M. Walker1, S. Khan-Wasti1, M. Fletcher1, A. Sheikh2; 1National Respiratory Training Centre, Warwick, UNITED KINGDOM, 2Division of Community Health Sciences: GP Section, University of Edinburgh, Edinburgh, UNITED KINGDOM. RATIONALE: Hayfever is a common condition which reaches peak prevalence in adolescence. Symptoms are often trivialised by patients and health professionals, although symptoms and some treatments (sedating anti-histamines) have been shown to affect learning and concentration. The aim of this study was to investigate hayfever symptoms and use of allergy medication in UK secondary school children. METHODS: All students aged 15/16 (n=3286) in 14 schools in the West Midlands area of the UK were invited to participate in the study via parental letter and consent. A pre-piloted questionnaire asking about respiratory health, smoking, and hayfever treatment was developed (using, where appropriate, validated questions from the ISAAC study) and piloted among a group of 16y olds. The questionnaire was distributed to all year 11 (15/16 yr old) students in April 2004. RESULTS: 3189/3286 (97%) students agreed to participate in the study, and questionnaires were completed and returned by 2282 (72%). 51% (1153) students reported symptoms indicative of hayfever although only 21% (485) reported a diagnosis of hayfever by their nurse or doctor. 25% (570) reported a diagnosis of asthma and 20% (461) smoked cigarettes. 22% (502) reported taking medication for their hayfever. The most commonly used treatments were non-sedating anti-histamines (49%), followed by nasal steroids (23%) and sedating anti-histamines (22%).
CONCLUSIONS: Of responders, 51% of UK 15/16 y olds report symptoms indicative of hayfever, although only 21% reported having had a clinical diagnosis of hayfever. Sedating anti-histamines are commonly prescribed despite the availability of effective alternatives. Funding: Schering-Plough UK Ltd
795
Prevalence of Rhinitis Among Teenagers
A. Teijeiro; Faculty of Medicine, Catholic University of Cordoba, Cordoba, ARGENTINA. RATIONALE: ISAAC (International Study of Asthma and Allergies in Childhood) provides, a unique opportunity for a worldwide comparison of the prevalence and severity of symptoms of rhinitis in adolescents. METHODS: A standardized, self-administered, written questionnaire was used in the randomized study sample of 13-14 years old teenagers attending 20 public and private secondary schools in Cordoba, Argentina as a part of the ISAAC phase III performed in 2002/2003. RESULTS: 3,445 children completed the questionnaire. Nose symptoms ever were found in 1,699 children (49.5%); nose symptoms in the last 12 months were found in 1,379 children (40%). 587 teenagers presented nose and eyes symptoms during the last 12 months (17%). 22% of children having symptoms of rhinitis have limited their daily activity. Physiciandiagnosis of allergic rhinitis was found in 12.7%. A great seasonal variation was found. The major burden of rhinitis was during winter time, 16% in June, 13.6% in August, and 13.9% in September, being the lowest at the beginning of summer (4.1% in December). CONCLUSIONS: This study shows that the prevalence and severity of rhinitis is highly prevalent in teenagers also affecting their quality of life. This study suggests that rhinitis is underdiagnosed. Rhinitis is an important public health problem in Cordoba, Argentina. Funding: INTERASMA Nasopharyngeal Lymphoma Presenting as Intractable Nasal Congestion in a Patient With Allergic Rhinitis S. Cherian1, S. Narula2, A. Apter2; 1Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, 2Allergy and Clinical Immunology, Hospital of the University of Pennsylvania, Philadelphia, PA. RATIONALE: Non-Hodgkin’s Lymphoma (NHL) of the nasal cavity and paranasal sinuses can present with similar symptoms as allergic rhinitis, and can be mistaken for persistent allergic rhinitis. METHODS: The case history of a patient with long-standing allergic rhinitis and breast cancer is reviewed. RESULTS: A 65 year old woman who lived in the Northeastern United States presented to her allergist in late February for persistent nasal congestion. She had a history of allergic rhinitis, GERD, and breast cancer. She continued to experience bilateral nasal congestion despite several months of combination antihistamines, nasal steroid sprays, and oral decongestants. Radiographic imaging later revealed prominent enlargement of lymphoid tissue in the nasopharynx without nasal polyps. CT of the abdomen and pelvis also revealed diffuse lymphadenopathy. Biopsy of the nasopharyngeal tissue showed a predominance of large transformed malignant lymphocytes, consistent with diffuse large B-cell lymphoma, a type of NHL. CONCLUSIONS: In older patients with intractable nasal congestion despite optimal medical therapy for allergic rhinitis, a thorough examination should be undertaken and alternative diagnoses considered. An otorhinolaryngological evaluation and imaging studies should look for an anatomical obstruction such as a malignant mass. In NHL of the nasal cavity, most patients are symptomatic for months prior to diagnosis. B symptoms are present only in the minority of patients. Recognition and early diagnosis is vital to ensure appropriate therapy.
796
MONDAY
Risk Factors of Airway Hyperresponsiveness in Childhood Allergic Rhinitis Without Asthma S. Satitpimpa, C. Direkwattanachai, S. Benjaponpitak, J. Sasisakulporn, S. Tongpradit; Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, THAILAND. RATIONAL: Allergic rhinitis patients who have bronchial hyperresponsiveness (BHR) are those who are more likely to develop asthma . The purposes of this study were to evaluate the prevalence of BHR in nonasthmatic children with allergic rhinitis by measuring the methacholine (Mch) reactivity and to evaluate the demographic data associated with BHR. METHODS: The study is a cross-sectional evaluation of BHR in 59 allergic rhinitis children (age range 6-18 years ) without asthmatic symptom and FEV1 > 80% predicted. All subjects were evaluated for their associated history of atopy and underwent the diagnostic evaluation including: skin prick test for common aeroallergens, pulmonary function test, peak expiratory flow rate variability (PEFv) and Mch bronchial challenge test. RESULTS: Eight of 59 patients had Mch positive (PD20< 80 breath units). The median PEFv was 5.92% (range 1-27) in Mch positive group and 4.33% (range 1-19.2) in Mch negative group, the difference being not significant (p=0.129, Mann-Whitney U-test). Comparing the risk factors between Mch positive and Mch negative group included criteria : birth weight, duration of breast feeding, cat or dog ownership, passive smoke exposure, pattern and number of skin prick test reactivity, day care attendance, history of eczema, and familial atopic disease. Statistically, however, there was no difference between the two groups. CONCLUSIONS: The prevalence of BHR in allergic rhinitis children was 13.56%. Only one case in Mch positive group had PEFv > 20% . This study revealed that there is no definite link between the studied risk factors and BHR in allergic rhinitis children. Funding: Faculty of Medicine , Ramathibodi Hospital ,THAILAND
793