Pollen-induced allergic rhinitis in 1360 Italian children: comorbidities and determinants of severity.
BACKGROUND
Pollen-induced allergic rhinoconjunctivitis (AR) is highly prevalent and rapidly evolving during childhood. General practitioners may not be fully aware of the nature and severity of symptoms experienced by patients and might underestimate the prevalence of moderate or severe disease. Thus, the relevance of early diagnosis and intervention may be overlooked.


OBJECTIVE
To investigate the severity of pollen-induced AR and its determinants in Italian children referred to allergy specialists and who had never received specific immunotherapy (SIT).


METHODS
Children (age 4-18 yr) affected by pollen-induced AR who had never undergone SIT were recruited between May 2009 and June 2011 in 16 pediatric outpatient clinics in 14 Italian cities. Recruited children's parents answered standardized questionnaires on atopic diseases (International Study of Allergy and Asthma in Childhood, Allergic Rhinitis and its Impact on Asthma, Global Initiative for Asthma). The children underwent skin-prick test (SPT) with several airborne allergens and six food allergens. Information on socio-demographic factors, parental history of allergic diseases, education, perinatal events, breastfeeding, nutrition and environmental exposure in early life was collected through an informatics platform shared by the whole network of clinical centers (AllergyCARD™).


RESULTS
Among the 1360 recruited patients (68% males, age 10.5 ± 3.4 yr), 695 (51%) had moderate-to-severe AR, 533 (39%) asthma, and 325 (23.9%) oral allergy syndrome (OAS). Reported onset of pollen-induced AR was on average at 5.3 ± 2.8 yr, and its mean duration from onset was 5.2 ± 3.3 yr. Only 6.2% of the patients were pollen-monosensitized, and 84.9% were sensitized to ≥3 pollens. A longer AR duration was significantly associated with moderate-to-severe AR symptoms (p 0.004), asthma (p 0.030), and OAS comorbidities (p < 0.001).


CONCLUSIONS
This nationwide study may raise awareness of the severity of pollen-induced AR among Italian children who have never received pollen SIT. The strong association between pollen-induced AR duration and several markers of disease severity needs replication in longitudinal studies, while suggesting that countrywide initiatives for earlier diagnosis and intervention should be planned.
Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Pediatric Unit, Department for Mother and Child, Ramazzini Hospital, Carpi, Italy.
Arianna
A
Dondi
Salvatore
S
Tripodi
Valentina
V
Panetta
Riccardo
R
Asero
Andrea Di Rienzo
AD
Businco
Annamaria
A
Bianchi
Antonio
A
Carlucci
Giampaolo
G
Ricci
Federica
F
Bellini
Nunzia
N
Maiello
Michele Miraglia
MM
del Giudice
Tullio
T
Frediani
Simona
S
Sodano
Iride
I
Dello Iacono
Francesco
F
Macrì
Valerio
V
Massaccesi
Carlo
C
Caffarelli
Laura
L
Rinaldi
Maria Francesca
MF
Patria
Elena
E
Varin
Diego
D
Peroni
Iolanda
I
Chinellato
Loredana
L
Chini
Viviana
V
Moschese
Sandra
S
Lucarelli
Roberto
R
Bernardini
Giuseppe
G
Pingitore
Umberto
U
Pelosi
Mariangela
M
Tosca
Francesco
F
Paravati
Stefania
S
La Grutta
Paolo
P
Meglio
Mauro
M
Calvani
Mario
M
Plebani
Paolo Maria
PM
Matricardi
D017668:Age of Onset; D000485:Allergens / Q000276:immunology; D052179:Antigens, Plant / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003233:Conjunctivitis, Allergic / Q000453:epidemiology*; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D011058:Pollen / Q000009:adverse effects / Q000276:immunology; D015995:Prevalence; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis / Q000453:epidemiology*; D012882:Skin Tests; D011795:Surveys and Questionnaires
D000485:Allergens; D052179:Antigens, Plant
Italy; allergic conjunctivitis; allergic rhinitis; asthma; children; epidemiology; multiple pollen syndrome; pan-allergens; profilin