title: Identifying the heterogeneity of young adult rhinitis through cluster analysis in the Isle of Wight birth cohort.
abstract: BACKGROUND
  Rhinitis affects many young adults and often shows comorbidity with asthma.
  
  
  OBJECTIVE
  We hypothesized that young adult rhinitis, like asthma, exhibits clinical heterogeneity identifiable by means of cluster analysis.
  
  
  METHODS
  Participants in the Isle of Wight birth cohort (n = 1456) were assessed at 1, 2, 4, 10, and 18 years of age. Cluster analysis was performed on those with rhinitis at age 18 years (n = 468) by using 13 variables defining clinical characteristics.
  
  
  RESULTS
  Four clusters were identified. Patients in cluster 1 (n = 128 [27.4%]; ie, moderate childhood-onset rhinitis) had high atopy and eczema prevalence and high total IgE levels but low asthma prevalence. They showed the best lung function at 18 years of age, with normal fraction of exhaled nitric oxide (Feno), low bronchial hyperresponsiveness (BHR), and low bronchodilator reversibility (BDR) but high rhinitis symptoms and treatment. Patients in cluster 2 (n = 199 [42.5%]; ie, mild-adolescence-onset female rhinitis) had the lowest prevalence of comorbid atopy, asthma, and eczema. They had normal lung function and low BHR, BDR, Feno values, and total IgE levels plus low rhinitis symptoms, severity, and treatment. Patients in cluster 3 (n = 59 [12.6%]; ie, severe earliest-onset rhinitis with asthma) had the youngest rhinitis onset plus the highest comorbid asthma (of simultaneous onset) and atopy. They showed the most obstructed lung function with high BHR, BDR, and Feno values plus high rhinitis symptoms, severity, and treatment. Patient 4 in cluster 4 (n = 82 [17.5%]; ie, moderate childhood-onset male rhinitis with asthma) had high atopy, intermediate asthma, and low eczema. They had impaired lung function with high Feno values and total IgE levels but intermediate BHR and BDR. They had moderate rhinitis symptoms.
  
  
  CONCLUSIONS
  Clinically distinctive adolescent rhinitis clusters are apparent with varying sex and asthma associations plus differing rhinitis severity and treatment needs.
authors.affiliation: David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, United Kingdom.
authors.forename: Ramesh J
authors.initials: RJ
authors.lastname: Kurukulaaratchy
authors.affiliation: Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tenn.
authors.forename: Hongmei
authors.initials: H
authors.lastname: Zhang
authors.affiliation: David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, United Kingdom.
authors.forename: Veeresh
authors.initials: V
authors.lastname: Patil
authors.affiliation: David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, United Kingdom.
authors.forename: Abid
authors.initials: A
authors.lastname: Raza
authors.affiliation: Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tenn.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Karmaus
authors.affiliation: Large Animal Clinical Sciences, Michigan State University, East Lansing, Mich.
authors.forename: Susan
authors.initials: S
authors.lastname: Ewart
authors.affiliation: David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, United Kingdom; Clinical and Experimental Medicine, Faculty of Medicine, University of Southampton, Southampton, United Kingdom. Electronic address: sha@soton.ac.uk.
authors.forename: S Hasan
authors.initials: SH
authors.lastname: Arshad
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D015331:Cohort Studies; D004485:Eczema / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D008297:Male; D008450:Maximal Midexpiratory Flow Rate; D009569:Nitric Oxide / Q000378:metabolism; D015995:Prevalence; D012220:Rhinitis / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D009569:Nitric Oxide; D007073:Immunoglobulin E
keywords: Asthma; cluster analysis; morbidity; rhinitis; wheezing
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