Early-life mold and tree sensitivity is associated with allergic eosinophilic rhinitis at 4 years of age.
BACKGROUND
Nasal eosinophils are a biomarker for allergic rhinitis (AR) and are associated with increased symptom severity.


OBJECTIVE
To identify predictors of allergic eosinophilic rhinitis (AER) in early childhood in children at higher risk for chronic allergic respiratory disorders.


METHODS
In the Cincinnati Childhood Allergy and Air Pollution Study, infants born to aeroallergen-sensitized and symptomatic parents were examined and underwent skin prick testing (SPT) annually to 15 aeroallergens from 1 to 4 years of age. Wheal circumferences were traced and scanned and areas were determined by computer planimetry. At 4 years, AER was defined as (1) at least 1 positive aeroallergen SPT result, (2) presence of sneezing and runny nose without a cold or influenza, and (3) nasal eosinophilia of at least 5%. Wheal areas at 1 to 3 years were analyzed for an association with AER compared with children without AR.


RESULTS
At 4 years, 487 children completed rhinitis health histories, SPT, and nasal sampling. Ninety-nine children (22.8%) had AR. Thirty-eight children had AER (8.8% of total sample and 38.4% of AR sample, respectively). At 3 years, for every 1-mm(2) increase in Penicillium species (adjusted odds ratio 1.18, 95% confidence interval 1.06-1.32, P = .002) and maple (adjusted odds ratio 1.07, 95% confidence interval 1.01-1.13, P = .02), wheal area significantly increased the risk of AER at 4 years of age.


CONCLUSIONS
Allergic eosinophilic rhinitis was identified in 8.8% of children at 4 years of age. Age 3 years was the earliest that aeroallergen SPT wheal areas were predictive of AER. Skin testing at 3 years identifies children at risk for an AR phenotype with nasal eosinophilia.
Department of Internal Medicine, Divisions of Immunology/Allergy and Pulmonary Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio; Division of Immunology and Microbiology, Rush University Medical Center, Chicago, Illinois. Electronic address: Christopher_D_Codispoti@rush.edu.
Christopher D
CD
Codispoti
Department of Internal Medicine, Divisions of Immunology/Allergy and Pulmonary Medicine, University of Cincinnati, Cincinnati, Ohio.
David I
DI
Bernstein
Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio.
Linda
L
Levin
Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio.
Tiina
T
Reponen
Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio; Division of Asthma Research, Children's Hospital Medical Center, Rush University Medical Center, Chicago, Illinois.
Patrick H
PH
Ryan
Division of Immunology and Microbiology, Rush University Medical Center, Chicago, Illinois.
Jocelyn M
JM
Biagini Myers
Department of Internal Medicine, Divisions of Immunology/Allergy and Pulmonary Medicine, University of Cincinnati, Cincinnati, Ohio.
Manuel
M
Villareal
Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio.
Jeff
J
Burkle
Department of Internal Medicine, Divisions of Immunology/Allergy and Pulmonary Medicine, University of Cincinnati, Cincinnati, Ohio.
Zana
Z
Lummus
Department of Internal Medicine, Divisions of Immunology/Allergy and Pulmonary Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio.
James E
JE
Lockey
Division of Asthma Research, Children's Hospital Medical Center, Rush University Medical Center, Chicago, Illinois.
Gurjit K
GK
Khurana Hershey
Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio.
Grace K
GK
LeMasters
D031002:Acer / Q000276:immunology*; D000485:Allergens / Q000276:immunology; D015415:Biomarkers; D002675:Child, Preschool; D004802:Eosinophilia / Q000276:immunology*; D004804:Eosinophils / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D009297:Nasal Mucosa / Q000276:immunology; D010407:Penicillium / Q000276:immunology*; D011446:Prospective Studies; D012221:Rhinitis, Allergic, Perennial / Q000175:diagnosis* / Q000276:immunology*; D012882:Skin Tests
D000485:Allergens; D015415:Biomarkers