title: Nasal obstructive disorders induce medical treatment failure in paediatric persistent allergic rhinitis (The NODPAR Study).
abstract: Allergic rhinitis (AR) is the most common chronic disease among children. To characterize the disease, a modified classification of severity (m-ARIA) has recently been validated in AR children. When medical treatment fails, surgery for nasal obstructive disorders (NOD) may be a therapeutic option. Our objective was to assess the prevalence of NOD and their influence in medical treatment response among children with persistent AR (PER).
  
  
  
  In a prospective, real-life study, 130 paediatric PER patients (13.1 ± 2.8 years, females 31.5%, severe rhinitis 49%) referred from Allergy to ENT department were assessed for their response (R, responders; NR, non-responders) to medical treatment (intranasal steroids and antihistamines or antileukotrienes) by direct questioning and nasal symptom visual analogue scale, the presence of NOD (septal deformity, turbinate enlargement and adenoidal hyperplasia), comorbidities, nasal symptoms, rhinitis severity (modified ARIA criterion) and asthma control (International Consensus On Pediatric Asthma criterion).
  
  
  
  After 2 months of treatment, the NR group presented a higher prevalence of obstructive septal deformity and severe inferior turbinate enlargement when compared with the R group. Higher septal deformity and turbinate enlargement scores were strongly associated with treatment refractoriness. The prevalence of severe PER was also higher for the NR group. Higher asthma control scores were associated with the probability of treatment-induced improvement.
  
  
  
  In paediatric PER patients, medical therapy refractoriness was associated with NOD, mainly septal deformity and turbinate enlargement. In those patients, ENT examination will facilitate an early NOD diagnosis in order to indicate potential corrective surgery.
authors: Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain.|Unidad de Rinología, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain.|Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya).
authors: Franklin S
authors: FS
authors: Mariño-Sánchez
authors: Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain.|Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain.
authors: Meritxell
authors: M
authors: Valls-Mateus
authors: Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain.
authors: Karen
authors: K
authors: Ruiz-Echevarría
authors: Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya).|Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain.
authors: Isam
authors: I
authors: Alobid
authors: Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain.
authors: Paulina
authors: P
authors: Cardenas-Escalante
authors: Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain.
authors: Rosa
authors: R
authors: Jiménez-Feijoo
authors: Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain.
authors: Jaime
authors: J
authors: Lozano-Blasco
authors: Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain.
authors: María T
authors: MT
authors: Giner-Muñoz
authors: HNO-Center Luzern AG, Luzern, Switzerland.
authors: Jesús
authors: J
authors: Rodríguez-Jorge
authors: Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain.
authors: Oliver
authors: O
authors: Haag
authors: Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain.
authors: Ana M
authors: AM
authors: Plaza-Martin
authors: Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya).|Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain.
authors: Joaquim
authors: J
authors: Mullol
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D004351:Drug Resistance; D005260:Female; D006633:Histamine Antagonists / Q000627:therapeutic use*; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D008297:Male; D015508:Nasal Obstruction / Q000453:epidemiology*; D009300:Nasal Septum / Q000033:anatomy & histology*; D015995:Prevalence; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012008:Recurrence; D065631:Rhinitis, Allergic / Q000188:drug therapy / Q000453:epidemiology*; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D013256:Steroids / Q000627:therapeutic use*; D017211:Treatment Failure; D014420:Turbinates / Q000033:anatomy & histology*
chemical_list: D006633:Histamine Antagonists; D020024:Leukotriene Antagonists; D013256:Steroids
keywords: allergic rhinitis; nasal obstruction; nasal septum deformity; paediatrics; turbinate hyperplasia