Abstract
Background: Childhood allergic rhinitis (AR) is clinically highly
heterogeneous. We aimed to identify distinct subgroups amongst children
with AR, and to ascertain their association with patterns of symptoms,
allergic sensitization and concomitant physician-diagnosed asthma.
Methods: We recruited 510 children with physician-diagnosed AR, of whom
205 (40%) had asthma. Latent class analysis (LCA) was performed to
identify latent structure within the data set using 17 variables
(allergic conjunctivitis, eczema, asthma, family history of asthma,
family history of allergic rhinitis, skin sensitization to 8 common
allergens, tonsillectomy, adenoidectomy). Results: A four−class solution
was selected as the optimal model based on statistical fit. We labeled
AR latent classes as: (1) AR with grass mono-sensitization and
conjunctivitis (n=361, 70.8%); (2) AR with house dust mite
sensitization and asthma (n=75, 14.7%); (3) AR with pet and grass
polysensitization and conjunctivitis (n=35, 6.9%) and (4) AR among
children with tonsils and adenoids removed (n=39, 7.6%). Perennial AR
was significantly more common among children in Class 2 (OR 5.83, 95%CI
3.42−9.94, p<0.001) and Class 3 (OR 2.88, 95%CI 1.36−6.13,
p=0.006). Mild and intermittent AR symptoms were significantly more
common in children in Class 3 compared to those in Class 1. AR was more
severe in Class 1, compared to other 3 classes, indicating that upper
respiratory symptoms are more severe among children with isolated
seasonal rhinitis, than in those with rhinitis and coexisting asthma.
Conclusion: We have identified 4 phenotypes in school-age children with
AR, which were associated with different patterns of clinical symptoms
and comorbidities.