Clinical spectrum of acute rhinosinusitis among atopic and nonatopic children in Taiwan

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Abstract

Background

Rhinitis and sinusitis are very common medical conditions and have been shown to be frequently associated. The role of allergies in the pathogenesis of chronic rhinosinusitis has been confirmed; however, the role of allergies in acute rhinosinusitis is debatable. Nonetheless, allergies are an important factor in the development of rhinosinusitis.

Objective

To evaluate the incidence of allergic rhinitis in patients with acute rhinosinusitis and identify the clinical spectrum in Taiwan.

Methods

This study randomly recruited 69 participants between 3 and 12 years of age with acute rhinosinusitis over the period of one and a half years. All participants underwent a nasal peak expiratory flow rate (nPEFR) test, skin-Prick test (SPT), nasal smear examination, nasal culture, radiography (Water's projection) and were requested to complete the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) as well as provide their allergic history.

Results

Among the 69 participants in the study, 27 (39.1%) participants were shown to have allergic rhinitis. The most troublesome symptoms among the 69 participants with acute rhinosinusitis were postnasal drip (3.00 ± 1.29), nasal obstruction (2.94 ± 1.39) and cough (2.67 ± 1.42). The most troublesome symptoms among the 27 participants with acute rhinosinusitis combined with allergic rhinitis were nasal obstruction (3.33 ± 1.24), postnasal drip (3.22 ± 1.09) and itchy eyes (2.74 ± 1.43) and with the higher values. In addition, the participants (≧6y/o) with acute rhinosinusitis combined with allergic rhinitis had significantly lower nPEFR values compared with the nonatopic children (75.2 ± 18.2 vs 96.6 ± 21.4, p < 0.05). If nPEFR is below 75 mL/min, the positive predict value in the patients of acute rhinosinusitis is 75.0% combined with allergic rhinitis (sensitivity 63.2%; specificity 85.7%). Streptococcus pneumoniae (29.0%), Haemophilus influenzae (20.3%), and Moraxella catarrhalis (17.4%) were the major isolated pathogens in this study. The prevalence of colonization with Staphylococcus aureus in the 69 participants with acute rhinosinusitis was 23.2%, and 15.9% for methicillin-resistant S. aureus (MRSA).

Conclusion

This study demonstrated that the bacteriological properties of acute rhinosinusitis among children in Taiwan are the same as those in other parts of the world; however, the prevalence of colonization by MRSA was higher than among healthy children. Second, atopic children were more likely to develop acute rhinosinusitis than nonatopic children. Third, most Taiwanese children with acute rhinosinusitis complained of postnasal drip, nasal obstruction and cough. If a child suffering from acute rhinosinusitis complained of severe nasal obstruction (nPEFR  75 mL/min), the doctor should be alerted to atopic conditions requiring further treatment. The issues dealt with in this study may require further research with a larger sample population over an extended period of time to verify these conclusions.

Introduction

Allergic rhinitis and rhinosinusitis are common diseases among children and adults consuming considerable health care resources and have been shown to be frequently associated [1], [2]. Although allergic rhinitis and rhinosinusitis have conventionally been considered as distinct clinical entities, they are increasingly being regarded as interrelated and part of a spectrum of upper airway inflammatory disease [3]. Children contract an average of six to eight colds per year with 0.5–5% developing rhinosinusitis [4]. The primary symptoms associated with rhinosinusitis in children are cough, rhinorrhea, nasal obstruction, snoring, postnasal drip, and facial pain [5]. This study focused on whether the symptoms differ among atopic and nonatopic children with acute rhinosinusitis. According to the clinical practice guidelines of the American Academy of Pediatrics (APP), acute rhinosinusitis is defined as an infection of the paranasal sinuses lasting less than 30 days and often presenting as an upper respiratory infections with symptoms worsening 7–10 days after onset. A severe upper respiratory infection with fever and concurrent purulent rhinorrhea for 3–4 consecutive days also meets the criteria for the diagnosis of acute rhinosinusitis [6]. Early, effective antibacterial therapy is essential to shorten the duration of infection and illness, to diminish mucosal damage, and to prevent contiguous infectious involvement of the orbit or central nervous system [7]. Unfortunately, little data is available concerning the bacteriological properties of acute rhinosinusitis among Taiwanese children [8], [9]. Therefore, this study investigated the bacterial isolates from Taiwanese children with acute rhinosinusitis.

The prevalence of allergic rhinitis is increasing, estimated to affect 27.6% (2002) of the children in Taiwan [10]. Allergic rhinitis presents as an inflammation of the nasal mucosa in which eosinophils and the damaged epithelium of the airway play a key role by releasing cytokines and other proinflammatory proteins. This mucosal inflammatory reaction has been shown in mice models to directly obstruct sinus drainage and enhance rhinosinusitis [11]. Subjects with allergic rhinitis show signs of more severely impaired paranasal sinus functioning during viral colds than nonallergic subjects and may face an increased risk of bacterial sinusitis [12]. The role play by allergies in the pathogenesis of chronic rhinosinusitis has been confirmed [13]. However, the link between allergies and acute rhinosinusitis remains an issue of debate. Nonetheless, allergies are an important factor in the development of rhinosinositis. For this reason, this study evaluated the incidence of allergic rhinitis among children with acute rhinosinusitis.

Section snippets

Participants

This study was conducted in the Division of Allergy, Asthma and Rheumatology in the Department of Pediatrics of Chung Shan Medical University Hospital in Taichung, Taiwan, between December 2006 and June 2008. Approval for the study was granted by the Chung Shan Medical University Hospital Institutional Review Board and written parental informed consent was obtained prior to commencing the study. The inclusion criteria for this study were as follows: (1) a history of recent upper respiratory

Results

A total of 69 patients were enrolled in this study, including 39 males and 30 females. The mean age of the patients was 6 (range 3–12) years. It was proved that 27 (39.1%) participants also suffered from allergic rhinitis. No significant differences except gender were observed in the baseline demographic or health characteristics among the patients of the two groups, including: age, height, body weight and personal and family allergic history. Patients with acute rhinosinusitis combined with

Discussion

In present study, the 69 patients with acute rhinosinusitis were randomly enrolled in the study. The incidence of allergic rhinitis (39.1%) was higher than the prevalence in the normal population (27.6%) [10]. Ramadan et al. pointed out that allergies are a significant factor in the development of rhinosinusitis [20]. Naclerio et al. presented several hypotheses to explain the link between allergies and rhinosinusitis. These include tissue edema and vascular congestion causing obstruction of

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