BACKGROUND Chronic rhinitis symptoms cause significant health burden among children and can have a heterogeneous presentation. Defining phenotypes of childhood chronic rhinitis and associated pathobiology may lead to prevention or improved treatments. OBJECTIVES We sought to identify longitudinal patterns of rhinitis symptoms in childhood and determine their associations with early life risk factors, allergic comorbidities, and nasal epithelial cell gene expression. METHODS Chronic rhinitis symptoms were evaluated from ages 1 through 11 years in 485 urban children at high risk for allergic disease in the URECA (Urban Environment and Childhood Asthma) birth cohort. We identified longitudinal rhinitis phenotypes and their relationships to early life exposures, atopic comorbidities, and patterns of nasal epithelial gene expression at age 11 years. RESULTS Chronic rhinitis symptoms started early in many children and were a risk factor for developing aeroallergen sensitization. We identified 4 longitudinal rhinitis phenotypes: low/minimal, persistent, persistent decreasing, and late increasing. Persistent rhinitis was most closely linked to allergic sensitization and asthma. Risk factors for persistent rhinitis included frequent colds (P < .001), antibiotic use (P < .001), and reduced exposure to common indoor aeroallergens (P = .003). Compared to low/minimal rhinitis phenotype, the other rhinitis phenotypes were associated with increased expression of canonical type 2 genes and decreased expression of immune response genes. CONCLUSIONS In urban children, rhinitis symptoms often precede aeroallergen sensitization. Rhinitis phenotypes based on symptoms had distinct risk factors and nasal transcriptome. These results suggest that focusing on early life risk factors and distinct immune mechanisms may be a target to preventing chronic rhinitis in childhood.

中文翻译：

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城市出生队列中纵向鼻炎表型的临床和分子分析。


背景 慢性鼻炎症状对儿童造成重大健康负担，并且可能具有异质性的表现。定义儿童慢性鼻炎的表型和相关病理学可能有助于预防或改进治疗。目的 我们试图确定儿童期鼻炎症状的纵向模式，并确定它们与早期生活危险因素、过敏合并症和鼻上皮细胞基因表达的相关性。方法 在 URECA （城市环境和儿童哮喘） 出生队列中，评估了 485 名过敏性疾病高危城市儿童从 1 岁到 11 岁的慢性鼻炎症状。我们确定了纵向鼻炎表型及其与 11 岁时早期生活暴露、特应性合并症和鼻上皮基因表达模式的关系。结果 慢性鼻炎症状在许多儿童早期开始，是发生空气过敏原致敏的危险因素。我们确定了 4 种纵向鼻炎表型： 低/最小、持续、持续下降和晚期增加。持续性鼻炎与过敏性致敏和哮喘最密切相关。持续性鼻炎的危险因素包括频繁感冒 （P < .001）、抗生素使用 （P < .001） 和减少暴露于常见的室内空气过敏原 （P = .003）。与低/轻微鼻炎表型相比，其他鼻炎表型与经典 2 型基因表达增加和免疫反应基因表达降低相关。结论 在城市儿童中，鼻炎症状常先于空气过敏原致敏。基于症状的鼻炎表型具有不同的危险因素和鼻转录组。 这些结果表明，关注早期生命风险因素和不同的免疫机制可能是预防儿童期慢性鼻炎的目标。