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Persistan rinitli çocuklarda bronş aşırı duyarlılığını saptamak için metakolin challenge testinin kullanımı

Year 2023, Volume: 48 Issue: 1, 29 - 36, 31.03.2023
https://doi.org/10.17826/cumj.1167916

Abstract

Amaç: Çocukluk çağında persistan rinit sıklığı gün geçtikçe artmaktadır. Persistan rinitli hastaların önemli bir kısmında bronşial hiperrekativite (BHR) ve astım görülebildiğinden, bu hastalarda astım gelişme riskini gösterebilecek olan belirteçlerin kullanılması klinik takipte çok önemlidir. Bu çalışmada çocukluk çağındaki persistan rinit astım ilişkisinin bronşial methacoline challenge testi (BMCT) kullanılarak gösterilmesi ve persistan rinitli hastalarda astım gelişme riskiyle ilişkili diğer faktörlerin araştırılması amaçlanmıştır.
Gereç ve Yöntem: Persistan rinit bulguları olan 6-18yaş arası hastalar ayrıntılı öykü, fizik muayene, spirometriyle değerlendirildi. Muayene bulguları ve spirometri bulguları normal olan hastalar ile muayene bulguları ve nazal inflamasyon bulguları orta-ağır rinitle uyumlu hastalar çalışmaya alındı ve cilt prik testiyle atopi durumları, BMCT yapılarak BHR’leri değerlendirildi.
Bulgular: Çalışmaya 73 hasta alındı. Yaş ortalaması 9±2,7yıl olarak bulundu. Hastaların %45,2’sinin erkek, %63’ü alerjik, %45,2’sinde ailede atopi öyküsü olduğu saptandı. BMCT ile hastaların %82,2Sinde BHR tespit edildi. BHR saptanan hastaların %24,7’sinde şiddetli; %32,9’unda orta, %24,7’sinde hafif derecede BHR olduğu gözlendi. Ortanca kan eosinofil sayısı (BEC) 320/mm3; IgE düzeyi 160 kU/ltidi. Alerjik hastaların, alerjik olmayanlara kıyasla IgE, BEC değerleri istatistiksel olarak anlamlı düzeyde yüksekti. BHR olan hastaların başvuru yaşı daha küçük, BEC daha yüksekti. Çoklu değişkenli analizde hasta yaşının <9 yıl; BEC >300/mm3 ve IgE düzeyinin >250IU/lt olması BMCT ile bronşial hiperreaktivite saptanma olasılığının arttığı gösterildi.
Sonuç: Persistan rinit yakınması olan her hasta BHR ve astım gelişme riski açısından mutlaka izlenmelidir. Bu açıdan atopi tetkikleri yapılmalı ancak atopi saptanmasa da bu hastalaraki BHR ve astım gelişme olasılığı akılda tutulmalıdır.

References

  • Roberts G, Xatzipsalti M, Borrego LM, Custovic A, Halken S, Hellings PW et al. Paediatric rhinitis: position paper of the European Academy of Allergy and Clinical Immunology. Allergy. 2013;68:1102-16.
  • Soyer Ö. Description and epidemiology of nonallergic rhinitis. Alerjik ve Nonalerjik Rinit (Ed A. Koçak):70-3. Ankara, Türkiye Klinikleri, 2020.
  • Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al; World Health Organization; GA(2)LEN; Allergen. Allergic rhinitisandits impact on asthma (ARIA) 2008 update. Allergy. 2008;63:8-160.
  • Testa D, DI Bari M, Nunziata M, Cristofaro G DE, Massaro G, Marcuccio G et al. Allergic rhinitis and asthma assessment of risk factors in pediatric patients: A systematic review. Int J Pediatr Otorhinolaryngol. 2020;129:109759.
  • Khan David A. Allergic rhinitis and asthma: epidemiology and common pathophysiology. Allergy Asthma Proc. 2014;35:357-61.
  • Cockcroft Donald W. Direct challenge tests: Airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest. 2010;138:18-24.
  • Karaatmaca B, Gur Cetinkaya P, Esenboga S, Ozer M, Soyer O, Karabulut E et al. Bronchial hyperresponsiveness in children with allergic rhinitis and the associated risk factors. Allergy. 2019;74:1563-65.
  • Li BH, Guan WJ, Zhu Z, Gao Y, An JY, Yu XX et al. Methacholine bronchial provocation test for assessment of bronchial hyperresponsiveness in preschool children. J Thorac Dis. 2019;11:4328-36.
  • Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG et al. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000;161:309-29.
  • Bachert C, Bousquet J, Hellings P. Rapid onset of action and reduced nasal hyperreactivity: new targets in allergic rhinitis management. Clin Transl Allergy. 2018;8:25-33.
  • Chawes B L K, Bønnelykke K, Kreiner-Møller E, Bisgaard H. Children with allergic and nonallergic rhinitis have a similar risk of asthma. J Allergy Clin Immunol. 2010;126:567-73.
  • Rochat MK, Illi S, Ege MJ, Lau S, Keil T, Wahn U et al. Multicentre Allergy Study (MAS) group. Allergic rhinitis as a predictor for wheezing onset in school-aged children. J Allergy Clin Immunol. 2010;126:1170-5.
  • Dixon AE. Rhinosinusitis and asthma: the missing link. Curr Opin Pulm Med. 2009;15:19-24.
  • Woo H, Samra MS, Dae Hyun Lim, Jeong Hee Kim. Current asthma prevalence using methacholine challenge test in Korean children from 2010 to 2014. J Korean Med Sci. 2021; 36: 130.
  • Shapiro GG, Furukawa CT, Pierson WE, Bierman CW. Methacholine bronchial challenge in children. J Allergy Clin Immunol. 1982;69:365-9.
  • Cockcroft DW. Direct challenge tests: airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest J. 2010;138:18‐24.
  • Lim SY, Jo YJ, Chun EM. The correlation between the bronchial hyperresponsiveness to methacholine and asthma like symptoms by GINA questionnaires for the diagnosis of asthma. BMC Pulm Med. 2014;14:161.
  • Lee E, Lee SH, Kwon JW, Kim Y H, Cho H J, Yang S I et al. Atopic dermatitis phenotype with early onset and high serumIL‐13 is linked to the new development of bronchial hyperresponsiveness in school children. Allergy. 2016;71:692‐700.
  • Youngjin A, Soo-Youn A, Tae-Bin W, Jeong-Whun K, Chul Hee L, Yang-Gi M et al. Nasal polyps: an independent risk factor for bronchial hyperresponsiveness in patients with allergic rhinitis. Am J Rhinol Allergy. 2010;24:359‐63.
  • Gruchalla RS, Gan V, Roy L, Bokovoy J, McDermott S, Lawrence G et al. Results of an inner-city school-based asthma and allergy screening pilot study: a combined approach using written questionnaires and step testing. Ann Allergy Asthma Immunol. 2003;90:491-99.
  • Yavuz ST, Civelek E, Tuncer A, Sahiner UM, Sekerel BE. Predictive factors for airway hyperresponsiveness in children with respiratory symptoms. Ann Allergy Asthma Immunol. 2011;106:365-70.
  • Plevkova J, Varechova S, Brozmanova M, Tatar M. Testing of cough reflex sensitivity in children suffering from allergic rhinitis and common cold. J Physiol Pharmacol. 2006;57:289–96.

Use of methacoline challenge test to detect bronchial hyperresponsiveness in children with persistent rhinitis

Year 2023, Volume: 48 Issue: 1, 29 - 36, 31.03.2023
https://doi.org/10.17826/cumj.1167916

Abstract

Purpose: The incidence of persistent rhinitis in childhood is increasing day by day. Since bronchial hyperreactivity (BHR) and asthma can also be seen in a significant proportion of patients with persistent rhinitis, the use of markers that may indicate the risk of developing asthma in these patients is very important in clinical follow-up. In this study, it was aimed to demonstrate the relationship between persistent rhinitis and asthma in childhood using the bronchial methacoline challenge test (BMCT) and to investigate other factors associated with the risk of developing asthma in patients with persistent rhinitis.
Materials and Methods: Patients aged 6-18 years who presented with findings of persistent rhinitis were evaluated with a detailed history, physical examination, and spirometry. Patients with normal examination findings and spirometry findings, and patients whose examination findings and nasal inflammation findings were compatible with moderate-to-severe rhinitis were included in the study, and their atopy status was evaluated by skin prick test, and their BHR was evaluated by BMCT.
Results: Seventy-three patients were included in the study. The mean age was 9±2.7years, 45.2% of the patients were male. 63% of the patients were allergic and family history of allergy was present in 45.2% of the patients. 82.2% of the patients had BHR detected with BMCT. The median blood eosinophil count (BEC) was 320/mm3 and the IgE level was 160kU/L. Patients with atopy had statistically significantly higher IgE and BEC values compared with non-allergic patients. Patients with BHR were found to be younger, and had higher median BEC values. In multivariant analysis, it was observed that the patient's age<9 years, BEC values>300/mm3, and IgE levels>250IU/L increased the probability of detecting BHR with BMCT.
Conclusion: Care should be taken for every patient with persistent rhinitis because of the risk of BHR and asthma. Atopy examinations should be performed, but the possibility of developing BHR and asthma should not be overlooked even in the patients who are non- allergic.

References

  • Roberts G, Xatzipsalti M, Borrego LM, Custovic A, Halken S, Hellings PW et al. Paediatric rhinitis: position paper of the European Academy of Allergy and Clinical Immunology. Allergy. 2013;68:1102-16.
  • Soyer Ö. Description and epidemiology of nonallergic rhinitis. Alerjik ve Nonalerjik Rinit (Ed A. Koçak):70-3. Ankara, Türkiye Klinikleri, 2020.
  • Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al; World Health Organization; GA(2)LEN; Allergen. Allergic rhinitisandits impact on asthma (ARIA) 2008 update. Allergy. 2008;63:8-160.
  • Testa D, DI Bari M, Nunziata M, Cristofaro G DE, Massaro G, Marcuccio G et al. Allergic rhinitis and asthma assessment of risk factors in pediatric patients: A systematic review. Int J Pediatr Otorhinolaryngol. 2020;129:109759.
  • Khan David A. Allergic rhinitis and asthma: epidemiology and common pathophysiology. Allergy Asthma Proc. 2014;35:357-61.
  • Cockcroft Donald W. Direct challenge tests: Airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest. 2010;138:18-24.
  • Karaatmaca B, Gur Cetinkaya P, Esenboga S, Ozer M, Soyer O, Karabulut E et al. Bronchial hyperresponsiveness in children with allergic rhinitis and the associated risk factors. Allergy. 2019;74:1563-65.
  • Li BH, Guan WJ, Zhu Z, Gao Y, An JY, Yu XX et al. Methacholine bronchial provocation test for assessment of bronchial hyperresponsiveness in preschool children. J Thorac Dis. 2019;11:4328-36.
  • Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG et al. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000;161:309-29.
  • Bachert C, Bousquet J, Hellings P. Rapid onset of action and reduced nasal hyperreactivity: new targets in allergic rhinitis management. Clin Transl Allergy. 2018;8:25-33.
  • Chawes B L K, Bønnelykke K, Kreiner-Møller E, Bisgaard H. Children with allergic and nonallergic rhinitis have a similar risk of asthma. J Allergy Clin Immunol. 2010;126:567-73.
  • Rochat MK, Illi S, Ege MJ, Lau S, Keil T, Wahn U et al. Multicentre Allergy Study (MAS) group. Allergic rhinitis as a predictor for wheezing onset in school-aged children. J Allergy Clin Immunol. 2010;126:1170-5.
  • Dixon AE. Rhinosinusitis and asthma: the missing link. Curr Opin Pulm Med. 2009;15:19-24.
  • Woo H, Samra MS, Dae Hyun Lim, Jeong Hee Kim. Current asthma prevalence using methacholine challenge test in Korean children from 2010 to 2014. J Korean Med Sci. 2021; 36: 130.
  • Shapiro GG, Furukawa CT, Pierson WE, Bierman CW. Methacholine bronchial challenge in children. J Allergy Clin Immunol. 1982;69:365-9.
  • Cockcroft DW. Direct challenge tests: airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest J. 2010;138:18‐24.
  • Lim SY, Jo YJ, Chun EM. The correlation between the bronchial hyperresponsiveness to methacholine and asthma like symptoms by GINA questionnaires for the diagnosis of asthma. BMC Pulm Med. 2014;14:161.
  • Lee E, Lee SH, Kwon JW, Kim Y H, Cho H J, Yang S I et al. Atopic dermatitis phenotype with early onset and high serumIL‐13 is linked to the new development of bronchial hyperresponsiveness in school children. Allergy. 2016;71:692‐700.
  • Youngjin A, Soo-Youn A, Tae-Bin W, Jeong-Whun K, Chul Hee L, Yang-Gi M et al. Nasal polyps: an independent risk factor for bronchial hyperresponsiveness in patients with allergic rhinitis. Am J Rhinol Allergy. 2010;24:359‐63.
  • Gruchalla RS, Gan V, Roy L, Bokovoy J, McDermott S, Lawrence G et al. Results of an inner-city school-based asthma and allergy screening pilot study: a combined approach using written questionnaires and step testing. Ann Allergy Asthma Immunol. 2003;90:491-99.
  • Yavuz ST, Civelek E, Tuncer A, Sahiner UM, Sekerel BE. Predictive factors for airway hyperresponsiveness in children with respiratory symptoms. Ann Allergy Asthma Immunol. 2011;106:365-70.
  • Plevkova J, Varechova S, Brozmanova M, Tatar M. Testing of cough reflex sensitivity in children suffering from allergic rhinitis and common cold. J Physiol Pharmacol. 2006;57:289–96.
There are 22 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Belgin Usta Güç 0000-0002-9432-3008

Suna Asilsoy 0000-0002-4235-0995

Publication Date March 31, 2023
Acceptance Date December 22, 2022
Published in Issue Year 2023 Volume: 48 Issue: 1

Cite

MLA Usta Güç, Belgin and Suna Asilsoy. “Use of Methacoline Challenge Test to Detect Bronchial Hyperresponsiveness in Children With Persistent Rhinitis”. Cukurova Medical Journal, vol. 48, no. 1, 2023, pp. 29-36, doi:10.17826/cumj.1167916.