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KMID : 1225720220140060730
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Allergy, Asthma & Immunology Research : AAIR
2022 Volume.14 No. 6 p.730 ~ p.741
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Distinct Endotypes of Pediatric Rhinitis Based on Cluster Analysis
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Kim Jin-Youp
Lee Sang-Jun
Suh Dong-In
Kim Dae-Woo
Yoon Hyung-Jin
Park Sue-K.
Rhee Chae-Seo
Han Doo-Hee
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Abstract
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Purpose : Despite the wide spectrum of pediatric rhinitis, endotyping of rhinitis based on type 2 inflammation and bronchial hyper-responsiveness (BHR) is lacking. This study aimed to investigate endotypes of pediatric rhinitis using cluster analysis.
Methods : Cluster analysis was performed on data from 241 children with rhinitis by using 12 variables reflecting clinical characteristics of skin prick, laboratory, and pulmonary function tests. After extracting clusters, between-cluster differences in clinical features, such as nasal symptom scores and asthma comorbidity, were assessed to investigate the association between the endotypes and clinical features.
Results : Four clusters were extracted by hierarchical cluster analysis. Cluster 1 (n = 32 [13.3%]) was the non-allergic rhinitis dominant cluster with low type 2 inflammation and the lowest rate of BHR. Patients in cluster 1 had the mildest nasal symptoms and no asthma comorbidity. Cluster 2 (n = 114 [47.3%]) was the largest cluster and exhibited intermediate type 2 inflammation and low BHR. Cluster 3 (n = 65 [27.0%]) showed high type 2 inflammation and intermediate BHR. However, the severity of nasal symptoms and asthma comorbidity in this cluster were comparable with those in cluster 2. Cluster 4 (n = 30 [12.4%]) revealed high type 2 inflammation and BHR with potential functional airway impairment. Additionally, cluster 4 displayed the most severe nasal symptoms and frequent asthma comorbidity.
Conclusions : Four distinct endotypes of pediatric rhinitis based on allergen sensitization, type 2 inflammation, and BHR correlate to symptoms and asthma comorbidity. These endotypes may aid clinicians in understanding the wide spectrum of pediatric rhinitis.
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KEYWORD
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Allergic rhinitis, asthma, bronchial hyperreactivity, child, cluster analysis, rhinitis, bronchial hyper-responsiveness, pediatric rhinitis, type 2 inflammation
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