Surgical correction of nasal cavity pathology in children with allergic rhinitis: quality of life

Introduction. Allergic rhinitis is one of the most common diseases. It is difficult to recognize concomitant pathology of allergic rhinitis on time, this fact reduces the effectiveness of therapy and affects the patient’s quality of life.

Objective. To assess the quality of life and effectiveness of surgical treatment of children with various diseases of the ENT organs in combination with allergic rhinitis.

Children characteristics and research methods. The intervention group included 169 children with allergic rhinitis and concomitant pathology of ENT organs aged from 6 to 17 years, the average age (median, upper and lower quartiles) 12 [9,0; 14,0] years. All patients underwent endoscopic endonasal surgical treatment. Quality of life was assessed using the questionnaire before and in 1 month after surgical treatment. The effectiveness of treatment was based on the changes in the quality of life in points (6 points — the maximum decrease in the quality of life; 0 points — no decrease in the quality of life).

Results. Initially the average quality of life was 4 [3; 5] points. In a month after surgery this indicator decreased to 2 [1; 2] points, i.e. we observed a significant decrease in the quality of life (p=0,0000001). The percentage change in the quality of life indicator was 60 [50; 67], which was significantly higher than in the control group (41 children) (p=0,0000001). The authors revealed a significant positive correlation between the level of total IgE (R=0,4; p=0,0000001), the concentration of specific IgE (R=0,5; p=0,0000001) and a decrease in the quality of life before surgery, as well as a negative correlation between the level of total IgE and the degree of change in quality of life (R= -0,2; p=0,02).

Conclusion. The combination of allergic rhinitis with non-allergic pathology of ENT organs is an indication for surgical treatment. The concentration of total IgE and specific IgE, along with questionnaires is an additional criterion for assessing the quality of life. At the same time, patients with high concentrations of total IgE are likely to have insufficient effectiveness of surgical treatment.

1. Meltzer E.O., Blaiss M.S., Naclerio R.M. Stoloff S.W, Derebery M.J., Nelson H.S. et al. Burden of allergic rhinitis: allergies in America, Latin America, and Asia-Pacific adult surveys. Allergy Asthma Proc 2012; 33: S113—141. DOI: 10.2500/aap.2012.33.3603

2. Brozek J.L., Bousquet J., Agache I., Agarwal A., Bachert C., Bosnic-Anticevich S. et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. Allergy Clin Immunol 2017; 140(4): 950-958. DOI: 10.1016/j.jaci.2017.03.050

3. Meltzer E.O. Allergic Rhinitis: Burden of Illness, Quality of Life, Comorbidities, and Control. Immunol Allergy Clin North Am 2016; 36(2): 235-48. DOI: 10.1016/j.iac.2015.12.002

4. de la HozCaballer B., Rodriguez M., Fraj J., Cerecedo I., AMtolin-Amerigo D., Colkset C. Allergic rhinitis and its impact on work productivity in primary care practice and a comparison with other common diseases: the Cross-sectional study to evaluate work productivity in allergic rhinitis compared with other common diseases (CAPRI) study. Am J Rhinol Allergy 2012; 26: 390-394. DOI: 10.2500/ajra.2012.26.3799

5. Juniper E.F., Howland W.C., Roberts N.B., Thompson A.K., King D.R. Measuring quality of life in children with rhinocon-junctivitis. J Allergy Clin Immunol 1998; 101(2P 1): 163-170.

6. Marino-Sanchez F., Valls-Mateus M., Cardenas-Escalante P., Haag O., Ruiz-Echevarna K., Jimenez-Feijoo R. et al. Influence of nasal septum deformity on nasal obstruction, disease severity, and medical treatment response among children and adolescents with persistent allergic rhinitis. Int J Pedi-atr Otorhinolaryngol 2017; 95: 145-154. DOI: 10.1016/j.ijporl.2017.02.005

7. Marino-Sanchez F.S., Valls-Mateus M., Ruiz-Echevarria K., Alobid I., Cardenas-Escalante P., Jimknez-Feijoo R. et al. Nasal Obstructive Disorders induce medical treatment failure in Pediatric Persistent Allergic Rhinitis (The NODPAR Study). Pediatr Allergy Immunol 2016; 28(2): 176-184. DOI: 10.1111/pai.12679

8. Khan D.A. Allergic rhinitis and asthma: epidemiology and common pathophysiology. Allergy Asthma Proc 2014; 35(5): 357-361. DOI: 10.2500/aap.2014.35.3794

9. Ohta K., Tanaka H., Tohda Y., Kohrogi H., Chihara J., Saka-kibara H. et al. Asthma exacerbations in patients with asthma and rhinitis: Factors associated with asthma exacerbation and its effect on QOL in patients with asthma and rhinitis. Al-lergol Int 2019; 6: S1323-8930(19)30059-0. DOI: 10.1016/j.alit.2019.04.008