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International Journal of Otolaryngology

Volume 2011, Article ID 487532, 7 pages
doi:10.1155/2011/487532

Clinical Study
Study of Allergic Rhinitis in Childhood

Dimitrios G. Balatsouras,1 George Koukoutsis,1 Panayotis Ganelis,1

Alexandros Fassolis,1 George S. Korres,2 and Antonis Kaberos1
1 ENT Department, Tzanion General Hospital of Piraeus, Afentouli 1 & Zanni, 18536 Piraeus, Greece
2 ENT Department, Atticon University Hospital of Athens, 1 Rimini Str., Haidari, 12462 Athens, Greece

Correspondence should be addressed to Dimitrios G. Balatsouras, [email protected]

Received 13 February 2011; Accepted 28 April 2011

Academic Editor: R. L. Doty

Copyright © 2011 Dimitrios G. Balatsouras et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Allergic rhinitis is common among children and quite often represents a stage of the atopic march. Although sensitization to food
and airborne allergens may appear in infancy and early childhood, symptoms of the disease are usually present after age 3. The aim
of this study was to determine the most frequent food and indoor and outdoor respiratory allergens involved in allergic rhinitis in
children in the region of Piraeus. The study was performed in the outpatient clinic of otolaryngologic allergy of a general hospital.
Fifty children (ranged 6–14 ) with symptoms of allergic rhinitis and positive radioallergosorbent test (RAST) for IgE antibodies or
skin prick tests were included in the study. Thirty six (72%) of the subjects of the study had intermittent allergic rhinitis. The most
common aeroallergens determined were grass pollens and Parietaria, whereas egg and milk were the food allergens identified. The
detection of indoor and outdoor allergens in the region of Piraeus, based on skin prick tests and RAST tests, showed high incidence
of grasses and food allergens, which is similar to other Mediterranean countries.

1. Introduction patients ranged from 6 to 14 years (mean 10.7 ± 2.1), and

they were all living in the region of Piraeus. Diagnosis was
Allergic rhinitis is one of the most common disorders, which on the basis of a history of allergic rhinitis, either seasonal
affects 5–40% of population, according to various reports or perennial, on the findings of clinical examination and
[1, 2]. It may be classified as persistent and intermittent al- on the presence of positive radioallergosorbent (RAST) test
lergic rhinitis, depending on the frequency of symptoms. It for IgE antibodies (RAST-CAP-FEIA, Pharmacia, Uppsala,
presents a high morbidity because it affects social life, pro- Sweden). All children were tested in a series of allergens,
fessional activities, and, especially in children, school perfor- including grasses, cereales, parietaria, urtica, tree allergens
mance [3]. (Olea europea, Cypressus sempervirens, Pinus pinea, and
Allergic rhinitis is common among children and quite Populus alba), dust mites, animal dander and food allergens.
often represents a stage of the atopic march [4]. Although The RAST results were classified, as Class 1 (low level of
sensitization to food and airborne allergens may appear in specific IgE), Class 2 (moderate level), Class 3 (high level),
infancy and early childhood, symptoms of the disease are and Class 4 (very high level) [5]. In a group of 12 older
usually present after age 3. The aim of this study was to children, skin-prick tests were also performed. Details of this
determine the most frequent respiratory and food allergens procedure are reported elsewhere [6]. The skin prick tests
as a cause of allergic rhinitis in children in the region of were considered positive if the mean wheal diameter was
Piraeus. 3 mm or larger.

2. Materials and Methods

3. Results and Discussion
We examined 50 children who presented with allergic rhinitis
in the outpatient clinic of otolaryngologic allergy, belonging The main clinical and demographic features of our patients
to the ENT department of our hospital. The age of the are shown in Table 1. Twenty-nine patients were females and
2 International Journal of Otolaryngology

Table 1: Clinical and demographic features of our patients.

Patient Sex Age Severity of rhinitis Type of rhinitis Other allergic symptoms Total IgE level (kU/L)
(1) M 11 Mild I − 224
(2) M 7 Mild I − 785
(3) M 10 Moderate/severe I + 454
(4) F 14 Mild I + 134
(5) F 10 Moderate/severe I + 224
(6) F 11 Moderate/severe I + 900
(7) M 6 Moderate/severe I − 342
(8) F 12 Moderate/severe I + 345
(9) F 13 Mild I − 296
(10) M 6 Moderate/severe I + 199
(11) F 13 Mild I + 400
(12) M 11 Moderate/severe I + 556
(13) F 10 Moderate/severe I + 256
(14) F 9 Mild I + 292
(15) F 11 Mild I − 378
(16) M 8 Mild I + 444
(17) M 7 Moderate/severe I + 1080
(18) F 11 Moderate/severe I − 577
(19) F 11 Mild I + 401
(20) M 10 Moderate/severe I + 899
(21) F 11 Moderate/severe I + 301
(22) M 6 Mild I − 247
(23) F 11 Mild I + 199
(24) F 12 Moderate/severe I + 434
(25) F 9 Moderate/severe I + 283
(26) F 11 Moderate/severe I + 1903
(27) M 11 Mild I − 390
(28) M 13 Mild I + 122
(29) F 10 Mild I − 345
(30) M 13 Moderate/severe I + 256
(31) F 13 Moderate/severe I − 412
(32) M 11 Moderate/severe I − 796
(33) F 11 Moderate/severe I + 156
(34) M 12 Moderate/severe I + 414
(35) F 12 Moderate/severe I + 342
(36) F 12 Mild I + 404
(37) M 11 Moderate/severe P + 1932
(38) M 9 Mild P + 435
(39) M 10 Moderate/severe P + 897
(40) F 10 Moderate/severe P + 563
(41) F 7 Mild P − 267
(42) F 11 Mild P + 1789
(43) M 14 Moderate/severe P + 567
(44) F 13 Mild P − 278
(45) M 10 Moderate/severe P + 387
(46) F 13 Moderate/severe P + 1023
(47) F 9 Moderate/severe P + 646
(48) M 12 Moderate/severe P + 1009
(49) F 13 Moderate/severe P + 2888
(50) F 14 Moderate/severe P + 399
I: intermittent; P: perennial.
International Journal of Otolaryngology 3

Table 2: Types of allergens, RAST classes, and skin reaction.

Patient Sex Age Type of allergen RAST class Skin reaction

(1) M 11 Parietaria 1 np

M 7 Parietaria
(2) 2 np
Pinus pinea

M 10 Parietaria
(3) 3 np
Olea europea

(4) F 14 Parietaria 2 +

F 10 Grasses
(5) 2 np
Olea europea
Parietaria
(6)
F 11 Grasses 3 np
Pinus pinea

M 6 Parietaria
(7) 2 np
Olea europea
Parietaria +
(8) F 12 Grasses 3 +
Olea europea −

(9) F 13 Parietaria 1 +

Cereales
(10) M 6 Olea europea 2 np
Cypressus semp.

F 13 Parietaria
(11) 1 np
Olea europea

M 11 Parietaria
(12) 4 np
Grasses

(13) F 10 Parietaria 3 np

F 9 Parietaria
(14) 1 np
Urtica
Parietaria
(15) F 11 Pinus pinea 3 np
Urtica

M 8 Parietaria
(16) 1 np
Urtica

(17) M 7 Olea europea 4 np

F 11 Parietaria
(18) 3 np
Olea europea
Cereales
(19) F 11 Pinus pinea 1 np
Populus alba

M 10 Parietaria
(20) 4 np
Olea europea

F 11 Grasses
(21) 1 np
Cypressus semp.

M 6 Parietaria
(22) 2 np
Olea europea
4 International Journal of Otolaryngology

Table 2: Continued.
Patient Sex Age Type of allergen RAST class Skin reaction

F 11 Parietaria
(23) 1 np
Urtica

(24) F 12 Olea europea 3 +

Parietaria
(25) F 9 Grasses 2 np
Olea europea
Parietaria
(26) F 11 Grasses 4 np
Populus alba

(27) M 11 Olea europea 4 +

M 13 Parietaria 1 −
(28)
Pinus pinea +

(29) F 10 Parietaria 3 np

M 13 Grasses +
(30) 2
Olea europea +
Parietaria
(31) F 13 Grasses 1 np
Urtica

M 11 Parietaria
(32) 3 np
Populus alba
Parietaria
(33) F 11 Cereales 2 np
Olea europea

M 12 Parietaria
(34) 1 np
Populus alba
Parietaria
(35)
F 12 Grasses 3 np
Urtica

(36) F 12 Olea europea 4 np

M 11 House dust
(37) 2 np
Mites

M 9 House dust np
(38) 1
Mites

(39) M 10 Canis fam. 2 np

F 10 Canis fam. np
(40) 4
Parietaria
(41) F 7 Felis dom. 1 np

F 11 House dust np
(42) 2
Mites

(43) M 14 Egg 3 +
International Journal of Otolaryngology 5

Table 2: Continued.
Patient Sex Age Type of allergen RAST class Skin reaction
F 13 2 +
(44) House dust
M 10 1 np
(45) Milk
F 13 Mites +
(46) 3
Felis dom. +
F 9 4 np
(47) Canis fam.
M 12 House dust
(48) 2 np
Mites
House dust +
(49) F 13 3
Parietaria +
(50) F 14 Canis fam. 4 +
np: not performed.

Table 3: Positive RAST (and skin prick test when performed) to to the criteria of ARIA [7]. Thirty-seven (74%) of the
various allergens in intermittent allergic rhinitis. children suffered from other allergic diseases as well,
including childhood asthma, allergic conjunctivitis, and
Positive tests
Allergens atopic dermatitis.
N %
Thirty six (72%) of the subjects of the study had inter-
Grasses 10 13.7 mittent allergic rhinitis, owed to pollen aeroallergens, with
Cereales 3 4.1 a mean of 2 allergens per patient (Tables 2 and 3). Nine
Parietaria 27 36.9 patients (18%) were sensitized to one allergen, 17 patients
(34%) were sensitized to two and 10 patients (20%) to three
Urtica 6 8.2
allergens. The remaining 14 (28%) children suffered from
Olea europea 16 21.9 persistent rhinitis, owed mainly to nonpollen aeroallergens
Cypressus 2.8
and to food allergens. A mean of 1.5 allergens per patient
2
sempervirens was found in this group (Tables 2 and 4). Seven (14%)
Pinus pinea 5 6.9 of them were sensitized to one allergen, and another 7
Populus alba 4 5.5 patients (14%) were sensitized to two allergens. The mean
values of total serum IgE were 449.7 (±336.9) kU/L in the
Total 73 100
first group (patients with intermittent disease) and 934.2
(±765.8) kU/L in the second group (patients with persistent
disease), presenting significant variability (Table 1). The rate
Table 4: Positive RAST (and skin prick test when performed) to of agreement between the results of the skin prick tests when
various aeroallergens and food allergens in persistent allergic rhini- performed and the results of RAST was high (Table 2). There
tis. was no consistent correlation between severity of allergic
Positive tests rhinitis and RAST classes, suggesting that probably antibody
Allergens levels are only one of the factors that determine symptom
N %
House dust 6 28.6 severity [8].
Allergic rhinitis is a significant clinical problem in chil-
Mites (D. pteronyssinus and D. farinae) 5 23.8
dren. In the Mediterranean region there are characteristic cli-
Dogs (Canis familiaris) 4 19.0 matic conditions, such as mildness of winter and poor rain-
Cats (Felis domesticus) 2 9.5 fall during the summer, that facilitate the growing of a typical
Egg 1 4.8 vegetation with production of allergenic pollen [1]. Rich and
long pollinic seasons are, thus, favored, and the pollen grains
Milk 1 4.8
of various plants can reach high atmospheric concentrations,
Parietaria 2 9.5 causing severe clinical symptoms of rhinoconjunctivitis and
Total 21 100 asthma. The prevalence of allergic rhinitis in children in the
Mediterranean countries has been reported to range from
9.4% to 16.8% [2, 9]. However, more than 40% of the
children reported allergic rhinoconjunctivitis symptoms in
21 males. Severity of rhinitis was mild in 19 patients (38%) the past [2, 10]. Most prevalent allergic plants with known
and moderate/severe in the remaining 31 (62%), according clinical significance are grasses, Parietaria and Olea europaea.
6 International Journal of Otolaryngology

Parietaria was the most important allergenic pollen in the resulting in the variety of allergens identified from our
children of our study. This is an Urticacea plant characteristic investigation.
of Mediterranean flora, which has been found to be the most
common cause of allergy in the Mediterranean countries,
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