Allergologia et Immunopathologia

Allergologia et Immunopathologia

Volume 48, Issue 2, March–April 2020, Pages 137-141
Allergologia et Immunopathologia

Original Article
Relationship between nasal mucociliary clearance and disease severity in children with allergic rhinitis: A comparative cross-sectional study

https://doi.org/10.1016/j.aller.2019.06.007Get rights and content

Abstract

Objectives

Mucociliary clearance (MCC) is impaired due to chronic inflammation in allergic rhinitis. Our aim was to evaluate MCC in children with allergic rhinitis, to determine its relationship with disease severity and evaluate MCC change after nasal irrigation.

Materials and methods

Saccharin test was performed in 51 patients with allergic rhinitis and in 50 controls. Nasal irrigation was performed to the patients and saccharin test was repeated at the 10th minute. Total nasal symptom score (TNSS) and visual analogue scale (VAS) results were recorded. Patients were divided into mild/moderate-severe groups according to TNSS, VAS, and ARIA guidelines. Nasal MCC time (NMCCT) of the patients and the controls and NMCCT before and after nasal irrigation of the patients were compared. Correlations between NMCCT and TNSS/VAS were evaluated. NMCCTs of the mild and moderate-severe groups were compared. The cut-off values ​​were calculated to discriminate the patient group.

Results

The mean NMCCT of the patient group was higher than the controls. Mean NMCCTs were different between before and after irrigation. NMCCT was higher in uncontrolled/moderate-severe groups than in controlled/mild groups. NMCCT correlated positively with VAS and TNSS. The sensitivity and specificity of NMCCT > 535 s were found to be 86.27% and 94%, respectively.

Conclusions

In children with allergic rhinitis, the prolongation of MCC may be identified with the easily applicable saccharin test, the deterioration in MCC increases as disease severity increases. Nasal irrigation is important in children with allergic rhinitis to improve MCC.

Introduction

Allergic rhinitis is a chronic disease in children with a prevalence of 2–25% and leads to impaired quality of life. It is the most common form of non-infectious rhinitis. In allergic rhinitis, IgE-mediated immune response to allergens occurs. Allergic rhinitis is diagnosed by the presence of nasal symptoms, and the presence of ocular symptoms is frequently accompanied by the presence of an allergic response.1, 2, 3

Mucociliary clearance (MCC) is a very important protection system for the protection of the nose from harmful molecules and allergens. With this system, the mucus formed in the nasal mucosa is mobilized by the movement of the nasal ciliates, and the particles are delivered through the nose to the nasopharynx through this movement. The particle that reaches the nasopharynx is either swallowed or removed orally.4

MCC can be evaluated by various methods. Some of these methods are the evaluation with indigo carmine dye, evaluation with gamma scintigraphy, and evaluation with saccharin test.5, 6, 7 The saccharin test is distinguished from other tests because it is easy to be applied in outpatient settings as well as being cheap and non-invasive. The saccharin test is based on the time elapsed between the placement of the saccharin piece in the anterior part of the inferior turbinate and the feeling of the sweet taste in the mouth, and which may be achieved within minutes.7

In allergic rhinitis patients, deterioration of the structure of the cilia, as well as changes in mucus viscosity due to long-term chronic inflammation, has been shown. Mechanical obstruction may also lead to mucus stagnation, causing pericellular compression and nasal MCC deterioration. With the deterioration of MCC, removal of allergens from the nasal cavity becomes difficult, contact with allergens increases, and therefore treatment success decreases.4, 8

The aim of our study was to evaluate MCC by saccharin test in children with allergic rhinitis, to determine its relationship with disease severity, and to evaluate MCC change after nasal irrigation.

Section snippets

Participants

Patients between 6 and 18 years of age diagnosed with allergic rhinitis were recruited as the patient group, and patients who presented to our clinic but were not diagnosed with allergic diseases by diagnostic tests or patients who had allergic diseases other than the involvement of the respiratory system were recruited as the control group. Those who received intranasal, inhaled or systemic steroids in the previous two months; antihistamines in the previous week; nasal or systemic

Results

The mean age of the patients was 9.65 ± 2.70 years and the mean age of the control group was 9.56 ± 2.53 years. 47.5% of the patients were female. Age and gender were not statistically different between the patient and the control groups. (p = 0.867, p = 0.761, respectively).

Forty-three of the patients (84.31%) had no adenoid vegetations according to their otolaryngology examination notes, and eight of the patients (15.68%) reported that they were told by their otolaryngology specialist that they had

Discussion

MCC is a mechanism for protection from allergens and pathogens, which may be impaired due to mucus changes, number and structural as well as molecular defects of the cilia and mechanical obstruction. In this study, it was shown that NMCCT in pediatric patients with allergic rhinitis was longer than the healthy controls, and that NMCCT was associated with disease severity, and that NMCCT improved after nasal irrigation.

In patients with allergic rhinitis, changes in mucus density and

Conflict of interest

The authors have no conflict of interest to declare.

Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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