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Allergic rhinitis underdiagnosed in Puerto Rican children with, without asthma

Physicians underdiagnosed allergic rhinitis in more than 75% of children with asthma and an even greater number of children without asthma in Puerto Rico, according to study results.

Researchers studied 547 children aged 6 to 14 years from March 2009 to June 2010 from randomly selected households in San Juan. Questionnaires, allergy skin testing and blood sample collection were included in the study protocol. Rhinitis symptoms, apart from colds, and skin test reactivity to allergens that were consistent with Allergic Rhinitis and its Impact on Asthma 2008 guidelines (STR-positive AR) were used to define allergic rhinitis (AR).

“Although Puerto Rican [PR] children are disproportionately affected by asthma, access to specialized care is limited,” the researchers reported. “PR allergists currently provide less than 4% of asthma care. We hypothesized that AR may be underdiagnosed in PR children.”

Asthma was diagnosed in 52.7% of the cohort, including 192 children who had STR-positive AR. Seventy-three children without asthma also had STR-positive AR.

Increased odds of STR-positive AR in children with asthma were associated with symptoms triggered by house dust, eczematous rash, private or employer-based health insurance, and either total IgE level or positive IgE to dust mite in either of two adjusted models.

Physician-diagnosed AR (PD-AR) was reported in lower proportions of children with asthma (17%) or without (4.3%) when compared with STR-positive AR. Forty-four children with asthma (15.3%) and nine without (9.5%) were diagnosed for AR correctly by physicians.

“AR is markedly underdiagnosed in PR children,” the researchers concluded. “Physicians missed more than 75% and more than 85% of AR in children with and without asthma, respectively,” the researchers concluded. “Physicians could accurately diagnose AR by inquiring about the presence of rhinitis symptoms, triggers, and measuring dust mite-IgE or total IgE level.”

Disclosure: See the study for a full list of relevant financial disclosures.