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Young adult rhinitis categorized into four distinct clusters

Young adult rhinitis could be categorized by four distinct clusters with differing associations with asthma, lung function, sex, age of disease onset, rhinitis severity and treatment needs, according to cluster analysis results.

Researchers assessed 1,456 members of a birth cohort established in 1989 on Isle of White, United Kingdom, at ages 1, 2, 4, 10 and 18 years. Thirteen variables defining clinical characteristics were used to conduct a cluster analysis of 468 of the patients when they were aged 18 years.

The analysis identified four clusters. Patients classified with moderate childhood-onset rhinitis (n=128) had “high atopy and eczema prevalence and high total IgE levels, but low asthma prevalence.” The best lung function was demonstrated by these patients aged 18 years who had normal fraction of exhaled nitric oxide (FENO), low bronchial hyperresponsiveness (BHR) and low bronchodilator reversibility (BDR) but high rhinitis symptoms and treatment.

Patients with mild adolescence-onset female rhinitis (n=199) had the lowest prevalence of atopy, comorbid asthma and eczema. They showed normal lung function and “low BHR, BDR, FENO values and total IgE levels plus low rhinitis symptoms, severity and treatment.”

Patients who experienced rhinitis onset at the youngest age (n=59) had the highest comorbid asthma and experienced the most obstructed lung function, with high BHR, BDR and FENO values, and high rhinitis symptoms, severity and treatment.

Patients classified as moderate, childhood-onset male rhinitis with asthma (n=82) had high atopy, low eczema and intermediate asthma prevalence. “They showed the most impairment of FEV₁ and FVC [forced vital capacity], with high FENO values and total IgE levels but intermediate BHR and BDR,” the researchers wrote.

“Rhinitis emerged as a common condition in young adulthood, affecting one-third of 18 year olds,” the researchers reported. “Most rhinitis was seasonal and of childhood onset. However, cluster analysis demonstrated that young adult rhinitis could be categorized by four distinct clusters. Recognition that earliest-onset rhinitis is associated with most severe young adult airways disease should focus early treatment efforts that might reduce later development of severe adult rhinitis and asthma.”

Disclosure: The researchers received research support from the NIH.