Prevalence of and associations with allergic rhinitis in children with chronic rhinosinusitis
Chronic rhinosinusitis (CRS) in children has been associated with a variety of disorders including atopic disease, cystic fibrosis, immunologic disorders and ciliary dyskinesia. Although a strong association, or even cause and effect relationship, between allergic rhinitis (AR) and CRS is commonly assumed, the epidemiologic relationship between these disorders has not yet been defined in children. A retrospective review of all children diagnosed with CRS on otolaryngology or allergy office evaluation at a large tertiary-care pediatric hospital over a ten-year period was performed. Demographic data and concomitant diagnoses of AR, cystic fibrosis, immunologic disorders and primary ciliary dyskinesia were analyzed for relationships with CRS. A total of 4044 children with an average age of 8.9 years and a slight male predominance (53.8%) with CRS were identified. Of these children, 0.2% had primary ciliary dyskinesia, 4.1% had cystic fibrosis, 12.3% had an immunologic disorder, and 26.9% had AR. A concomitant asthma diagnosis was positively associated with a diagnosis of AR (OR=6.24, 95% CI: 5.27-7.39, P<0.001), whereas a concomitant cystic fibrosis diagnosis was negatively associated (OR=0.12, 95% CI: 0.06-0.26, P<0.001). AR is more prevalent than the other comorbidities combined in children with CRS, and is independently associated with the presence of asthma. Formal allergy testing, guided by clinical history and regional allergen sensitivity prevalence, should be strongly considered in all children with CRS, in particular those with reactive airway disease.