Diagnosis and differential diagnosis values of indirect markers of inflammation in atopic children

Main Article Content

Selçuk Yazıcı https://orcid.org/0000-0002-6526-9460
Fatma Damla Kurt https://orcid.org/0000-0001-9922-8379
Yağmur Güvendik https://orcid.org/0009-0002-9405-9304
Aslıhan İzol https://orcid.org/0000-0002-9957-1828

Keywords

atopic children, indirect markers of inflammation, neutrophil-to-lymphocyte ratio, eosinophil-to lymphocyte ratio, platelet-to-lymphocyte ratio

Abstract

Atopic diseases are characterized by intense inflammation. There are increasing studies examining the relationship between atopic diseases and hematological parameters and indirect markers of inflammation, such as neutrophil-to-lymphocyte ratio (NLR), eosinophil-to-lymphocyte ratio (ELR), and platelet-to-lymphocyte ratio (PLR). The aim of this study was to investigate these parameters in patients with asthma, allergic rhinitis, and atopic dermatitis. The study was conducted retrospectively and cross-sectionally. The study group consisted of 172 patients (53 with asthma, 93 with allergic rhinitis, and 26 with atopic dermatitis) and 105 controls. There were no age or gender differences between patients and controls. When all atopic patients were compared to controls, ELR (P < 0.001), eosinophil count (P < 0.0019), and WBC (P < 0.05) were significantly higher in the patient group. When patient groups were compared independently, ELR (P < 0.001), eosinophil count (P < 0.001), and WBC (P < 0.05) were higher in asthmatic patients than in controls. In allergic rhinitis patients, ELR (P < 0.001) and eosinophil count (P < 0.001) were higher than in controls. In patients with atopic dermatitis, ELR (P < 0.001), eosinophil count (P > 0.001), WBC (P = 0.0019), and, additionally, NLR (P < 0.001) and PLR (P < 0.05) were higher than in controls. NLR and PLR were significantly higher in patients with atopic dermatitis than in controls, in patients with asthma and in patients with allergic rhinitis. Among all hemogram parameters, only ELR and eosinophil count stand out as markers that may be useful in the diagnosis of atopic diseases. NLR and PLR may be useful in the differential diagnosis of AD among atopic patients.

Abstract 318 | PDF Downloads 253 HTML Downloads 0 XML Downloads 11

References

1 Cheng C, Zhang L. Nonlinear association between neutrophil-to-lymphocyte ratio and asthma in children and adolescents in the United States: A cross-sectional study. Clin Exp Pediatr. Jul. 2025;68(7):489–46. 10.3345/cep.2024.01844

2 Khanzadeh M, et al. Prognostic role of neutrophil to lymphocyte ratio in allergic rhinitis: A systematic review and meta-analysis, Indian J Otolaryngol Head Neck Surg. 2024;76(1):1389–97. 10.1007/s12070-023-04148-8

3 Zhang L, et al. The association of ınflammatory ındexes derived from peripheral blood cell count and clinical signs with response to treatment with dupilumab in pediatric patients with moderate-to-severe atopic dermatitis. J Inflamm. Res. 2025:18:271–282. 10.2147/JIR.S501883

4 Hagino T, Saeki H, Fujimoto E, Kanda N. The eosinophil-to-lymphocyte ratio acts as an ındicator for ımprovement of clinical signs and ıtch by upadacitinib treatment in atopic dermatitis. J Clin Med. 2023;12(6):2201. 10.3390/jcm12062201

5 Cansever M. The association of allergic rhinitis severity with neutrophil–lymphocyte and platelet–lymphocyte ratio in children. North Clin Istanb. 2022;9(6):602–609. 10.14744/nci.2022.96236

6 Doğru M, Yesiltepe Mutlu R.G. The evaluation of neutrophil–lymphocyte ratio in children with asthma. Allergol Immunopathol (Madr). 2016;44(4):292–6. 10.1016/j.aller.2015.09.005

7 Batmaz S. Simple markers for systemic inflammation in pediatric atopic dermatitis patients. Indian J Dermatol. Jul. 2018;63(4):305. 10.4103/ijd.IJD_427_17

8 Duman Şenol H, Özdoğru EE, Sancaklı Ö, Doğru M, Tuncel T. Which has an ınfluence on mean platelet volume: Allergic rhinitis or asthma? J Pediatr Res. Sep. 2022;9(3):223–7. 10.4274/jpr.galenos.2022.93899

9 Sekar M, Inamadar A, Janagond A. Hematological parameters in pediatric atopic dermatitis: Correlation with disease severity and duration. Iran J Dermatol. Mar. 2024;27(1):28–34. 10.22034/ijd.2023.379696.1647

10 Jiang Y, Ma W. Assessment of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in atopic dermatitis patients. Med Sci Monit. 2017;23:1340–6. 10.12659/MSM.900212

11 Di J, et al. Eosinophil-to-lymphocyte ratio and eosinophil count as new predictive markers for osteoarthritis. J Pain Res. 2024;17:3803–15. 10.2147/JPR.S480925

12 Başaran AE, Karataş Torun N, Kocacık Uygun DF, Bingöl A. Distribution of aeroallergens on skin prick tests of atopic children living in the Akdeniz region, Turkey. Asthma Allergy Immunol. Mar 2018; 10.21911/aai.280

13 Ciğerci Günaydın N, et al. Evaluation of allergen sensitization in patients with allergic rhinitis and/or asthma in Tekirdağ. J Pediatr Res. 2022;9(3):259–66. 10.4274/jpr.galenos.2022.87094

14 Can C, Altınel N, Hatipoglu S. Aeroallergen sensitisation patterns of children aged 5 years and younger with asthma and/or allergic rhinitis in Istanbul. Arch Pédiatrie. Jan. 2021;28(1):7–11. 10.1016/J.ARCPED.2020.10.014

15 Arıkoğlu T, Batmaz SB, Kuyucu S. Allergen sensitization patterns in atopic children in Mersin Province of Turkey. Asthma Allergy Immunol. Dec. 2017; 10.21911/aai.398

16 Cobanoglu HB, Isik AU, Topbas M, Ural A. Prevalence of allergic rhinitis in children in the Trabzon Province of the Black Sea region of Turkey. Turk Otolarengol Arsivi (Turkish Arch Otolaryngol). 2016;54(1):21–28. 10.5152/tao.2016.1089

17 Tüten Dal S, Sahiner UM, Soyer O, Sekerel BE. Mite allergen sensitization patterns in Turkish children: Age-related changes and molecular correlations. Pediatr Allergy Immunol. 2024;35(2):1–10. 10.1111/pai.14093

18 Özdoğru EE, Gönülal M. Atopic dermatitis, inhalant allergy and food allergy: A paediatric approach. Dermatol Ther. 2021;34(1):1–5. 10.1111/dth.14542

19 Posa D et al. Evolution and predictive value of IgE responses toward a comprehensive panel of house dust mite allergens during the first 2 decades of life. J Allergy Clin Immunol. 2017;139(2):541–9.e8. 10.1016/j.jaci.2016.08.014

20 Gıray D, Ozdemır M. Evaluation of mean platelet volume and other complete blood count parameters in children with atopic asthma. Bezmialem Sci. 2018;6(3):181–5. 10.14235/bs.2018.1759

21 Esmaeilzadeh H, Nouri F, Nabavizadeh SH, Alyasin S, Mortazavi N. Can eosinophilia and neutrophil–lymphocyte ratio predict hospitalization in asthma exacerbation? Allergy Asthma Clin Immunol. 2021;17(1):1–8. 10.1186/s13223-021-00512-x

22 Çiçek F, Köle MT, Kandemir İ. The role of hematological parameters in the diagnosis of childhood allergic conjunctivitis. Bagcilar Med Bull. 2023;8(3):236–40. 10.4274/BMB.galenos.2023.2023-07-066

23 Cansever M. The association of allergic rhinitis severity with neutrophil–lymphocyte and platelet–lymphocyte ratio in children. North Clin Istanbul. 2022;9(6):602–9. 10.14744/nci.2022.96236

24 Akçal O, Taskırdı İ. Do platelet count and mean platelet volume have a predictive role as a marker in children with atopic dermatitis? Indian J Dermatol. 2022;67(6):688–92. 10.4103/ijd.ijd_689_22

25 Chen X, Yang X, Zhang M, Zhao Y, Guo S. Neutrophil-lymphocyte and platelet-lymphocyte ratios as systemic inflammatory biomarkers for atopic dermatitis in US adults: A cross-sectional NHANES study revealing subgroup heterogeneity. Front Immunol. 2025;160; 1-09. 10.3389/fimmu.2025.1585451