Rhinomanometry: point of care test (POCT) for allergic rhinitis in children?

Main Article Content

Velia Malizia
Giuliana Ferrante
Giovanna Cilluffo
Salvatore Fasola
Laura Montalbano
Stefania La Grutta

Keywords

Allergic rhinitis, rhinomanometry, point of care test, diagnostic procedures, children

Abstract

Allergic rhinitis (AR) is a global health problem: its prevalence is 23% in Europe, although it is underestimated because as many as 45% of the cases remain undiagnosed. Globally, almost 500 million people suffer from AR, which shows its increasing incidences. The diagnostic course of AR is based on clinical history, supported by anterior rhinoscopy. This inspects the anterior part of the nasal cavity accompanied by allergic sensitivity tests (cutaneous allergic skin tests or specific immunoglobulin E levels). The availability of standardised diagnostic procedures is able to provide objective evaluations of inflammatory situation, and the degree of nasal obstruction may give an advantage in reducing the risk of underestimating the diagnosis of AR. Diagnostic tests with a high level of accuracy are able to provide immediate results, which can sustain the doctor in diagnostic–therapeutic framework. The development of Point of Care Tests (POCTs) could be a useful tool. Considering that nasal obstruction is the most common symptom in patients with AR, the rhinomanometry (RM) test is the most indicated objective evaluation for nasal obstruction. Several studies have also shown the practicability of such diagnostic techniques applied in children. So far, no study has evaluated whether all the applicable requirements are fulfilled by RM in order to be considered as a POCT. The purpose of this perspective was to assess whether all the POCT requirements are fulfilled by RM by conducting a narrative review of the existing literature in which RM has been used in the diagnosis and management of AR in children. A few but encouraging results of studies on children supported the potential use of RM in the area of POCT. However, costs of instruments and the training of personnel involved remain to be explored. The studies support the potential use of RM in POCTs.

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References

1. Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J. 2004 Nov;24(5):758–64. https://doi.org/10.1183/09031936.04.00013904
2. Licari A, Ciprandi G, Marseglia A, Castagnoli R, Barberi S, Caimmi S, et al. Current recommendations and emerging options for the treatment of allergic rhinitis. Expert Rev Clin Immunol. 2014 Oct;10(10):1337–47. https://doi.org/10.1586/1744666X.2014.955476
3. Roberts G, Xatzipsalti M, Borrego LM, Custovic A, Halken S, Hellings PW, et al. Paediatric rhinitis: position paper of the European Academy of Allergy and Clinical Immunology. Allergy. 2013 Sep;68(9):1102–16. https://doi.org/10.1111/all.12235
4. Zuberbier T, Lötvall J, Simoens S, Subramanian SV, Church MK. Economic burden of inadequate management of allergic diseases in the European Union: A GA(2) LEN review. Allergy. 2014 Oct;69(10):1275–9. https://doi.org/10.1111/all.12470
5. Pai NP, Vadnais C, Denkinger C, Engel N, Pai M. Point-of-care testing for infectious diseases: Diversity, complexity, and barriers in low- and middle-income countries. PLoS Med. 2012;9(9):e1001306. https://doi.org/10.1371/journal.pmed.1001306
6. Gelardi M, Landi M, Ciprandi G. The pragmatic role of nasal cytology: A point-of-care testing to implement precision medicine in clinical practice. Rev Alerg Mex. 2018 Jul–Sep;65(3):259–63. https://doi.org/10.29262/ram.v65i3.373
7. Scadding G, Hellings P, Alobid I, Bachert C, Fokkens W, van Wijk RG, et al. Diagnostic tools in rhinology EAACI position paper. Clin Transl Allergy. 2011, Oct;1(1):2. https://doi.org/10.1186/2045-7022-1-2
8. Passàli D, Mezzedimi C, Passàli GC, Nuti D, Bellussi L. The role of rhinomanometry, acoustic rhinometry, and mucociliary transport time in the assessment of nasal patency. Ear Nose Throat J. 2000;79(5):397–400. https://doi.org/10.1177/014556130007900515
9. Cilluffo G, Zicari AM, Ferrante G, Malizia V, Fasola S, Duse M, et al. Assessing repeatability and reproducibility of Anterior Active Rhinomanometry (AAR) in children. BMC Med Res Methodol. 2020 Apr 17;20(1):86. https://doi.org/10.1186/s12874-020-00969-1
10. Ciprandi G, Marseglia GL, Klersy C, Tosca MA. Relationships between allergic inflammation and nasal airflow in children with persistent allergic rhinitis due to mite sensitization. Allergy. 2005 Jul;60(7):957–60. https://doi.org/10.1111/j.1398-9995.2005.00664.x
11. Vogt K, Jalowayski AA, Althaus W, Cao C, Han D, Hasse W, et al. 4-Phase-rhinomanometry (4PR)—Basics and practice 2010. Rhinol Suppl. 2010;21:1–50.
12. Chen IC, Lin YT, Hsu JH, Liu YC, Wu JR, Dai ZK. Nasal airflow measured by rhinomanometry correlates with FeNO in children with asthma. PLoS One. 2016 Oct 28;11(10):e0165440. https://doi.org/10.1371/journal.pone.0165440
13. Priftis KN, Drigopoulos K, Sakalidou A, Triga M, Kallis V, Nicolaidou P. Subjective and objective nasal obstruction assessment in children with chronic rhinitis. Int J Pediatr Otorhinolaryngol. 2006 Mar;70(3):501–5. https://doi.org/10.1016/j.ijporl.2005.07.027
14. Zicari AM, Occasi F, Montanari G, Indinnimeo L, De Castro G, Tancredi G, et al. Intranasal budesonide in children affected by persistent allergic rhinitis and its effect on nasal patency and Nasal Obstruction Symptom Evaluation (NOSE) score. Curr Med Res Opin. 2015 Mar;31(3):391–6. https://doi.org/10.1185/03007995.2015.1009532
15. Chandra RK, Patadia MO, Raviv J. Diagnosis of nasal airway obstruction. Otolaryngol Clin North Am. 2009 Apr;42(2):207–25, vii. https://doi.org/10.1016/j.otc.2009.01.004
16. Zicari AM, Occasi F, Di Fraia M, Mainiero F, Porzia A, Galandrini R, et al. Local allergic rhinitis in children: Novel diagnostic features and potential biomarkers. Am J Rhinol Allergy. 2016 Sep;30(5):329–34. https://doi.org/10.2500/ajra.2016.30.4352
17. Scadding G, Hellings P, Alobid I, Bachert C, Fokkens W, van Wijk RG, et al. Diagnostic tools in rhinology EAACI position paper. Clin Transl Allergy. 2011 Jun 10;1(1):2. https://doi.org/10.1186/2045-7022-1-2