Aeroallergen sensitization in school-age children with allergic rhinitis: What has changed during the COVID-19 pandemic?

Main Article Content

Nursen Cigerci Gunaydin
Ceren Tanc
Ezgi Tanburoglu Celiker
Sule Guler Kacmaz
Nedim Samanci
Aysin Nalbantoglu
Burcin Nalbantoglu


aeroallergens, allergic rhinitis, children, COVID-19 pandemic, skin prick test


Background: Pandemic period may affect aeroallergen sensitization.

Objective: The study aimed to investigate changes in allergen sensitivities of skin prick test (SPT) in patients with allergic rhinitis (AR) during pandemic and to evaluate relationship with disease severity.

Methods: In all, 164 AR patients with or without asthma, aged 6–17 years, who have undergone SPTs prior to the pandemic and after October 1, 2021 (18th month of the pandemic), were evaluated retrospectively. The wheal size of allergens in performed SPTs during and prior to the pandemic were compared. Detected changes in allergen sensitivities via SPT results were compared with changes in the disease severity parameters (AR severity, asthma severity, and the number of asthma exacerbations per year), frequency of upper respiratory tract infections and antibiotic use, laboratory parameters, demographic characteristics, and visual analogue scores (VAS).

Results: House dust mites (HDMs), cat, pollen, Artemisia, and Cupressus sensitization increased in AR patients during the Coronavirus disease 2019 (COVID-19) pandemic. HDM, mold, and pollen wheal diameters increased in SPTs. Proportion of polysensitization increased during the pandemic, compared to pre-pandemic period (9.1% vs 3%; P < 0.001), and number of non-sensitized patients decreased during the pandemic period compared to the pre-pandemic period (7.9% vs 22.6%; P < 0.001). An increase in HDM sensitivity in SPTs was correlated with VAS for nasal blockage, and an increase in cat sensitivity was correlated with VAS for all nasal symptoms.

Conclusion: We believe that inhalant allergen sensitization might have been affected by the lifestyle changes of patients during the pandemic. Hence, it is important to evaluate patients for allergen sensitization, especially patients with moderate/severe AR, to revise disease control measurements.

Abstract 129 | PDF Downloads 126 HTML Downloads 16 XML Downloads 5


1. Asher MI, Montefort S, Björkstén B, Lai CK, Stranchan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC phase one and three repeat multicountry cross-sectional surveys. Lancet. 2006;368(9537):733–43. 10.1016/S0140-6736(06)69283-0

2. Li J, Huang Y, Lin X, Zhao D, Tan G, Wu J, et al. Influence of degree of specific allergic sensitivity on severity of rhinitis and asthma in Chinese allergic patients. Respir Res. 2011;12(1):95. 10.1186/1465-9921-12-95

3. Tham EH, Lee AJ, Bever HV. Aeroallergen sensitization and allergic disease phenotypes in Asia. Asian Pac J Allergy Immunol. 2016;34(3):181–9.

4. Salo PM, Sever ML, Zeldin DC. Indoor allergens in school and day care environments. J Allergy Clin Immunol. 2009;124(2):185–94. 10.1016/j.jaci.2009.05.012

5. Farrokhi S, Gheybi MK, Movahed A, Tahmasebi R, Iranpour D, Fatemi A, et al. Common aeroallergens in patients with asthma and allergic rhinitis living in southwestern part of Iran: Based on skin prick test reactivity. Iran J Allergy Asthma Immunol. 2015;14(2):133–8.

6. Ozkaya E, Sogut A, Kucukkoc M, Eres M, Acemoglu H, Yuksel H, et al. Sensitisation pattern of inhalant allergens in children with asthma who are living different altitudes in Turkey. Int J Biometeorol. 2015;59(11):1685–90. 10.1007/s00484-015-0975-0

7. Sahiner UM, Civelek E, Yavuz ST, Buyuktiryaki AB, Tuncer A, Sekerel BE. Skin prick testing to aeroallergen extracts: What is the optimal panel in children and adolescents in Turkey? Int Arch Allergy Immunol. 2012;157(4):391–8. 10.1159/000329870

8. Wu Z, McGoogan JM. Characteristics of and ımportant lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239. 10.1001/jama.2020.2648

9. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species severe acute respiratory syndrome-related coronavirus: Classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536–44. 10.1038/s41564-020-0695-z

10. World Health Organization. Global-Turkey. Available from: Accessed November 30, 2020.

11. Platts-Mills TA, Vervloet D, Thomas WR, Aalberse RC, Chapman MD. Indoor allergens and asthma: Report of the third ınternational workshop. J Allergy Clin Immunol. 1997;100:2–24. 10.1016/S0091-6749(97)70292-6

12. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, et al. Development of the asthma control test: A survey for assessing asthma control. J Allergy Clin Immunol. 2004;113(1):59–65. 10.1016/j.jaci.2003.09.008

13. Global İnitiative for Asthma (GINA). Global strategy for asthma management and prevention. NHLBI/WHO workshop report. Bethesda, MD: National Institute of Health, and National Heart, Lung and Blood Institute; revised 2020.

14. Bousquet PJ, Combescure C, Neukirch F, Klossek JM, Mechin H, Daures JP, et al. Visual analog scales can assess the severity of rhinitis graded according to ARIA guidelines. Allergy. 2007;62(4):367–72. 10.1111/j.1398-9995.2006.01276.x

15. Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines–2016 revision. J Allergy Clin Immunol. 2017;140(4): 950–8. 10.1016/j.jaci.2017.03.050

16. Meltzer EO, Blaiss MS, Derebery MJ, Mahr TA, Gordon BR, Sheth KK, et al. Burden of allergic rhinitis: Results from the Pediatric Allergies in America survey. J Allergy Clin Immunol. 2009;124(3):43–70. 10.1016/j.jaci.2009.05.013

17. de Jong AB, Dikkeschei LD, Brand PL. Sensitization patterns to food and inhalant allergens in childhood: A comparison of nonsensitized, monosensitized and polysensitized children. Pediatr Allergy Immunol. 2011;22(1):166–71. 10.1111/j.1399-3038.2010.00993.x

18. Platts-Mills TA, Wheatley LM, Aalberse RC. Indoor versus outdoor allergens in allergic respiratory disease. Curr Opin Immunol. 1998;10(6):634–9. 10.1016/S0952-7915(98)80081-2

19. Visitsunthorn N, Chaimongkol W, Visitsunthorn K, Pacharn P, Jirapongsananuruk O. Great flood and aeroallergen sensitization in children with asthma and/or allergic rhinitis. Asian Pac J Allergy Immunol. 2018;36(2):69–76.

20. Testa D, DI Bari M, Nunziata M, Cristofaro G, Massaro G, Marcuccio G, Motta G. Allergic rhinitis and asthma assessment of risk factors in pediatric patients: A systematic review. Int J Pediatr Otorhinolaryngol. 2020;129:109759. 10.1016/j.ijporl.2019.109759

21. Baatenburg de Jong A, Dikkeschei LD, Brand PLP. Sensitization patterns to food and inhalant allergens in childhood: a comparison of non-sensitized, monosensitized, and polysensitized children: Sensitization patterns to food and inhalant allergens. Pediatr Allergy Immunol. 2011;22(2):166–71. 10.1111/j.1399-3038.2010.00993.x

22. Dogru M. Investigation of asthma comorbidity in children with different severities of allergic rhinitis. Am J Rhinol Allergy. 2016;30(3):186–9. 10.2500/ajra.2016.30.4315

23. Gruchalla RS, Pongracic J, Plaut M, Evans R, Visness CM, Walter M, et al. Inner City Asthma Study: Relationships among sensitivity, allergen exposure, and asthma morbidity. J Allergy Clin Immunol. 2005;115(3):478–85. 10.1016/j.jaci.2004.12.006

24. Yucel E, Suleyman A, Demirkale ZH, Guler N, Tamay ZU, Ozdemir C. “Stay at home”: Is it good or not for house dust mite sensitized children with respiratory allergies? Pediatr Allergy Immunol. 2021;32(5):963–70. 10.1111/pai.13477

25. Tovey ER, Almqvist C, Li Q, Crisafulli D, Marks GB. Nonlinear relationship of mite allergen exposure to mite sensitization and asthma in a birth cohort. J Allergy Clin Immunol. 2008;122(1):114–8. 10.1016/j.jaci.2008.05.010

26. Davies JM, Weber RW.A. Aerobiology of outdoor allergens. In: Burks AW, Holgate ST, O’Hehir RE, Brodie DH, Bacharier LB, Hershey GKK, Peebles RS, editors. Middleton’s allergy principles and practice, 9th ed. Philadelphia, PA: Elsevier; 2020. Vol. 1., pp. 428–50.

27. Gabet S, Ranciere F, Just J, Blic J, Lezmi G, Amat F, et al. Asthma and allergic rhinitis risk depends on house dust mite specific IgE levels in PARIS birth cohort children. World Allergy Organ J. 2019;12(9):100057. 10.1016/j.waojou.2019.100057

28. Langley SJ, Goldthorpe S, Craven M, Morris J, Woodcock A, Custovic A. Exposure and sensitization to indoor allergens: association with lung function, bronchial reactivity, and exhaled nitric oxide measures in asthma. J Allergy Clin Immunol. 2003;112 (2):362–8. 10.1067/mai.2003.1654

29. Baumann LM, Romero KM, Robinson CL, Hansel NN, Gilman RH,Hamilton RG, et al. Prevalence and risk factors for allergic rhinitis in two resource-limited settings in Peru with disparate degrees of urbanization. Clin Exp Allergy. 2015;45(1):192–9. 10.1111/cea.12379

30. Weinmayr G, Gehring U, Genuneit J, Buchele G, Kleiner A, Siebers R, et al. Strachan, dampness and moulds in relation to respiratory and allergic symptoms in children: Results from phase two of the international study of asthma and allergies in childhood (ISAAC phase two). Clin Exp Allergy. 2013;43(7):762–74. 10.1111/cea.12107

31. Caillaud D, Leynaert B, Keirsbulck M, Nadif R. Indoor mould exposure, asthma and rhinitis: Findings from systematic reviews and recent longitudinal studies. Eur Respir Rev. 2018;27(148):170137. 10.1183/16000617.0137-2017

32. Plaza V, Serrano J, Picado C, Cosano J, Ancochea J, de Diego A, et al. Clinical characteristics of the fatal and near-fatal asthma in Alternaria alternata sensitized patients. Med Clin (Barc). 2003;121(19):721–4. 10.1016/S0025-7753(03)74076-7

33. Chew GL, Correa JC, Perzanowski MS. Mouse and cockroach allergens in the dust and air in northeastern United States inner-city public high schools. Indoor Air. 2005;15(4):228–34. 10.1111/j.1600-0668.2005.00363.x

34. Li J, Sun B, Huang Y, Lin X, Zhao D, Tan G, et al. A multicentre study assessing the prevalence of sensitizations in patients with asthma and/or rhinitis in China. Allergy. 2009;64 (7):1083–92. 10.1111/j.1398-9995.2009.01967.x