The Role of Nasal Nitric Oxide and Anterior Active Rhinomanometry in the Diagnosis of Allergic Rhinitis and Asthma: A Message for Pediatric Clinical Practice

Giulia Brindisi; Valentina De Vittori; Rosalba De Nola; Antonio Di Mauro; Giovanna De Castro; Maria Elisabetta Baldassarre; Ettore Cicinelli; Bianca Cinicola; Marzia Duse; Anna Maria Zicari

doi:10.2147/JAA.S275692

The Role of Nasal Nitric Oxide and Anterior Active Rhinomanometry in the Diagnosis of Allergic Rhinitis and Asthma: A Message for Pediatric Clinical Practice

J Asthma Allergy. 2021 Mar 25:14:265-274. doi: 10.2147/JAA.S275692. eCollection 2021.

Affiliations

¹ Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy.
² Department of Biomedical Science and Human Oncology, Gynecology and Obstetrics Section, "Aldo Moro" University of Bari, Bari, 70124, Italy.
³ Department of Tissues and Organs Transplantation and Cellular Therapies, "Aldo Moro" University of Bari, Bari, 70124, Italy.
⁴ Department of Biomedical Sciences and Human Oncology-Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari, 70124, Italy.

^# Contributed equally.

Abstract

Background: Allergic rhinitis (AR) and asthma are two common atopic diseases, often associated with a common ethiopathogenesis characterized by a Th2 inflammatory response with the release of many biomarkers, such as nitric oxide (NO).

Purpose: To evaluate and compare inflammatory (nFeNO and eFeNO) and functional (mNF and FEV1) parameters in AR children with or without asthma in comparison to controls. Secondly, we aimed to identify nFeNO cut-off values and verify their reliability to predict the presence of rhinitis or asthma alone or in combination.

Patients and methods: We enrolled 160 children (6-12 years of age) with AR and/or asthma divided into four groups: controls, AR, asthma, and AR + asthma. All children underwent the following inflammatory and functional measurements: nFeNO, eFeNO, mNF and FEV1.

Results: We observed that levels of nFeNO were extremely higher in children with AR and even more in those with AR + asthma in respect to controls. Notably, all the pathological conditions, especially AR + asthma, showed significantly lower values of mNF compared to healthy children. A negative correlation linked mNF and nFeNO. Then, we found eFeNO values significantly higher in all the pathological groups compared to controls, with major values of this marker in patients affected by asthma and AR + asthma, as well as FEV1 values significantly lower in all the disease groups, especially in children with asthma and AR+ asthma. ROC curve analysis showed that nFeNO was a great predictor for rhinitis alone or with asthma, revealing an accurate cut-off of 662 ppb.

Conclusion: nFeNO measurement is non-invasive, easy to perform, economic and a valuable test in case of AR alone or in association with asthma. Thus, it should be used in patients with rhinitis, together with anterior active rhinomanometry (AAR) to diagnose and estimate the degree of nasal obstruction but also in children with asthma to assess their nasal involvement and improve the therapeutic management.

Keywords: allergic rhinitis; anterior active rhinomanometry; asthma; children; exhaled nitric oxide; nasal nitric oxide.