Characterization of clinical features of monosensitized and polysensitized allergic rhinitis patients with pollen allergy

Abstract

Objectives: The present study evaluates the prevalence of monosensitization and polysensitization in patients with pollen-hypersensitive moderate-to-severe persistent allergic rhinitis (AR), and determines the clinical characteristics of the two phenotypes.

Methods: This retrospective cohort study included 160 patients with moderate-to-severe persistent AR among the 3,699 patients who presented to allergy outpatient clinics who were found to have hypersensitivity to pollen based on a skin prick test and/or allergen-specific IgE positivity. The patients were divided into two groups: monosensitized (hypersensitivity to pollen alone), and polysensitized (hypersensitivity to pollen and other allergens). Both groups were evaluated for allergen hypersensitivity, symptoms of AR, symptom frequency and comorbidities related to AR.

Results: Of the 160 patients, 83 (51.9%) were monosensitized and 77 (48.1%) were polysensitized. The mean age was 29.5 ± 10.7 yeasrs and 28.3 ± 8.3 years, respectively and the female-to-male ratio was 42/41 and 47/30 in the two groups. Nasal congestion was remarkably more common in the polysensitized patients than in the monosensitized patients (p = 0.01). Hypersensitivity to weed mix and Cupressus arizonica pollen identified with a skin prick test was significantly more common in the polysensitized patients than in the monosensitized patients (p = 0.03 and p = 0.01, respectively). The two groups were similar in terms of the prevalence of asthma and other comorbidities related to rhinitis (p = 0.78).

Conclusions: In this single-center study, the rates of monosensitization and polysensitization were found to be similar in patients with pollen-hypersensitive moderate-to-severe AR, and the clinical characteristics of the polysensitized phenotype were different from those of the monosensitized phenotype.

Keywords

• Pollen allergy
• allergic rhinitis
• monosensitization
• polysensitization
• skin prick test

References

1. 1. Brożek 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;140:950-8.
2. 2. Small P, Kim H. Allergic rhinitis. Allergy Asthma Clin Immunol 2011;7 (Suppl 1):S3-8.
3. 3. Ciprandi G, Incorvaia C, Puccinelli P, Soffia S, Scurati S, Frati F. Polysensitization as a challenge for the allergist: the suggestions provided by the Polysensitization Impact on Allergen Immunotherapy studies. Expert Opin Biol Ther 2011;11:715-22.
4. 4. Migueres M, Dávila I, Frati F, Azpeitia A, Jeanpetit Y, Lhéritier-Barrand M, et al. Types of sensitization to aeroallergens: definitions, prevalences and impact on the diagnosis and treatment of allergic respiratory disease. Clin Transl Allergy 2014:4:16.
5. 5. Ciprandi G, Cirillo I. Monosensitization and polysensitization in allergic rhinitis. Eur J Intern Med 2011;22:e75-9.
6. 6. Oh JW. Pollen allergy in a changing planetary environment. Allergy Asthma Immunol Res 2022;14:168-81.
7. 7. Bousquet PJ, Castelli C, Daures JP, Heinrich J, Hooper R, Sunyer J, et al. Assessment of allergen sensitization in a general population-based survey (European Community Respiratory Health Survey I). Ann Epidemiol 2010;20:797-803.
8. 8. Arbes Jr SJ, Gergen PJ, Elliott L, Zeldin DC. Prevalences of positive skin test responses to 10 common allergens in the US population: results from the third National Health and Nutrition Examination Survey. J Allergy Clin Immunol 2005;116:377-83.

9. 9. de Jong AB, Dikkeschei LD, Brand PL. Sensitization patterns to food and inhalant allergens in childhood: a comparison of non-sensitized, monosensitized and polysensitized children. Pediatr Allergy Immunol 2011;22:166-71.
10. 10. Migueres M, Fontaine JF, Haddad T, Grosclaude M, Saint-Martin F, Bem-David D, et al. Characteristics of patients with respiratory allergy in France and factors influencing immunotherapy prescription: a prospective observational study (Realis). Int J Immunopathol Pharmacol 2011;24:387-400.
11. 11. Didier A, Chartier A, Demonet G: Specific sublingual immunotherapy: for which profiles of patients in practice? Midterm analysis of ODISSEE (observatory of the indication and management of respiratory allergies [rhinitis and/or conjunctivitis and/or allergic asthma] by specific sublingual immunotherapy). Rev Fr Allergol 2010;50:426-33.
12. 12. Navarro A, Colás C, Antón E, Conde J, Dávila I, Dordal MT, et al. Rhinoconjunctivitis Committee of the SEAIC: Epidemiology of allergic rhinitis in allergy consultations in Spain: Alergológica-2005. J Investig Allergol Clin Immunol 2009;2(Suppl):7-13.
13. 13. Silvestri M, Rossi GA, Cozzani S, Pulvirenti G, Fasce L. Age-dependent tendency to become sensitized to other classes of aeroallergens in atopic asthmatic children. Ann Allergy Asthma Immunol 1999;83:335-40.
14. 14. Calderon MA, Cox L, Casale TB, Moingeon P, Demoly P. Multiple-allergen and single-allergen immunotherapy strategies in polysensitized patients: looking at the published evidence. J Allergy Clin Immunol 2012;129:929-34.
15. 15. Ciprandi G, Alesina R, Ariano R, Aurnia P, Borrelli P, Cadario G, et al. Characteristics of patients with allergic polysensitization: the POLISMAIL study. Eur Ann Allergy Clin Immunol 2008;40:77-83.
16. 16. Ciprandi G, Klersy C, Cirillo I, Marseglia GL. Quality of life in allergic rhinitis: relationship with clinical, immunological, and functional aspects. Clin Exp Allergy 2007;37:1528-35.
17. 17. Ciprandi G, Cirillo I, Vizzaccaro A, Tosca MA, Passalacqua G, Pallestrini E, et al. Seasonal and perennial allergic rhinitis: is this classification adherent to real life? A population based study. Allergy 2005;60:882-7.
18. 18. Prigione I, Morandi F, Tosca MA. Silvestri, Pistoia V, Ciprandi G, et al. Interferon-gamma and IL-10 may protect from allergic polysensitization in children: preliminary evidence. Allergy 2010;65:740-2.
19. 19. Burbach GJ, Heinzerling LM, Edenharter G, Bachert C, Bindslev-Jensen C, Bonini S, et al. GA2LEN skin test study II: clinical relevance of inhalant allergen sensitizations in Europe. Allergy Eur J Allergy Clin Immunol 2009;64:1507-15.
20. 20. Bousquet J, Annesi-Maesano I, Carat F, Leger D, Rugina M, Pribil C, et al. Characteristics of intermittent and persistent allergic rhinitis: DREAMS study group. Clin Exp Allergy 2005;35:728-32.
21. 21. Pavón-Romero GF, Calderón-Ezquerro MDC, Rodríguez-Cervantes MA, Villanueva DF, Melgoza-Ruiz E, Ramírez-Jiménez F, et al. Association of allergic sensitivity and pollination in allergic respiratory disease: the role of pollution. J Asthma Allergy 2022;15:1227-43.