Distinct Clinical and Cytokine Features of Moderate-Severe Persistent AR Phenotype by ARIA Classification: COCOA

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PURPOSE: The prevalence of allergic rhinitis (AR) has increased rapidly. However, the AR phenotype in the general population remains poorly explored. In this study, we aimed to determine the distinct features of AR phenotypes according to Allergic Rhinitis and its Impact on Asthma (ARIA) classification in Korean children. METHODS: We enrolled 1,113 children aged 7 years from the COhort for Childhood Origin of Asthma and allergic diseases (COCOA) study. AR was diagnosed by a physician at each scheduled visit, and the AR phenotype was defined according to the ARIA classification. We analyzed the results of skin prick tests and performed cytokine assays using blood samples collected at ages 3 and 7. RESULTS: , birch, oak, and cat at age 7 increased the risk of moderate-to-severe persistent AR phenotype. Upon cytokine analysis, interleukin (IL)-4 tended to be elevated at age 3 in children with moderate-to-severe persistent AR. By age 7, concentrations of IL-5 and IL-17A were significantly higher in children with moderate-to-severe persistent AR phenotype. CONCLUSIONS: , birch, and Japanese hop at age 3 and prenatal antibiotic use are risk factors. Furthermore, this phenotype may involve both T helper 2 and T helper 17-related immune responses, reflecting a potential shift toward more complex or mixed patterns of inflammation.

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