| Objectives:1.To investigate the prevalence of allergic rhinitis in 6 to 12 years old children in Wuhan,Hubei Province,and to clarify the epidemiological characteristics and related risk factors of AR in this age group preliminarily;2.To explore the clinical efficacy of subcutaneous immunotherapy,and to analyze the factors affecting the outcome;3.To study the changes of the gene expression in peripheral blood mononuclear cells and related immune indexes at the early treatment stage of patients with allergic rhinitis undergoing different immunotherapy regimens,in order to explore the immune tolerance mechanism of subcutaneous immunotherapy.Methods:1.All children aged 6 to 12 in six primary schools were randomly selected from all primary schools in the urban area of Wuhan.The questionnaires were distributed via mobile phone APP in the form of a QR code and filled out by the children and their parents online jointly.Allergic rhinitis was diagnosed by Score for Allergic Rhinitis.Logistic regression analysis was used to assess the correlation between AR and risk factors.2.Data of patients with allergic rhinitis who received routine subcutaneous immunotherapy in our clinic from January 2017 to December 2019 were retrospectively analyzed.The visual analogue scale was used to measure the patients’ nasal symptoms.The efficacy index was evaluated based on the rate of nasal symptom score reduction.t test or Spearman correlation test was used for analysis.3.Patients with allergic rhinitis were assigned to receive conventional immunotherapy,cluster immunotherapy and rush immunotherapy,respectively.Peripheral blood mononuclear cells were separated at three time points,before the treatments,3 and 7 weeks after treatment.m RNA sequencing was performed to detect early gene expression changes in the three groups.The changes of immune indexes were measured after the treatments.Results:1.A total of 5550 children aged 6 to 12 participated in the survey,and the total prevalence of allergic rhinitis was 24.2%.There were significant differences between the prevalence of different age groups and the 6-year-old group has the highest prevalence,29.0%.Nasal blockage and cough were the most common nasal and bronchial symptoms,respectively.The most common trigger of nasal symptoms was dust mites or dust(92.6%).Seasonal incidence of nasal symptoms had two peaks,one in spring and one in autumn.The incidence of all combined allergic diseases,as well as most of infective diseases,was significantly higher in the AR children than in the other children.Multivariate analysis revealed that male,family history of atopy,previous food allergy,air purifier,exposure to dust,maternal exposure to smoke during pregnancy,living in towns or metropolis before 2 years old,antibiotics given in the first year of life,frequent application of antibiotics were risk factors for AR,while daily outdoor time for more than 1 hour and breastfeeding for more than 6 months reduced the risk significantly.2.A total of 170 patients with allergic rhinitis aged 5 to 61 years old participated in subcutaneous immunotherapy.The total effective rates of treatment for 15 weeks,6months,1 year and 18 months were 95.29%,94.00%,98.21% and 98.46%,respectively.The significant effective rate reached 96.92% after 18 months of treatment.At any time point of follow-up,the VAS score of four nasal symptoms and total symptom scores were significantly lower than the baseline(P<0.05).It was found that age,gender,and the combination of other allergic diseases had no significant correlation with the differences of symptom score(P > 0.05).The symptom score of patients sensitized to multiple allergens and with higher baseline VAS score decreased more significantly(P< 0.05).3.Two patients of each group were selected to construct an effective sequencing library.Compared with the baseline,the number of differentially expressed genes after3 weeks in conventional immunotherapy group,CIT group and RIT group were 24,24 and 91,respectively,while 42,52 and 175 after 7 weeks.The differentially expressed genes were mainly involved in disease regulation and immune-related pathways.q PCR validation of the differential genes showed that CXCR1,CXCR2,IER3,PPP1R15 A,RN7SK,SNHG22,SCARNA17 were consistent with the sequencing results except RP11-213H15.4.In the early stage of immunotherapy,t Ig E level was significantly increased,while IL-2,IL-4,IL-5,IL-6 and other cytokines levels were significantly decreased(P<0.05).The effect of baseline levels of s Ig E,s Ig E/t Ig E and other immune indicators on efficacy prediction was analyzed,and it was found that baseline s Ig E/t Ig E level in the early effective group was significantly lower than that in the ineffective group(P < 0.05).Conclusions:1.The prevalence of allergic rhinitis in children aged 6 to 12 years in the urban area of Wuhan was 24.2%.Both genetic and environmental factors were associated with the development of AR,while breastfeeding for more than 6 months and moderate outdoor activity may be inclined to protective factors.2.Conventional immunotherapy was an effective method for allergic rhinitis.The sensitization factors and baseline VAS scores were significantly related to the improvement of nasal symptoms.3.Gene expression changes were observed in patients with allergic rhinitis who received subcutaneous immunotherapy at the early stage of treatment.The differentially expressed genes were mainly involved in disease regulation and immune-related pathways.t Ig E level increased significantly in the early stage of immunotherapy,while IL-2,IL-4,IL-5,IL-6 and other cytokines decreased significantly.Baseline s Ig E/t Ig E levels may be predictive of early outcome. |
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