Valoración de la respuesta a inmunoterapia tras provocación nasal alergéno específica valorada mediante rinometría acústica y cuestionario de síntomas en pacientes pediátricos con rinitis alérgica

Abstract

Introduction: Allergic rhinitis is a major public health problem. It is a disease that reduces the quality of life and can cause multiple morbidities. The only etiological treatment capable of modifying the natural history of this disease is immunotherapy. Until now, there is no effective instrument that allows evaluating the response to immunotherapy early. In this study, nasal provocation assessed by acoustic rhinometry together with a symptom and medication consumption questionnaire is proposed as a useful tool to early measure the effectiveness of immunotherapy. Material and methods: Quasi-experimental, prospective, descriptive and analytical study in 57 pediatric patients diagnosed with allergic rhinitis due to mites, candidates for treatment with specific immunotherapy against mites. Nasal provocation assessed by acoustic rhinometry was carried out together with a symptom questionnaire before the start of immunotherapy, 6 months and one year after starting it, subsequently comparing the results. The data were processed with the statistical package IBM SPSS Statistics 22.0 for Windows, and a descriptive and analytical analysis of the variables was carried out. Results: In the nasal provocation, when comparing the volumes of the nasal provocation at a mite concentration of 1:100, there is a reduction in the volume decrease with statistical significance at 6 months and one year after starting ITE. Likewise, we found a reduction in symptoms during nasal provocation with statistically significant differences at both 1:100 and 1:10 mite concentrations. Also, a clinical improvement was observed 6 months and one year after starting immunotherapy, translated into an improvement in the score on all clinical scales, with statistically significant differences. When correlating the different tools used to evaluate the response to immunotherapy, we found no correlation between the objective variables, obtained from nasal provocation with acoustic rhinometry, with the subjective variables, obtained from the symptom questionnaires. Although both are useful used independently. Finally, the results obtained in the nasal provocation assessed by rhinometry and in the symptom questionnaires have been compared according to gender, severity of allergic rhinitis, presence or absence of bronchial asthma and number of sensitizations, without finding statistically significant differences between both groups in most cases. Conclusions: In light of our results, we can conclude that nasal provocation with acoustic rhinometry and questionnaires can be useful tools to evaluate the response to immunotherapy.