Clinical and anamnestic characteristics, risk factors, sensitization patterns, and major respiratory allergens among young children with allergic rhinitis in Magnitogorsk population

Recent epidemiological studies show a rising prevalence of allergic rhinitis (AR) in children. Early identification of symptoms, sensitization patterns, and causative respiratory allergens enables timely allergenspecific immunotherapy, which may prevent asthma development. The present study aimed to characterize disease features, risk factors, sensitization profiles, and clinically relevant allergens in young children with AR living in Magnitogorsk. An open-label, single-center, prospective study included 92 children with AR (aged 2-4 years, mean 3.15±0.80) and 45 age-matched controls. All participants (n = 137) underwent clinical (blood counts, urinalysis), biochemical, parasitological, and allergological testing (sIgE, ImmunoCAP). Children with AR and polyvalent sensitization (n = 11) were further evaluated using ISAC-112. AR symptom onset occurred at a median of 29.00 (24.00-36.00) months (range: 8.00-45.00). Persistent AR was observed in 77.2% of patients, while 22.8% had intermittent symptoms. Moderate-to-severe AR (37% of cases) had the severity scores of 7.00 (6.00-8.00) (by a visual analogue scale). Significant AR risk factors included: family history of atopy (OR 4.4; 95% CI 2.2-8.9); parental history of persistent AR (OR 10.4; 95% CI 2.4-44.4); comorbid allergies (OR 17.1; 95% CI 6.4-45.9); history of wheezing (OR 10.8; 95% CI 3.7-31.5); atopic dermatitis (OR 3.9; 95% CI 1.4-10.3); cesarean delivery (OR 2.8; 95% CI 1.2-6.8); pet exposure (OR 3.6; 95% CI 1.8-7.3); and parental smoking (OR 2.8; 95% CI 1.4-5.8). Cat dander (71.74%), dog dander (70.65%), and birch pollen (67.39%) were the most frequent sensitizing allergens for the studied group in Magnitogorsk. Seasonal AR symptoms were revealed in 57% of patients, while 35.44% reacted to animal allergens. Sensitization to major allergens Bet v1 (birch) and Fel d1 (cat) did confirm the true allergic responses. A complete symptom control and prevention of bronchial asthma are the primary treatment goals for children with AR. Early diagnosis and precise treatment strategies are essential to meet these objectives.

1. Allergic rhinitis: Clinical guidelines of the Ministry of Health of the Russian Federation [Electronic resource]. Moscow, 2024. 88 p. Available at: https://library.mededtech.ru/rest/documents/KP261_2.

2. Barycheva L.Yu., Dushina L.V., Masalskiy S.S. Evaluation of the effectiveness of subcutaneous pollen weed polen allergens. Allergologiya i immunologiya v pediatrii = Allergology and Immunology in Pediatrics, 2022, no. 1, pp. 16-26. (In Russ.)

3. Belan E.B. Allergen-specific immunotherapy as a treatment method for allergic diseases. Astrakhanskiy meditsinskiy zhurnal = Astrakhan Medical Journal, 2018, Vol. 13, no. 1, pp. 6-14. (In Russ.)

4. Kamaltynova E.M., Deev I.A., Belonogova E.G. Comparative epidemiological characteristics of bronchial asthma according to the "International Study of Asthma and Allergies in Childhood" (ISAAC) program. Byulleten sibirskoy meditsiny = Bulletin of Siberian Medicine, 2009, Vol. 8, no. 4, pp. 92-97. (In Russ.)

5. Kuzmicheva K.P., Malinina E.I., Richkova O.A. The issue of the allergic diseases prevalence among children: a current review. Allergologiya i immunologiya v pediatrii = Allergology and Immunology in Pediatrics, 2021, no. 2, pp. 4-10. (In Russ.)

6. Kulaga O.S., Avoyan G.E., Esaulova D.R., Andreev I.V., Nechay K.O., Andreev A.I., Kicheeva K.B., Baklakova O.S., Mislavsky O.V., Gegechkori V.I., Cherchenko N.G., Sankov M.N., Toptygin А.Y., Shvets S.M., Romanova T.S., Latysheva E.A., Martynov А.I., Khaitov M.R. Study of the silver birchpollen allergoid. Rossiyskiy allergologicheskiy zhurnal = Russian Journal of Allergy, 2022, Vol. 19, no. 3, pp. 328-335. (In Russ.)

7. Nazarova E.V., Khaitov M.R. Characteristics of the allergic disorder and sensibilization spectrum distributions in the Russian Federation taking into account climatic and geographical features of the regions. Rossiyskiy allergologicheskiy zhurnal = Russian Journal of Allergy, 2024, Vol. 21, no. 4, pp. 440-450. (In Russ.)

8. Smolkin Yu.S., Masalskiy S.S., Shakhova N.V., Molochkova A.N. Adherence of doctors to clinical recommendations in the management of children and adolescents with allergic rhinitis. Allergologiya i immunologiya v pediatrii = Allergology and Immunology in Paediatrics, 2025, no. 1, pp. 5-20. (In Russ.)

9. Trusova OV, Kamaev AV, Lyashenko NL, Makarova IV, Stolyarova EA. Sensitization to household allergens in children with bronchial asthma and allergic rhinitis in St. Petersburg. Allergologiya i immunologiya v pediatrii = Allergology and Immunology in Pediatrics, 2021, Vol. 2, no. 65, pp. 11-18. (In Russ.)

10. Shakhova N.V., Kashinskaya T.S., Kamaltynova E.M. Prevalence of bronchial asthma and allergic diseases among children. Allergologiya i immunologiya v pediatrii = Allergology and Immunology in Pediatrics, 2022, Vol. 2, no. 65, pp. 5-12. (In Russ.)

11. Shakhova N.V., Kamaltynova E.M., Lobanov Yu.P., Ardatova T.S. Allergic rhinitis in pre-school children living in urban settings of the altai region: a population-based cross-sectional study. Voprosy sovremennoy pediatrii = Current Pediatrics, 2018, Vol. 17, no. 3, pp. 236-243. (In Russ.)

12. Asher M.I., Montefort S., Björkstén B., Lai C.K., Strachan D.P., Weiland S.K., Williams H.; ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet, 2006, Vol. 368, no. 9537, pp. 733-743.

13. Bousquet J., Anto J.M., Bachert C., Baiardini I., Bosnic-Anticevich S., Canonica G.W., Melén E., Palomares O., Scadding G.K., Togias A., Toppila-Salmi S. Allergic rhinitis. Nat. Rev. Dis. Primers, 2020, Vol. 6, no. 1, 95. doi: 10.1016/j.jaci.2019.06.049.

14. Bousquet J., Schünemann H.J., Togias A., Bachert C., Erhola M., Hellings P.W., Klimek L., Pfaar O., Wallace D., Ansotegui I., Agache I., Bedbrook A., Bergmann K.-C., Bewick M., Bonniaud P., Bosnic-Anticevich S., Bossé I., Bouchard J., Boulet L.-P., Brozek J., Brusselle G., Calderon M.A., Canonica W.G., Caraballo L., Cardona V., Casale T., Cecchi L., Chu D.K., Costa E.M., Cruz A.A., Czarlewski W., D'Amato G., Devillier P., Dykewicz M., Ebisawa M., Fauquert J.-L., Fokkens W.J., Fonseca J.A., Fontaine J.-F., Gemicioglu B., van Wijk R.G., Haahtela T., Halken S., Ierodiakonou D., Iinuma T., Ivancevich J.-C., Jutel M., Kaidashev I., Khaitov M., Kalayci O., Tebbe J.K., Kowalski M.L., Kuna P., Kvedariene V., La Grutta S., Larenas-Linnemann D., Lau S., Laune D., Le L., Lieberman P., Lodrup Carlsen K.C., Lourenço O., Marien G., Carreiro-Martins P., Melén E., Menditto E., Neffen H., Mercier G., Mosgues R., Mullol J., Muraro A., Namazova L., Novellino E., O'Hehir R., Okamoto Y., Ohta K., Park H.S., Panzner P., Passalacqua G., Pham-Thi N., Price D., Roberts G., Roche N., Rolland C., Rosario N., Ryan D., Samolinski B., Sanchez-Borges M., Scadding G.K., Shamji M.H., Sheikh A., Bom A.-M.T., Toppila-Salmi S., Tsiligianni I., ValentinRostan M., Valiulis A., Valovirta E., Ventura M.-T., Walker S., Waserman S., Yorgancioglu A., Zuberbier T.; Allergic Rhinitis and Its Impact on Asthma Working Group. Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence. J. Allergy Clin. Immunol., 2020, Vol. 145, no. 1, pp. 70-80.

15. D'Amato G., D'Amato M. Climate change, air pollution, pollen allergy and extreme atmospheric events. Curr. Opin. Pediatr., 2023, Vol. 35, no. 3, pp. 356-361.

16. D'Amato G., Chong-Neto H.J., Monge Ortega O.P., Vitale C., Ansotegui I., Rosario N., Haahtela T., Galan C., Pawankar R., Murrieta-Aguttes M., Cecchi L., Bergmann C., Ridolo E., Ramon G., Gonzalez Diaz S., D'Amato M., Annesi-Maesano I. The effects of climate change on respiratory allergy and asthma induced by pollen and mold allergens. Allergy, 2020, Vol. 75, no. 9, pp. 2219-2228.

17. Dramburg S., Hilger C., Santos A.F., de las Vecillas L., Aalberse R.C., Acevedo N., Aglas L., Altmann F., Arruda K.L., Asero R., Ballmer-Weber B., Barber D., Beyer K., Biedermann T., Bilo M.B., Blank S., Bosshard P.P., Breiteneder H., Brough H.A., Bublin M., Campbell D., Caraballo L., Caubet J.C., Celi G., Chapman M.D., Chruszcz M., Custovic A., Czolk R., Davies J., Douladiris N., Eberlein B., Ebisawa M., Ehlers A., Eigenmann P., Gadermaier G., Giovannini M., Gomez F., Grohman R., Guillet C., Hafner C., Hamilton R.G., Hauser M., Hawranek T., Hoffmann H.J., Holzhauser T., Iizuka T., Jacquet A., Jakob T., Janssen-Weets B., Jappe U., Jutel M., Kalic T., Kamath S., Kespohl S., Kleine-Tebbe J., Knol E., Knulst A., Konradsen J.R., Korošec P., Kuehn A., Lack G., Le T.- M., Lopata A., Luengo O., Mäkelä M., Marra A.M., Mills C., Morisset M., Muraro A., Nowak-Wegrzyn A., Nugraha R., Ollert M., Palosuo K., Pastorello E.A., Patil S.U., Platts-Mills T., Pomés A., Poncet P., Potapova E., Poulsen L.K., Radauer C., Radulovic S., Raulf M., Rougé P., Sastre J., Sato S., Scala E., Schmid J.M., Schmid-Grendelmeier P., Schrama D., Sénéchal H., Traidl-Hoffmann C., Valverde-Monge M., van Hage M., van Ree R., Verhoeckx K., Vieths S., Wickman M., Zakzuk J., Matricardi P.M., Hoffmann-Sommergruber K. First published: 26 April 2023 . EAACI Molecular Allergology User's Guide 2.0. Pediatr. Allergy Immunol., 2023, Vol. 34, Suppl. 28, e13854. doi: 10.1111/pai.13854.

18. Kumar S., Jeong Y., Ashraf M.U., Bae Y.S. Dendritic cell-mediated Th2 immunity and immune disorders. Int. J. Mol. Sci., 2019, Vol. 20, no. 9, 2159. doi: 10.3390/ijms20092159.

19. Licari A., Magri P., de Silvestri A., Giannetti A., Indolfi C., Mori F., Marseglia G.L., Peroni D. Epidemiology of allergic rhinitis in children: a systematic review and meta-analysis. J. Allergy Clin. Immunol. Pract., 2023, Vol. 11, no. 8, pp. 2547-2556.

20. Loo E.X.L., Liew T.M., Yap G.C., Wong L.S.Y., Shek L.P., Goh A., van Bever H.P.S., Teoh O.H., Yap F., Tan K.H., Thomas B., Ramamurthy M.B., Goh D.Y.T., Eriksson J.G., Chong Y.S., Godfrey K.M., Lee B.W., Tham E.H. Trajectories of early-onset rhinitis in the Singapore GUSTO mother-offspring cohort. Clin. Exp. Allergy, 2021, Vol. 51, no. 3, pp. 419-429.

21. Minami T., Fukutomi Y., Inada R., Tsuda M., Sekiya K., Miyazaki M., Tsuji F., Taniguchi M. Regional differences in the prevalence of sensitization to environmental allergens: Analysis on IgE antibody testing conducted at major clinical testing laboratories throughout Japan from 2002 to 2011. Allergol. Int., 2019, Vol. 8, no. 4, pp. 440-449.

22. Shamji M.H., Sharif H., Layhadi J.A., Zhu R., Kishore U., Renz H. Diverse immune mechanisms of allergen immunotherapy for allergic rhinitis with and without asthma. J. Allergy Clin. Immunol., 2022, Vol. 149, no. 3, pp. 791-801.