Predictors of Persistent Chronic Rhinosinusitis in Children

A 5-YEAR prospective study has identified clinical and immunological markers that may help predict which preschool children with chronic rhinosinusitis (CRS) are likely to experience persistent disease and develop house dust mite (HDM)-induced allergic rhinitis. 

The study followed 133 children aged 4–8 years with CRS symptoms, with or without IgE-mediated sensitisation to HDM, to investigate factors associated with disease progression. A total of 117 children completed the 5-year follow-up. 

Baseline Symptoms Linked to Long-Term Chronic Rhinosinusitis Persistence 

The researchers found that CRS persisted in 35% of participants, with symptom severity at preschool age emerging as a strong predictor of ongoing disease. Children with a baseline Sinus and Nasal Quality of Life Survey (SN-5) score greater than 3.6 were more than three times as likely to have persistent CRS at school age compared with those with lower scores (odds ratio [OR] 3.41; 95% CI 1.50–7.76). 

The study also identified a potential immunological marker of disease persistence. Group 2 innate lymphoid cells (ILC-2s), which are associated with type 2 inflammation, were detected more frequently in nasal samples from children whose CRS persisted throughout the study period. 

In addition to predicting persistent CRS, the investigators examined factors associated with the later development of HDM-induced allergic rhinitis. A history of food allergy during infancy was independently associated with almost a four-fold increased likelihood of developing HDM allergy (OR 3.87; 95% CI 1.10–13.60). Similarly, children whose allergy-related symptoms accounted for at least 21% of their baseline SN-5 score were nearly four times more likely to receive a diagnosis of HDM-induced allergic rhinitis (OR 3.96; 95% CI 1.20–13.10). 

The researchers reported that combining these clinical characteristics further improved the prediction of HDM allergy, suggesting that readily available clinical information could help identify children at increased risk before school age. 

Early Identification Could Support Timely Allergen Immunotherapy 

The authors conclude that assessing baseline symptom burden alongside immune and allergy-related factors may improve the early identification of children at risk of persistent CRS and HDM allergy. They suggest that recognising these high-risk patients earlier could support more timely initiation of allergen immunotherapy in appropriate children, although further validation of the predictive model is warranted. 

Reference 

Dobrakowski Ł et al. Predicting the course of chronic rhinosinusitis in young children—5-year prospective study. Pediatr Allergy Immunol. 2026; 37:e70416. 

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