A NEW study suggests that mixed rhinitis (MR) may be a significantly underrecognized condition in children and adolescents previously diagnosed with allergic rhinitis (AR), with nearly half of patients potentially misclassified. The research proposes a practical screening tool to help clinicians better identify patients who also suffer from symptoms triggered by non-specific irritants, not just allergens.
In this cross-sectional study of 126 patients aged 8 to 18 years with a confirmed diagnosis of AR, researchers evaluated the burden of irritant sensitivity using an 18-item nasal irritant questionnaire (NIQ). Participants who provided at least eight high-intensity responses (score ≥5) were classified as having a “high irritant burden” consistent with MR, while others were considered to have “low irritant burden” AR.
Findings revealed that 42.9% of participants met the threshold for MR, with affected individuals more likely to be adolescent males and to have experienced symptoms for an average of three years. Notably, these patients reported significantly poorer control of rhinitis symptoms, despite no major differences in allergic sensitization, indoor allergen exposure, or atopic comorbidities compared with their AR-only counterparts.
The absence of standardized diagnostic tools for MR in pediatrics has complicated efforts to differentiate it from classic AR. This study proposes a cut-off of eight positive responses on the NIQ as a feasible clinical marker for MR, offering a structured method to refine diagnosis and guide more tailored treatment strategies.
The authors emphasize the need for clinicians to consider mixed triggers when managing pediatric rhinitis, particularly in patients with ongoing symptoms despite conventional AR management. Early recognition of MR may be key to improving symptom control and quality of life in this population.
Reference:
Burla Manhães I et al. Mixed rhinitis: an underestimated diagnosis in children and adolescents? Eur Ann Allergy Clin Immunol. 2025. doi: 10.23822/EurAnnACI.1764-1489.404. [Online ahead of print]
