Cross-sectional study on exhaled nitric oxide in relation to upper airway inflammatory disorders with regard to asthma and perennial sensitization

Christina Krantz (1) , Simone Accordini (2) , Kjell Alving (1) , Angelo Guido Corsico (3, 4) , P Demoly (5, 6, 7, 8) , Diogenes Seraphim Ferreira (9, 10) , Bertil Forsberg (11) , Judith Garcia-Aymerich (12, 13, 14) , Thórarinn Gislason (15, 16) , Joachim Heinrich (17, 18, 19) , Rain Jõgi (20) , Ane Johannessen (21) , Bénédicte Leynaert (22) , Alessandro Marcon (2) , Jesús Martínez-Moratalla Rovira (23, 24) , Elisabet Nerpin (1, 25) , Dennis Alexander Nowak (17, 18) , Anna Carin Olin (26) , Mario Olivieri (2) , Antonio R. Pereira-Vega (27) , Chantal Raherison-Semjen (28, 29) , Francisco Real (21, 30) , Torben Sigsgaard (31) , Giulia Squillacioti (32) , Christer Janson (1) , Andreï Malinovschi (1)

1 Uppsala University
2 UNIVR - Università degli studi di Verona = University of Verona
3 Fondazione IRCCS Policlinico San Matteo [Pavia]
4 UNIPV - Università degli Studi di Pavia = University of Pavia
5 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
6 Hôpital Arnaud de Villeneuve [CHRU Montpellier]
7 PREMEDICAL - Médecine de précision par intégration de données et inférence causale
8 IDESP - Institut Desbrest de santé publique
9 Monash University [Melbourne]
10 UFPR - Universidade Federal do Parana [Curitiba]
11 Umeå University
12 ISGlobal - Instituto de Salud Global - Institute For Global Health [Barcelona]
13 UPF - Universitat Pompeu Fabra [Barcelona]
14 CIBERESP - Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública = Consortium for Biomedical Research of Epidemiology and Public Health
15 Landspitali National University Hospital of Iceland
16 University of Iceland [Reykjavik]
17 CPC -M - Comprehensive Pneumology Center Munich [Munich, Germany]
18 German Center for Lung Research
19 University of Melbourne
20 Tartu University Hospital [Tartu, Estonia]
21 UiB - University of Bergen
22 CESP - Centre de recherche en épidémiologie et santé des populations
23 Complejo Hospitalario Universitario de Albacete
24 UCLM - Universidad de Castilla-La Mancha = University of Castilla-La Mancha
25 Dalarna University
26 GU - Göteborgs Universitet = University of Gothenburg
27 Hospital Juan Ramón Jiménez
28 BPH - Bordeaux population health
29 CHU Bordeaux
30 Haukeland University Hospital
31 Aarhus University [Aarhus]
32 UNITO - Università degli studi di Torino = University of Turin

Background: Fractional exhaled nitric oxide (FeNO) is a well-known marker of type-2 inflammation. FeNO is elevated in asthma and allergic rhinitis, with IgE sensitization as a major determinant. Objective: We aimed to see whether there was an independent association between upper airway inflammatory disorders (UAID) and FeNO, after adjustment for asthma and sensitization, in a multi-centre population-based study. Methods: A total of 741 subjects with current asthma and 4155 non-asthmatic subjects participating in the second follow-up of the European Community Respiratory Health Survey (ECRHS III) underwent FeNO measurements. Sensitization status was based on measurement of IgE against airborne allergens; information on asthma, UAID and medication was collected through interview-led questionnaires. Independent associations between UAID and FeNO were assessed in adjusted multivariate regression models and test for interaction with perennial sensitization and asthma on the relation between UAID and FeNO were made. Results: UAID were associated with higher FeNO after adjusting for perennial sensitization, asthma and other confounders: with 4.4 (0.9–7.9) % higher FeNO in relation to current rhinitis and 4.8 (0.7–9.2) % higher FeNO in relation to rhinoconjunctivitis. A significant interaction with perennial sensitization was found in the relationship between current rhinitis and FeNO (p =.03) and between rhinoconjunctivitis and FeNO (p =.03). After stratification by asthma and perennial sensitization, the association between current rhinitis and FeNO remained in non-asthmatic subjects with perennial sensitization, with 12.1 (0.2–25.5) % higher FeNO in subjects with current rhinitis than in those without. Conclusions & Clinical Relevance: Current rhinitis and rhinoconjunctivitis was associated with higher FeNO, with an interaction with perennial sensitization. This further highlights the concept of united airway disease, with correlations between symptoms and inflammation in the upper and lower airways and that sensitization needs to be accounted for in the relation between FeNO and rhinitis.

Mots clés: Rhinitis; Population-based; Nasal polyposis; FeNO; Exhaled nitric oxide; Asthma

Domaines: Allergologie; Immunologie; Pneumologie et système respiratoire

Christina Krantz, Simone Accordini, Kjell Alving, Angelo Guido Corsico, P Demoly, et al.. Cross-sectional study on exhaled nitric oxide in relation to upper airway inflammatory disorders with regard to asthma and perennial sensitization. Clinical and Experimental Allergy, 2022, 52 (2), pp.297-311. ⟨10.1111/cea.14019⟩. ⟨hal-03604113⟩