Intranasal Corticosteroids Reduced Acute Rhinosinusitis in Children (PDF)

Journal of Microbiology, Immunology and Infection 57 (2024) 175e183 Available online at www.sciencedirect.com ScienceDirect...

Journal of Microbiology, Immunology and Infection 57 (2024) 175e183 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.e-jmii.com Original Article Intranasal corticosteroids reduced acute rhinosinusitis in children with allergic rhinitis: A nested caseecontrol study Chia-ling Lin a,1, Kuo-Huang Lee a,1, Wan-Ting Huang b, Ling-Chin Hsieh a, Chuang-Ming Wang a,* a Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 60002, Taiwan b Clinical Medical Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 60002, Taiwan Received 29 April 2023; received in revised form 7 November 2023; accepted 28 November 2023 Available online 4 December 2023 KEYWORDS Abstract Background: Children with allergic rhinitis (AR) have substantially more acute rhi- Allergic rhinitis; nosinusitis than children without AR. We evaluated whether intranasal corticosteroids (INCS), Acute rhinosinusitis; second-generation antihistamines (SGH), and/or intranasal antihistamines (INH) for AR affect Intranasal acute rhinosinusitis in children with AR aged 2e18 years. corticosteroid; Methods: By using the National Health Research Institutes Database 2005 of Taiwan, a cohort Second-generation of patients with AR aged 2e18 years treated with AR medications between 2002 and 2018 was antihistamines; made, within which a nested caseecontrol study was performed. Risk settings for acute rhino- Nested caseecontrol sinusitis cases matched controls for age, sex, and comorbidities. Current users of INCS, INH, study and/or SGH were compared with remote and recent users of any AR medications and current users of INCS with and without SGH were compared with current users of SGH. Results: Current users of SGH and/or INCS had a higher risk of acute rhinosinusitis than remote users of AR drugs, and current users of SGH had a higher risk of acute rhinosinusitis than recent users; however, no difference in the risk of acute rhinosinusitis was found between current users of INCS and recent users of AR drugs. Current users of INCS with and without SGH had a lower risk of acute rhinosinusitis than current users of SGH alone. Conclusions: Treatment of INCS with and without SGH diminished the risk of acute rhinosinu- sitis compared with treatment using SGH alone. Adequate INCS treatment for patients with AR is important to reduce the incidence of acute rhinosinusitis. * Corresponding author. Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No.539, Zhongxiao Rd., East Dist., Chiayi City 60002, Taiwan. E-mail address: [email protected] (C.-M. Wang). 1 The authors Chia-ling Lin and Kuo-Huang Lee contributed equally to this work. https://doi.org/10.1016/j.jmii.2023.11.005 1684-1182/Copyright ª 2023, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).  C.-l. Lin, K.-H. Lee, W.-T. Huang et al. Copyright ª 2023, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/). Introduction Institutes. The NHIRD contains details of beneficiaries registered in Taiwan’s National Health Insurance program Allergic rhinitis (AR) is a common disease that affects launched in 1995. Up to 99.8% of the population of Taiwan is approximately 30% of children in Taiwan.1,2 Upper airway included in this program. Data included in the LHID2005 are diseases such as rhinosinusitis and otitis media are highly claims data from 2 million randomly selected patients in associated with AR.3 Children with AR experience substan- the 2005 registry for the NHIRD, which in turn contains all tially more acute rhinosinusitis than children without AR.4 the claims data collected from January 01, 2000, to Viral cold is believed to be the main contributor to the December 31, 2018. pathogenesis of acute sinusitis. Upper respiratory tract in- This study used data from 2002 to 2016 to ensure that fections (URTIs) lead to osteomeatal obstruction with a sig- each patient’s medical history was traceable for at least 2 nificant impairment in sinus ventilation and mucociliary years. Information from the NHIRD includes the registry of clearance.5 Levels of intercellular adhesion molecule-1 beneficiaries, clinical records detailed in ambulatory care (ICAM-1) are higher in epithelial cells in patients with grass claims, hospitalizations, diagnostic codes, and prescription pollen-induced AR than in healthy controls exposed to pol- records. The information from the NHIRD employs a lens.6 The upregulation of the expression of ICAM-1, a major scrambled clinical record in ambulatory care claims, hos- rhinovirus receptor, may increase tissue susceptibility to pitalization of patients, diagnostic codes (which follow the rhinovirus infection.7 AR is involved in impaired paranasal International Classification of Disease, 9th Revision, Clinical sinus function. Individuals with AR demonstrated more severe Modification (ICD-9-CM) codes), and prescription drugs. paranasal sinus obstruction in CT than non-AR individuals This study was endorsed by the Institutional Review during viral colds.8 Therefore, URTIs and allergic inflamma- Board of Chia-Yi Christian Hospital in Taiwan (Institutional tion are significant risk factors for acute rhinosinusitis. Review Board No. CYCHIRB: 2020134). A previous study revealed that antibiotic therapy alone cannot resolve acute rhinosinusitis symptoms in children with Study population AR.9 The use of antihistamines as standard treatment in pa- tients and acute rhinosinusitis having AR has improved the This study assembled a cohort of patients with AR to un- control of some sinusitis symptoms.10 Another study found that dertake a nested caseecontrol study. Patients diagnosed antihistamines are closely associated with acute rhinosinusi- with AR (ICD-9-CM: 477.X) more than twice within a 90 days tis.11 In patients with AR, treatment with intranasal cortico- between 2002 and 2016 and had had to take AR medications steroids (INCS) and/or secondary generation antihistamines were enrolled in the cohort. AR medications comprise an (SGHs) for asthma may reduce the incidence of acute exac- INCS, INH, and/or SGH. INCS include beclometasone (ATC erbation of asthma.12 Meta-analysis studies have demon- code R01AD01), budesonide (ATC code R01AD05), betame- strated that INCS provides a small therapeutic advantage in thasone (ATC code R01AD06), fluticasone (ATC code resolving or improving acute rhinosinusitis symptoms.13,14 R01AD08), mometasone (ATC code R01AD09), triamcinolone However, no studies have determined whether the (ATC code R01AD11), and fluticasone furoate (ATC code treatment of AR with INCS, SGHs, and/or intranasal anti- R01AD12). INHs include levocabastine (ATC code R01AC02), histamines (INHs) could prevent the risk of acute rhinosi- and azelastine (ATC code R01AC03). SGH includes cetirizine nusitis in children with AR. This study aimed to investigate (ATC code R06AE07), levocetirizine (ATC code R06AE09), whether the treatment of AR with INCS, SGH, and/or INH ebastine (ATC code R06AX22), fexofenadine (ATC code could reduce the incidence of acute rhinosinusitis in chil- R06AX26), mequitazine (ATC code R06AD07), and deslor- dren with AR of different ages. Therefore, we assessed the atadine (ATC code R06AX27). association between AR drugs and the risk of acute rhino- Patients diagnosed with AR from January 01, 2000, to sinusitis in children with AR in a nested caseecontrol study December 31, 2001, were excluded from this study. How- using data from the Taiwan National Health Insurance ever, all patients with incomplete claims data or those aged Research Database (NHIRD) database. 18 years were excluded. The primary outcome of interest in this study was the occurrence of acute rhinosinusitis after 90 days to 2 years of a Methods confirmed diagnosis of AR in children of different ages. The study included patients with acute rhinosinusitis (ICD-9-CM: Data resources 461. x) who were in an outpatient setting and had concurrent oral antibiotic prescriptions. Antibiotics given orally included The data analyzed in this study were retrospectively amoxicillin (ATC code J01CA04), ampicillin and sulbactam derived from a subset of the NHIRD known as the Longitu- (ATC code J01CR01), amoxicillin and clavulanate (ATC code dinal Health Insurance Database 2005 (LHID2005) that was J01CR02), cephalexin (ATC code J01DB01), cefaclor (ATC code administered by Taiwan’s National Health Research J01DC04), cefuroxime (ATC code J01DC02), cefixime (ATC 176  Journal of Microbiology, Immunology and Infection 57 (2024) 175e183 code J01DD08), ceftibuten (ATC code J01DD14), sulfameth- were investigated. The baseline comorbidities were oxazole and trimethoprim (ATC code J01EE01), ciprofloxacin determined for each patient throughout the study period. (ATC code J01MA02), levofloxacin (ATC code J01MA12), erythromycin (ATC code J01FA01), clarithromycin (ATC code Statistical analyses J01FA09), and azithromycin (ATC code J01FA10). Among pa- tients who met the AR criteria, we identified all those with As regards categorical variables, data were shown as fre- acute rhinosinusitis between the entry date (defined as the AR quencies (percentages), whereas for continuous variables, date þ 90 days) and the last date of follow-up (defined as the data were shown as standard deviations (SDs). Student’s t- AR date þ2 years); these patients were defined as having test was used to compare the AR and non-AR groups for acute rhinosinusitis. Controls were selected from patients who continuous parametric data, whereas the categorical data did not have acute rhinosinusitis between the time of AR of the two groups were compared using the chi-square test. diagnosis and the end of follow-up. Each case was matched to The risk factors for acute rhinosinusitis were evaluated four controls based on patients’ AR date (180 days). The date using conditional logistic regression with adjustments for of acute rhinosinusitis (for cases) or the equivalent date of potential risk factors (age, sex, asthma, AD, and GERD). All follow-up without acute rhinosinusitis (for controls) was statistical analyses were conducted using SAS 9.4 for Win- referred to as the “study reference date” (Fig. 1). dows (SAS Institute, Inc., Cary, NC, USA), and a two-tailed p-value of 0.999 Male 101,100 (58.76) 80,880 (58.76) 20,220 (58.76) Comorbidities Asthma 35,487 (20.62) 28,392 (20.63) 7095 (20.62) 0.972 Atopic dermatitis 11,317 (6.58) 9412 (6.84) 1905 (5.54)