Nasal effects of environmental tobacco smoke exposure in children with allergic rhinitis

INTRODUCTION AND PURPOSE: Exposure to environmental tobacco smoke (ETS) increases allergen sensitization and the severity of allergic disease. Myeloperoxidase enzyme (MPO) is a marker of neutrophil activation in nasal mucosa. Respiratory epithelial cell protein clara cell-16 (CC-16) has anti-inflammatory and cytoprotective activity for epithelial cells. In the literature, there are no studies examining these two biomarkers in individuals with AR who are exposed to ETS. Our aim with this study is to show the change caused by ETS exposure in the nasal mucosa of AR, and to reveal its effect on AR symptoms. MATERIAL/METHOD: The study was conducted between August 2020 and August 2021 with 204 patients, aged 5-16 years, who applied to Pediatric Allergy Immunology Policlinic of Manisa Celal Bayar University Faculty of Medicine between August 2020 and August 2021, and were followed up with the diagnosis of allergic rhinitis. Patient data were recorded at the time of admission. AR symptoms were evaluated according to the total 5-symptom score (T5SS). Nasal lavage sample was collected to evaluate CC16 and MPO level and urine sample was collected to evaluate cotinine level on the same day. SPSS.15 program was used for statistical data analysis. RESULTS: Of the 204 patients included in the study, 139 (68.1%) were male and 65 (31.9%) were female. The mean age of the patients was 11 ± 3.6 years. ETS exposure was detected in 26% of the patients. The mean age of the cases with ETS exposure was found to be higher (p<0.05). The rate of exposure to ETS was found to be higher in patients with persistent AR than in patients with intermittent AR (p<0.05). The T5SS value of the patient group with ETS exposure was found to be higher than the group without exposure (p<0.05). Patients with multiple allergen and pollen sensitivities had the highest mean T5SS values, while those with mold sensitivities had the lowest (p<0.05). There was no relationship between the severity of AR disease, duration of symptoms, history of allergic disease in the patient and his parents, and ETS exposure. There was a negative correlation between age, T5SS and MPO levels (p<0.05). It was determined that the rate of exposure to ETS was higher in patients with allergic rhinitis with low CC-16 levels (p<0.05). No correlation was found between ETS exposure and MPO levels. CONCLUSION: In our study, CC-16 levels were found to be lower in cases with allergic rhinitis who were exposed to tobacco smoke. This may be related to the damage caused by exposure to tobacco smoke in the nasal epithelium. Another finding supporting this damage is that exposure to ETS was shown to be associated with more frequent and severe AR findings. While there was no relationship between MPO and ETS exposure, symptom score was found to be associated with MPO. This situation suggested that the relationship between epithelial damage and neutrophilic inflammation plays a more prominent role in the effect of ETS exposure on the severity of allergic rhinitis.