Allergic rhinitis phenotypes with distinct transcriptome profiles in children: a birth cohort

BACKGROUND:Allergic rhinitis (AR) phenotypes in childhood are unclear. OBJECTIVE:To determine AR phenotypes and investigate their natural course and clinical and transcriptomic characteristics. METHODS:Latent class trajectory analysis was used for phenotyping AR in 1050 children from birth through 12 years using a birth cohort study. Blood transcriptome analyses were performed to define the underlying mechanisms of each phenotype. RESULTS:Five AR phenotypes were identified: early-onset (n=88, 8.4%), intermediate transient (n=110, 10.5%), late-onset (n=209, 19.9%), very late-onset (n=187, 17.8%), and never/infrequent (n=456, 43.4%). Children with early-onset AR were associated with higher AR severity and sensitizations to foods at age 1 and inhalants at age 3 and asthma symptoms, but not with bronchial hyperresponsiveness (BHR). Children with late-onset AR phenotype associated with sensitizations to various foods at age 1, but not from age 3, and to inhalants from age 7 and with asthma with BHR. Children with very late-onset AR phenotype associated with sensitizations to foods throughout preschool age and to inhalants at ages 7 and 9 and with asthma with BHR. Transcriptome analysis showed that early-onset AR was associated with viral/bacterial infection-related defense response, whereas late-onset AR was associated with T cell-related immune response. CONCLUSIONS:Early-onset AR phenotype was associated with sensitization to foods and inhalants at an early age and asthma symptoms, but not with BHR, whereas very late- and late-onset AR phenotypes were positively associated with sensitization to inhalants and asthma with BHR. Transcriptomic analyses indicated that early- and late-onset AR phenotypes had distinct underlying mechanisms related to AR as well.