Elevated Saliva Pepsin Concentration as a Risk Factor for Asthma in Children with Allergic Rhinitis: A Preliminary Study

Abstract

Objective

This study aimed to explore whether saliva pepsin concentration (SPC) could be regarded as a risk factor for the occurrence and unfavorable control of asthma in children with allergic rhinitis.

Methods

A prospective study was conducted on a group of 20 consecutive children newly diagnosed with allergic rhinitis and asthma (referred to as the asthma group). All these children underwent fractional exhaled nitric oxide (FeNO) measurement, lung function tests, and assessment of asthma control using the 7-item Childhood Asthma Control Test (C-ACT) score. Simultaneously, a control group consisting of 20 children with simple allergic rhinitis, matched for baseline characteristics, was included. SPC measurement was performed in the two groups.

Results

The SPC value was significantly higher in the asthma group than that in the control group (165.0 ± 82.8 ng/mL vs 68.4 ± 34.5 ng/mL) (P < 0.001). In the asthma group, SPC was independently associated with FeNO, the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC), and forced expiratory flow at 50% and 75% of FVC (FEF50 and FEF75) (all P < 0.05). The severity of nasal symptoms evaluated by the visual analogue scale (N-VAS) was independently associated with FEF75, the maximal mid-expiratory flow (MMEF), and C-ACT score (P < 0.05).

Conclusion

Direct pepsin exposure and uncontrolled nasal symptoms may play crucial roles in the pathogenesis and progression of childhood allergic asthma. The SPC value can be considered as a risk factor for asthma in children with allergic rhinitis.

Keywords:

• saliva pepsin concentration
• asthma
• allergic rhinitis
• gastroesophageal reflux disease

Abbreviations

GERD, gastroesophageal reflux disease; SPC, saliva pepsin concentration; BMI, body mass index; N-VAS, the severity of nasal symptoms evaluated by visual analogue scale; FeNO, fractional exhaled nitric oxide; FEV1/FVC, the ratio of forced expiratory volume in 1s to forced vital capacity; FEF50 and FEF75, forced expiratory flow at 50% and 75% of FVC; MMEF, the maximal mid-expiratory flow; C-ACT, the 7-item Childhood Asthma Control Test; LPR, laryngopharyngeal reflux.

Data Sharing Statement

The data underlying this article will be shared upon reasonable request to the corresponding author.

Ethics Statement

The study protocol had been proved by the Ethics Committee of Peking University First Hospital with an ID of 2021-250, and all the children’s caregivers had provided signed informed consents. No patient-identifying information was accessible during the study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest and report no conflicts of interest for this work.

Additional information

Funding

This work was supported by the National High Level Hospital Clinical Research Funding (Youth clinical research project of Peking University First Hospital) (No. 2022CR103), the Beijing Municipal Natural Science Foundation (No. 7204315), and the Youth clinical research project of Peking University First Hospital (No. 2019CR30).