Format

Send to

Choose Destination
Asian Pac J Allergy Immunol. 2019 Jun 4. doi: 10.12932/AP-170818-0395. [Epub ahead of print]

Hierarchical clustering in evaluating inflammatory upper airway phenotypes; increased symptoms in adults with allergic multimorbidity.

Author information

1
Haartman Institute, Medicum, University of Helsinki, Helsinki, Finland.
2
Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
3
Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
4
Department of Ear and Oral diseases, Tampere University Hospital, Tampere, Finland.
5
Department of Otorhinolaryngology, Hospital District of P?ij?t-H?me, Lahti, Finland.
6
Department of Otolaryngology-Head and Neck Surgery, Zagreb School of Medicine, University Hospital Centre "Sestre milosrdnice", Zagreb, Croatia.
7
Faculty of Social Sciences, University of Tampere, Tampere, Finland.
8
Finnish Institute of Molecular Medicine, University of Helsinki, Helsinki, Finland.
9
HUSLAB, Helsinki University Hospital, Helsinki, Finland.

Abstract

BACKGROUND:

Inflammatory upper airway diseases cause significant morbidity. They include phenotypes with different treatment; allergic or non-allergic rhinitis (AR, nAR), and chronic rhinosinusitis with or without nasal polyps (CRSwNP, CRSsNP). In clinical practice, these phenotypes are often difficult to distinguish and may overlap.

OBJECTIVE:

To evaluate if hierarchical clustering can be used to distinguish these phenotypes based on the presence of nasal polyps, off-seasonal allergic symptoms, and self-reported background characteristics - e.g. atopic dermatitis (AD); and to further analyse the obtained clusters.

METHODS:

We studied a random sample of 74 CRS (chronic rhinosinusitis) patients, and a control group of 80 subjects without CRS with/without AR (tertiary hospitals, 2006-2012). All underwent interview and nasal examination, and filled a questionnaire. Variables regarding demographics, off-seasonal symptoms, and clinical findings were collected. Hierarchical clustering was performed, the obtained clusters were cross-tabulated and analysed.

RESULTS:

Four clusters were identified; 1: "Severe symptoms and CRSwNP" (n = 29), 2: "Asymptomatic AR and controls" (n = 39), 3: "Moderate symptoms and CRSsNP" (n = 36), and 4: "Symptomatic and AD" (n = 50). Cluster 1 had most sinonasal symptoms, cluster 3 had a high prevalence of facial pain. The presence of AR did not distinguish CRS groups. Of the AR subjects, 51 % belonged to cluster 4, where AR with off-seasonal airway symptoms and AD predominated.

CONCLUSION:

Hierarchical clustering can be used to distinguish inflammatory upper airway disease phenotypes. The AR phenotype was subdivided by the presence of AD. Adult AR+ AD patients could benefit from active clinical care of the upper airways also off-season.

PMID:
31175712
DOI:
10.12932/AP-170818-0395

Supplemental Content

Loading ...
Support Center