Allergic rhinitis and nasal septum deviation in children: cause, consequence, or bidirectional relationship? Insights from the ARHINASD study

Background – Allergic rhinitis (AR) is one of the most common allergic conditions in children. Nasal septum deviation (NSD) is observed in nearly 34% of the pediatric population and is characterized by reduced nasal airflow and mucosal inflammation. While NSD and AR can coexist, the potential relationship between the two conditions remains largely unexplored. Here, we present the baseline data from the Allergic Rhinitis in pediatric subjects with Nasal Septum Deviation (ARHINASD) study, which investigates the relationship between NSD and AR in children. Methods – A multicenter, prospective study was conducted involving 138 participants aged 6–14 years with (NSD+, n = 69) or without NSD (NSD−, n = 69). AR diagnosis and sensitization, nasal endoscopy and cytology, nasal fluid cytokines, nasal airflow (nasal peak inspiratory flow, NPIF), and nasal obstruction (visual analog scale, VAS) were evaluated in all participants. Results – The prevalence of AR was significantly higher in NSD+ children than in NSD− children (66.7% vs. 36.2%; p < 0.0001). A multivariable logistic regression analysis showed that NSD was independently associated with AR (aOR 3.51, 95% CI 1.65–7.47; p = 0.001), along with a family history of allergy (aOR 2.49, 95% CI 1.01–6.16; p = 0.048). NSD+ children experienced more severe AR, with higher VAS scores, median (interquartile range, IQR) [7(3.5) vs. 2(4), p < 0.05] and lower NPIF values [40(30) vs. 60(40) L/min, p < 0.05]. NSD+ children had higher eosinophil counts and increased levels of IL-4, IL-5, and eosinophil cationic protein (ECP) in the nasal fluid compared to NSD− children (p < 0.05). Conclusion – The findings suggest a higher prevalence of AR among NSD children. NSD may negatively influence the disease course of AR. Early identification and management of NSD may improve AR outcomes and reduce the overall disease burden. Longitudinal studies are needed to confirm causality and to explore preventive strategies.