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objectives and its benefits for their children. Faculty of
Medicine, Assiut University Ethical Committee approved
the study protocol.

Table 1. Demographic and Laboratory Characteristics of Study
Patients.a

Study Design

Variable

This was a case-controlled study undertaken in Assiut and
Al-Azhar University Hospitals, Assiut city, Egypt.

 Age
 Gender

Patients
This study included 120 patients aged 7 to 13 years with AR
who were recruited to the study from 2 outpatient clinics in
Al-Azhar and Assiut University Hospitals, Assiut, Egypt during winter 2016 (from September to December to avoid the
seasonal variation in vitamin D levels.). The diagnosis of AR
was performed according to Allergic Rhinitis and its Impact
on Asthma (ARIA) guidelines and supported by a skin prick
test.7 Skin prick tests were performed using the same antigens
for all patients with a wide panel of most widespread aeroallergens in our locality, which included house dust, hay dust,
mixed mites, mixed molds, mixed pollens, and cat epithelium.
In addition to the allergens tested, there were positive and
negative controls. The positive control, was a histamine solution, should become itchy within a few minutes, then red, and
swollen with a wheal in the center. The negative control was a
saline solution and should show no reaction. A senior otorhinolaryngologist evaluated all patients and controls before the
children were recruited into the study. The severity grading
and classification of all children with AR were performed
based upon ARIA criteria into mild or moderate-severe rhinitis7 and total nasal symptom score (TNSS, nasal congestion,
runny nose, itchy nose, and sneezing). Total nasal symptom
score was assessed in all patients depending on the severity of
AR manifestations. For every symptom TNSS has the following scores: 0 ¼ no symptom; 1 ¼ mild, unremarkable symptoms; 2 ¼ moderate, disturbing but tolerable; and 3 ¼ severe,
disturbing, interfere with routine activities and/ or sleep.8 One
hundred age- and sex-matched nonatopic, healthy children
were recruited as normal control group. Any treatment with
systemic corticosteroids and antihistamines were stopped 2
weeks before the study. The exclusion criteria were: (1) any
accompanying disease that could affect vitamin D status, for
example, rheumatologic diseases, chronic gastrointestinal and
renal diseases, and endocrine disorders; (2) children who had
received some drugs, for example, vitamin D, calciumcontaining drugs, and immunotherapy; (3) patients with other
types of rhinitis, for example, infectious, drug-induced, hormonal, or another non-AR.

Laboratory Investigations
Venous blood samples were collected from all patients and
controls after 12-hour fasting between 8:00 and 10:00 AM.
Serum samples were separated after centrifugation for 10 minutes and kept in À80 C until the day of analysis. All patients










Weight
Height
BMI
Total IgE, IU/mL
Calcium, mg/dL
25(OH)D, ng/mL
1, 25(OH)2D, ng/mL
Vitamin D status, n (%)
Normal (>30 ng/mL)
Deficiency (<20 ng/mL)
Insufficiency (20-30 ng/mL)

Children With
Allergic Rhinitis
(n ¼ 120)

Healthy
Controls
(n ¼ 100)

P Value

6.29 + 4.03 7.08 + 2.91 NS
54 males,
43 males,
NS
66 females
57 females
29.5 + 14.6 30.1 + 13.9 NS
118.0 + 24.6 115.0 + 31.8 NS
18.1 + 6.2
19.2 + 8.3
NS
306.2 + 57.9 52.8 + 17.8 <.0001b
8.9 + 3.01 10.3 + 2.91 <.0001b
27.5 + 14.3 36.2 +19.8 <.001b
19.9 + 16.4 29.5 + 12.7 <.0001b
28 (23.3%)
37 (30.8%)
55 (45.9%)

52 (52%)
8 (8%)
40 (40%)

.002b
<.0001b
NS

Abbreviations: BMI, body mass index; igE, immunoglobulin E; NS, nonsignificant.
a
Data expressed as mean (standard deviation).
b
Significant.

and controls underwent laboratory tests which included total
IgE levels were measured by enzyme-linked immunosorbent
assay. Serum calcium was measured using the automated
standard laboratory method. All samples were assessed in
duplicates. Serum 25(OH)D and 1,25(OH)2D were quantified by radioimmunoassay using Immuno-Diagnostic
systems-kits (Immunodiagnostic System Ltd, Boldon Business Park, Boldon, Tyne and Wear, United Kingdom).
Serum 25OHD3 levels <20 ng/mL were considered as vitamin D deficiency, levels between 20 and 30 ng/mL as vitamin D insufficiency, while levels from 30 and 80 ng/mL
were considered as normal.9

Statistical Analysis
We analyzed our data by the Statistical Package for Social
Sciences version 22 (SPSS Inc, Chicago, Illinois, USA). Data
were expressed as the mean (standard deviation [SD]). The
mean values in AR and healthy groups were compared by the
unpaired Student t test and Mann-Whitney U test. The correlation coefficient r was generated by Spearman rank correlation.
Statistical significance was defined as p < .05.

Results
Table 1 shows demographic and laboratory criteria of all
study participants. Table 2 shows the classification and nasal
manifestations of all patients. Our study was conducted on 220
children. There were 120 children in the AR group (mean age
6.29 [4.03] years; 54 [45%] males) and 100 children in control
group (mean age: 7.08 [2.91] years; 43 [43%] males). There
was no statistical difference between both groups in age,
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