Multidimensional characterization of allergic rhinitis in Mysuru, South India: A cluster-based approach
Mahesh, Padukudru Anand Praveena, Attahalli Shivanarayanprasad Kaleem Ullah, Mohammed Greeshma, Mandya Venkateshmurthy Siddaiah, Jayaraj Biligere Daniel, Jefferson Christopher, Devasahayam Jesudas Nirantharakumar, Krishnarajah Mansur, Adel H Scadding, Glenis
Mahesh, Padukudru Anand
Praveena, Attahalli Shivanarayanprasad
Kaleem Ullah, Mohammed
Greeshma, Mandya Venkateshmurthy
Siddaiah, Jayaraj Biligere
Daniel, Jefferson
Christopher, Devasahayam Jesudas
Nirantharakumar, Krishnarajah
Mansur, Adel H
Scadding, Glenis
Abstract
Background: Allergic rhinitis (AR) affects approximately 10% of Indian adults, but its clinical and biological heterogeneity remains poorly defined.
Objective: We sought to characterize AR phenotypes in South Indian adults using clinical features, spirometry, fractional exhaled nitric oxide (Feno), skin prick tests, blood biomarkers, and cluster analysis.
Methods: This was a prospective observational study of 122 patients (≥18 years old) with AR with or without asthma attending a South Indian tertiary allergy clinic and 50 asymptomatic nonatopic control subjects. Participants underwent standardized symptom/exposure assessments, spirometry, Feno, blood counts, serum IgE, and skin prick tests to 10 aeroallergens. Principal component analysis, correlation networks, and unsupervised k-means clustering were applied to define phenotypes.
Results: Patients with AR were younger than control subjects, predominantly female, and frequently exposed to incense and mosquito repellents. Sensitization to house dust mite (>70%) and polysensitization were common. Compared with control subjects, patients with AR had elevated Feno (43 vs18 ppb; P < .01) but no significant differences in serum IgE or eosinophils. Spirometry revealed modestly lower FEV1/forced vital capacity in patients with AR (P < .01), though values remained within normal limits. Cluster analysis identified 3 subgroups: high Feno, low eosinophils, moderate-to-severe AR with less asthma; low Feno, high eosinophils, with more asthma; and impaired lung function with moderate eosinophilia and the highest asthma burden. Network analysis demonstrated strong cosensitization between house dust mite, Parthenium hysterophorus (weed pollen), Cynodon dactylon (Bermuda pollen), and cockroach.
Conclusions: This study showed 3 distinct AR clusters with high dust mite sensitization alongside cosensitization with cockroach, weed, and Bermuda pollens. Multicenter studies are warranted to further refine AR clusters, including tissue-level biomarker profiling and relevance to pharmacotherapy and immunomodulatory therapies.
MIDER Authors
Date
2026-02-11
Type
Article
Subject
Rhinitis, allergic, perennial, Cluster analysis, Phenotype, Phenotype, Spirometry
Collections
Citation
Mahesh PA, Praveena AS, Kaleem Ullah M, Greeshma MV, Siddaiah JB, Daniel J, Christopher DJ, Nirantharakumar K, Mansur AH, Scadding G, Wraith DC, Krishna MT. Multidimensional characterization of allergic rhinitis in Mysuru, South India: A cluster-based approach. J Allergy Clin Immunol Glob. 2026 Feb 11;5(3):100664. doi: 10.1016/j.jacig.2026.100664.
Journal / Source Title
The Journal of Allergy and Clinical Immunology: Global
DOI
10.1016/j.jacig.2026.100664
PMID
41858441
Publisher
Elsevier
Publisher’s URL
https://www.sciencedirect.com/journal/journal-of-allergy-and-clinical-immunology-global