Multidimensional Characterization of Allergic Rhinitis in Mysuru, South India: a cluster-based approach

Padukudru Anand Mahesh; Attahalli Shivanarayanprasad Praveena; Mohammed Kaleem Ullah; Mandya Venkateshmurthy Greeshma; Jayaraj Biligere Siddaiah; Jefferson Daniel; Devasahayam Jesudas Christopher; Krishnarajah Nirantharakumar; Adel H. Mansur; Glenis Scadding; David C. Wraith; Mamidipudi Thirumala Krishna

doi:10.1016/j.jacig.2026.100664

Multidimensional Characterization of Allergic Rhinitis in Mysuru, South India: a cluster-based approach

Padukudru Anand Mahesh^*
, Attahalli Shivanarayanprasad Praveena
, Mohammed Kaleem Ullah
, Mandya Venkateshmurthy Greeshma
, Jayaraj Biligere Siddaiah
, Jefferson Daniel
, Devasahayam Jesudas Christopher
, Krishnarajah Nirantharakumar
, Adel H. Mansur
, Glenis Scadding
, David C. Wraith
, Mamidipudi Thirumala Krishna^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background

Allergic rhinitis (AR) affects ∼10% of Indian adults, but its clinical and biological heterogeneity remains poorly defined.

Objective

To characterize AR phenotypes in South Indian adults using clinical features, spirometry, Fractional Exhaled Nitric Oxide (FeNO), skin prick tests (SPTs), blood biomarkers, and cluster analysis.

Methods

Prospective observational study of patients with AR with or without asthma (N=122; ≥18 years), attending a South Indian tertiary allergy clinic, and 50 asymptomatic non-atopic controls. Participants underwent standardized symptom/exposure assessments, spirometry, FeNO, blood counts, serum IgE, and SPTs to 10 aeroallergens. Principal component analysis, correlation networks, and unsupervised k-means clustering were applied to define phenotypes.

Results

AR cases were younger, predominantly female, and frequently exposed to incense and mosquito repellents. Sensitization to house dust mite (>70%) and polysensitization were common. Compared with controls, AR cases had elevated FeNO (43 vs.18 ppb; p<0.01) but no significant differences in serum IgE or eosinophils. Spirometry revealed modestly lower FEV₁/FVC in AR (p<0.01), though values remained within normal limits. Cluster analysis identified three subgroups: (i) FeNO-high, eosinophil-low, moderate–severe AR with less asthma; (ii) FeNO-low, eosinophil-high, with more asthma; and (iii) impaired lung function with moderate eosinophilia and the highest asthma burden. Network analysis demonstrated strong co-sensitization between house dust mite, Parthenium hysterophorus (weed pollen), Cynodon dactylon (Bermuda pollen), and cockroach.

Conclusion

This study showed 3 distinct AR clusters with high dust mite sensitization alongside co-sensitization with cockroach, weed, and Bermuda pollens. Multi-centre studies are warranted to further refine AR clusters, including tissue-level biomarker profiling and relevance to pharmacotherapy and immunomodulatory therapies.

Original language	English
Article number	100664
Journal	Journal of Allergy and Clinical Immunology: Global
Early online date	11 Feb 2026
DOIs	https://doi.org/10.1016/j.jacig.2026.100664
Publication status	E-pub ahead of print - 11 Feb 2026

Keywords

Allergic rhinitis
Phenotypes
Cluster analysis
House dust mite
India

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Mahesh, P. A., Praveena, A. S., Ullah, M. K., Greeshma, M. V., Siddaiah, J. B., Daniel, J., Christopher, D. J., Nirantharakumar, K., Mansur, A. H., Scadding, G., Wraith, D. C., & Thirumala Krishna, M. (2026). Multidimensional Characterization of Allergic Rhinitis in Mysuru, South India: a cluster-based approach. Journal of Allergy and Clinical Immunology: Global, Article 100664. Advance online publication. https://doi.org/10.1016/j.jacig.2026.100664

@article{54350e9443bd46dcbdceff1aadf88679,

title = "Multidimensional Characterization of Allergic Rhinitis in Mysuru, South India: a cluster-based approach",

abstract = "BackgroundAllergic rhinitis (AR) affects ∼10\% of Indian adults, but its clinical and biological heterogeneity remains poorly defined. ObjectiveTo characterize AR phenotypes in South Indian adults using clinical features, spirometry, Fractional Exhaled Nitric Oxide (FeNO), skin prick tests (SPTs), blood biomarkers, and cluster analysis. MethodsProspective observational study of patients with AR with or without asthma (N=122; ≥18 years), attending a South Indian tertiary allergy clinic, and 50 asymptomatic non-atopic controls. Participants underwent standardized symptom/exposure assessments, spirometry, FeNO, blood counts, serum IgE, and SPTs to 10 aeroallergens. Principal component analysis, correlation networks, and unsupervised k-means clustering were applied to define phenotypes. ResultsAR cases were younger, predominantly female, and frequently exposed to incense and mosquito repellents. Sensitization to house dust mite (>70\%) and polysensitization were common. Compared with controls, AR cases had elevated FeNO (43 vs.18 ppb; p<0.01) but no significant differences in serum IgE or eosinophils. Spirometry revealed modestly lower FEV1/FVC in AR (p<0.01), though values remained within normal limits. Cluster analysis identified three subgroups: (i) FeNO-high, eosinophil-low, moderate–severe AR with less asthma; (ii) FeNO-low, eosinophil-high, with more asthma; and (iii) impaired lung function with moderate eosinophilia and the highest asthma burden. Network analysis demonstrated strong co-sensitization between house dust mite, Parthenium hysterophorus (weed pollen), Cynodon dactylon (Bermuda pollen), and cockroach. ConclusionThis study showed 3 distinct AR clusters with high dust mite sensitization alongside co-sensitization with cockroach, weed, and Bermuda pollens. Multi-centre studies are warranted to further refine AR clusters, including tissue-level biomarker profiling and relevance to pharmacotherapy and immunomodulatory therapies.",

keywords = "Allergic rhinitis, Phenotypes, Cluster analysis, House dust mite, India",

author = "Mahesh, \{Padukudru Anand\} and Praveena, \{Attahalli Shivanarayanprasad\} and Ullah, \{Mohammed Kaleem\} and Greeshma, \{Mandya Venkateshmurthy\} and Siddaiah, \{Jayaraj Biligere\} and Jefferson Daniel and Christopher, \{Devasahayam Jesudas\} and Krishnarajah Nirantharakumar and Mansur, \{Adel H.\} and Glenis Scadding and Wraith, \{David C.\} and \{Thirumala Krishna\}, Mamidipudi",

year = "2026",

month = feb,

day = "11",

doi = "10.1016/j.jacig.2026.100664",

language = "English",

journal = "Journal of Allergy and Clinical Immunology: Global",

issn = "2772-8293",

publisher = "Elsevier",

}

Mahesh, PA, Praveena, AS, Ullah, MK, Greeshma, MV, Siddaiah, JB, Daniel, J, Christopher, DJ, Nirantharakumar, K, Mansur, AH, Scadding, G, Wraith, DC & Thirumala Krishna, M 2026, 'Multidimensional Characterization of Allergic Rhinitis in Mysuru, South India: a cluster-based approach', Journal of Allergy and Clinical Immunology: Global. https://doi.org/10.1016/j.jacig.2026.100664

TY - JOUR

T1 - Multidimensional Characterization of Allergic Rhinitis in Mysuru, South India

T2 - a cluster-based approach

AU - Mahesh, Padukudru Anand

AU - Praveena, Attahalli Shivanarayanprasad

AU - Ullah, Mohammed Kaleem

AU - Greeshma, Mandya Venkateshmurthy

AU - Siddaiah, Jayaraj Biligere

AU - Daniel, Jefferson

AU - Christopher, Devasahayam Jesudas

AU - Nirantharakumar, Krishnarajah

AU - Mansur, Adel H.

AU - Scadding, Glenis

AU - Wraith, David C.

AU - Thirumala Krishna, Mamidipudi

PY - 2026/2/11

Y1 - 2026/2/11

N2 - BackgroundAllergic rhinitis (AR) affects ∼10% of Indian adults, but its clinical and biological heterogeneity remains poorly defined. ObjectiveTo characterize AR phenotypes in South Indian adults using clinical features, spirometry, Fractional Exhaled Nitric Oxide (FeNO), skin prick tests (SPTs), blood biomarkers, and cluster analysis. MethodsProspective observational study of patients with AR with or without asthma (N=122; ≥18 years), attending a South Indian tertiary allergy clinic, and 50 asymptomatic non-atopic controls. Participants underwent standardized symptom/exposure assessments, spirometry, FeNO, blood counts, serum IgE, and SPTs to 10 aeroallergens. Principal component analysis, correlation networks, and unsupervised k-means clustering were applied to define phenotypes. ResultsAR cases were younger, predominantly female, and frequently exposed to incense and mosquito repellents. Sensitization to house dust mite (>70%) and polysensitization were common. Compared with controls, AR cases had elevated FeNO (43 vs.18 ppb; p<0.01) but no significant differences in serum IgE or eosinophils. Spirometry revealed modestly lower FEV1/FVC in AR (p<0.01), though values remained within normal limits. Cluster analysis identified three subgroups: (i) FeNO-high, eosinophil-low, moderate–severe AR with less asthma; (ii) FeNO-low, eosinophil-high, with more asthma; and (iii) impaired lung function with moderate eosinophilia and the highest asthma burden. Network analysis demonstrated strong co-sensitization between house dust mite, Parthenium hysterophorus (weed pollen), Cynodon dactylon (Bermuda pollen), and cockroach. ConclusionThis study showed 3 distinct AR clusters with high dust mite sensitization alongside co-sensitization with cockroach, weed, and Bermuda pollens. Multi-centre studies are warranted to further refine AR clusters, including tissue-level biomarker profiling and relevance to pharmacotherapy and immunomodulatory therapies.

AB - BackgroundAllergic rhinitis (AR) affects ∼10% of Indian adults, but its clinical and biological heterogeneity remains poorly defined. ObjectiveTo characterize AR phenotypes in South Indian adults using clinical features, spirometry, Fractional Exhaled Nitric Oxide (FeNO), skin prick tests (SPTs), blood biomarkers, and cluster analysis. MethodsProspective observational study of patients with AR with or without asthma (N=122; ≥18 years), attending a South Indian tertiary allergy clinic, and 50 asymptomatic non-atopic controls. Participants underwent standardized symptom/exposure assessments, spirometry, FeNO, blood counts, serum IgE, and SPTs to 10 aeroallergens. Principal component analysis, correlation networks, and unsupervised k-means clustering were applied to define phenotypes. ResultsAR cases were younger, predominantly female, and frequently exposed to incense and mosquito repellents. Sensitization to house dust mite (>70%) and polysensitization were common. Compared with controls, AR cases had elevated FeNO (43 vs.18 ppb; p<0.01) but no significant differences in serum IgE or eosinophils. Spirometry revealed modestly lower FEV1/FVC in AR (p<0.01), though values remained within normal limits. Cluster analysis identified three subgroups: (i) FeNO-high, eosinophil-low, moderate–severe AR with less asthma; (ii) FeNO-low, eosinophil-high, with more asthma; and (iii) impaired lung function with moderate eosinophilia and the highest asthma burden. Network analysis demonstrated strong co-sensitization between house dust mite, Parthenium hysterophorus (weed pollen), Cynodon dactylon (Bermuda pollen), and cockroach. ConclusionThis study showed 3 distinct AR clusters with high dust mite sensitization alongside co-sensitization with cockroach, weed, and Bermuda pollens. Multi-centre studies are warranted to further refine AR clusters, including tissue-level biomarker profiling and relevance to pharmacotherapy and immunomodulatory therapies.

KW - Allergic rhinitis

KW - Phenotypes

KW - Cluster analysis

KW - House dust mite

KW - India

UR - http://www.sciencedirect.com/journal/journal-of-allergy-and-clinical-immunology-global

U2 - 10.1016/j.jacig.2026.100664

DO - 10.1016/j.jacig.2026.100664

M3 - Article

SN - 2772-8293

JO - Journal of Allergy and Clinical Immunology: Global

JF - Journal of Allergy and Clinical Immunology: Global

M1 - 100664

ER -

Multidimensional Characterization of Allergic Rhinitis in Mysuru, South India: a cluster-based approach

Abstract

Keywords

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