Introduction. Growing prevalence of allergic rhinitis (AR) and significant socioeconomic losses related to implementing medical and prevention activities indicate the necessity to examine what role exogenous factors play in the disease onset and development. The aim of this study was to establish pathogenetic peculiarities of AR onset and development in schoolchildren under combined exposure to various environmental risk factors.

Materials and methods. We analyzed results of clinical and laboratory examinations of schoolchildren’s health and data obtained by questioning and taken from diaries of daily rations provided at school for four hundred thirty nine AR children. They attended either an ordinary secondary school or a school with profound studies of some subjects. Influence of risk factors on clinical and laboratory indicators was evaluated by using one-factor logistic regression models that described “adverse exposure – likelihood of a response (effect)” relationships. Leading risk factors and pathogenetic peculiarities of AR onset and development were identified based on analyzing established cause-effect relations “risk factor – laboratory indicator – likelihood of diagnosing AR».

Results. More significant violations of hygienic standards were established in schools with profound studies of some subjects; we identified improper management of educational activities, non-rational diets, and too intensive use of electronic devices. Likelihood of AR is 4.2 times higher for schoolchildren in such schools than for their counterparts from ordinary schools (OR=4.2) under combined exposure to adverse factors related to the educational process, diets, the environment (blood contamination with nickel, chromium, manganese, zinc, benzene, and toluene) and low physical activity. We established cause-effect relations between the disease development and the examined factors as well as their contributions to likelihood of risk-associated AR (12–60 %). We identified adverse laboratory effects in AR children who attended schools with profound studies of some subjects and established their association with affecting environmental factors. Pathogenetic peculiarities of the disease onset and development were posited based on modelling associations between laboratory indicators of disrupted homeostasis and AR development.

Limitations. The examination was performed with 439 schoolchildren participating in it. Participants were not divided into sex-specific groups when describing peculiarities of allergic rhinitis development.

Conclusion. The established key pathogenetic components in development of risk-associated AR are relevant targets for hygienic activities as regards the educational process and quality of the environment.

Compliance with ethical standards. Written informed voluntary consent was obtained from legal representatives of all the examined children prior to the study in accordance with the ethical principles of biomedical research stated in the Declaration of Helsinki (with 2008 addenda), and the national Standard of the RF GOST-Р 52379-2005 Good Clinical Practice (ICH E6 GCP). The study was approved by the local ethics committee of the Federal Scientific Center for Medical and Preventive Health Risk Management Technologies. (Meeting report No. 3 dated March 01, 2019).

Contributions:Zaitseva N.V. — study concept and design;Valina S.L. — clinical and laboratory tests, statistical analysis, writing the text;Ustinova О.Yu. — writing and editing the text;Shtina I.Е. — data collection and statistical analysis;Maklakova О.А. — data processing, writing the text;Osheva L.V. — data processing, writing the text.All the authors have approved of the ultimate version of the manuscript and bear full responsibility for integrity of its parts.

Conflict of interest. The authors declare no conflict of interest.

Acknowledgement. The study had no sponsorship.

Received: September 6, 2023 / Accepted: September 26, 2023 / Published: November 20, 2023