Objectives: Asthma exacerbations in children represent a significant contributor to disease burden, with the risk of occurrence depending on the type of allergic sensitization. Identification of clinical and biological factors may improve risk stratification and support therapeutic management. The aim of this study was to assess the relationships between exacerbation frequency, lung function, inflammatory biomarkers, and the severity of sinonasal symptoms in children with asthma. Material and Methods: In a retrospective observational study, 80 children with allergic rhinitis and asthma were enrolled. Patients were stratified according to exacerbation frequency (<2 vs. ≥2 over 12 months) and sensitization to house dust mites (HDM). Assessments included spirometry (FEV₁, FEV₁/FVC), fractional exhaled nitric oxide (FeNO), peripheral blood eosinophil count, and serum soluble receptor for advanced glycation end products (sRAGE). Asthma control was evaluated using the Childhood Asthma Control Test (c-ACT), while sinonasal symptoms were assessed using the Sino-Nasal 5 (SN-5) questionnaire. Advanced glycation end products were assessed using skin autofluorescence. Results: In children without sensitization to HDM, more frequent exacerbations correlated with higher sRAGE concentrations (p = 0.0259) and greater activity limitation due to sinonasal symptoms (p = 0.0309). In HDM-sensitized children, frequent exacerbations were associated with lower FEV₁ (p = 0.0089), reduced FEV₁/FVC (p = 0.0186), and poorer asthma control (p = 0.0117). Greater severity of sinonasal symptoms was observed in children with poorer asthma control (p = 0.012). Conclusions: Exacerbation risk in asthma is associated with distinct profiles depending on sensitization status. Elevated sRAGE concentrations and increased sinonasal inflammation may characterize phenotypes not associated with HDM. In contrast, impaired lung function and poor asthma control predominate in HDM-associated asthma. Int J Occup Med Environ Health. 2026;39(3)