Rhinitis, With or Without Allergies, Is Linked to Adult-Onset Asthma

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Title: Rhinitis, With or Without Allergies, Is Linked to Adult-Onset Asthma
URL: http://www.pslgroup.com/dg/22CC22.htm
Doctor's Guide
September 18, 2008

NEW YORK -- September 18, 2008 -- Rhinitis, whether allergic or nonallergic, is a powerful predictor of adult-onset asthma, according to a study published in Asthma Special Issue of The Lancet.

Rafea Shaaban, MD, National Institute of Health and Medical Research (INSERM), Paris, France, and colleagues used data from the European Community Health Survey to investigate the onset of asthma in adult patients aged 20 to 44 years with allergic and nonallergic rhinitis over 8.8 years.

The study analysed 6,461 patients from 29 centres in 14 countries, mostly in Western Europe, all without asthma at the beginning of the study. Patients were diagnosed as having rhinitis or not; then their allergic reactions were tested by a skin-prick test for house dust mites, cat, 2 types of fungus, grass, birch, the flowering plant Parietaria, olive, or ragweed.

After this, patients were classified into 4 groups: (1) controls (no atopy, no rhinitis, n = 3,163); (2) atopy only (atopy, no rhinitis, n = 704); (3) nonallergic rhinitis (rhinitis, no atopy, n = 1,377); and (4) allergic rhinitis (atopy and rhinitis, n = 1,217).

After the 8.8 years, asthma had developed in 1.1% of controls, 1.9% of the atopy only group, 3.1% of the nonallergic rhinitis group, and 4.0% of the allergic rhinitis group.

The data were then adjusted for country, sex, baseline age, body mass index, lung capacity, family history of asthma, and smoking. After this, people with allergies only were more than 63% more likely than controls to have asthma. Those with nonallergic rhinitis were more than 2.5 times more likely to have asthma, and those with allergic rhinitis were 3.5 times more likely to have asthma.

Only allergic rhinitis with sensitisation to house dust mites was associated with increased risk of asthma independently of other allergens, with a near trebling of risk. These associations were seen in both men and women.

"This large prospective study provides strong evidence for an increased risk of asthma in adults with allergic rhinitis, and to a lesser extent non-allergic rhinitis ... Several clinical trials in asthmatic patients with allergic rhinitis were associated with a reduction in asthma symptoms. However, only interventional studies could be used to conclude that the treatment of allergic rhinitis is effective in reducing the incidence of asthma," the authors wrote.

In an accompanying comment, Erika von Mutius, MD, University Children's Hospital, Munich, Germany, said: "The idea that allergic rhinitis could cause asthma raises the possibility of preventing asthma by preventing atopic sensation, which could in turn prevent allergic rhinitis." She further discusses how possible treatment strategies for both asthma and allergic rhinitis could affect the symptoms for each other.

SOURCE: The Lancet

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