Allergic rhinitis and asthma: How important is the link?☆,☆☆,★
Section snippets
Epidemiologic studies: coexistence or cause-and-effect?
A large number of cross-sectional studies have demonstrated that rhinitis and asthma commonly occur together. Nasal symptoms have been reported among 28% to 78% of patients with asthma,1, 2, 3 compared with approximately 20% of the general population.4 Similarly, as many as 19% to 38% of patients with allergic rhinitis may have asthma,1, 3 much more than the 3% to 5% prevalence among the general population.5 In a survey of 6563 residents, new diagnoses of probable allergic rhinitis or asthma
Clinical trials: The effects of nasal therapy on asthma
In anecdotal experience, physicians have often noted improvements in asthma after successful treatment of rhinitis. Until recently, however, few controlled clinical trials have been attempted to measure this effect. Since the mid 1980s, several investigators have begun to evaluate carefully the impact of rhinitis therapy on asthma symptoms, pulmonary function, and airway responsiveness.
Laboratory research: Exploring the mechanisms
Although there is compelling evidence that allergic rhinitis may influence the clinical course of asthma, the mechanisms connecting upper and lower airway dysfunction are poorly understood. A variety of theories have been proposed to explain the apparent relation between nasal disease and asthma. These theories include (1) the existence of a nasal-bronchial reflex, (2) mouth breathing caused by nasal obstruction, and (3) pulmonary aspiration of nasal contents.
Summary and future directions
Epidemiologic surveys have shown that allergic rhinitis and asthma commonly coexist and that an important minority of patients with nasal allergy demonstrate nonspecific bronchial hyperresponsiveness in the absence of overt asthma. A limited number of studies suggest that allergic rhinitis is a risk factor for asthma and that asymptomatic bronchial hyperresponsiveness may influence this process. Among patients who have both rhinitis and asthma, intranasal corticosteroids and antihistamines,
References (55)
- et al.
National trends in the morbidity and mortality of asthma in the U.S.: prevalence, hospitalization and death from asthma over two decades, 1965–1984
Chest
(1987) - et al.
Epidemiology of asthma and allergic rhinitis in a total community, Tecumseh, Michigan
J Allergy Clin Immunol
(1974) - et al.
Comparative action of acetyl-beta-methylcholine, histamine, and pollen antigens in subjects with hay fever and patients with bronchial asthma
J Allergy
(1965) - et al.
Seasonal increase of bronchial reactivity in allergic rhinitis
J Allergy Clin Immunol
(1987) - et al.
Bronchial sensitivity to methacholine in current and former asthmatic and allergic rhinitis and control subjects
J Allergy Clin Immunol
(1975) - et al.
Different prevalence and degree of nonspecific bronchial hyperreactivity between seasonal and perennial rhinitis
J Allergy Clin Immunol
(1990) - et al.
Airway hyperresponsiveness in allergic rhinitis: a risk factor for asthma
Chest
(1987) - et al.
Nasal beclomethasone prevents the seasonal increase in bronchial responsiveness in patients with allergic rhinitis and asthma
J Allergy Clin Immunol
(1992) - et al.
Treatment of allergic rhinitis with intranasal corticosteroids in patients with mild asthma: effect on lower airway responsiveness
J Allergy Clin Immunol
(1993) - et al.
Efficacy of beclomethasone nasal solution, flunisolide and cromolyn in relieving symptoms of ragweed allergy
Mayo Clin Proc
(1987)
Cetirizine in patients with seasonal allergic rhinitis and concomitant asthma: prospective, randomized, placebo-controlled trial
J Allergy Clin Immunol
Where is the allergic reaction in ragweed asthma?
J Allergy Clin Immunol
Pulmonary response to nasal-challenge testing of atopic subjects with stable asthma
J Allergy Clin Immunol
Changes in bronchial responsiveness following nasal provocation with allergen
J Allergy Clin Immunol
Airway cooling in asthmatic and nonasthmatic subjects during nasal and oral breathing
J Allergy Clin Immunol
Pharyngeal aspiration in normal adults and patients with depressed consciousness
Am J Med
Absence of pulmonary aspiration of sinus contents in patients with asthma and sinusitis
J Allergy Clin Immunol
Natural history of childhood asthma: 20-year follow-up
Arch Dis Child
Epidemiology and natural history of asthma, allergic rhinitis and atopic dermatitis (eczema)
Asthma and allergic rhinitis in the same patients
Allergy
Allergic rhinitis: update
Otolaryngol Head Neck Surg
Frequency and hereditability of asthma and allergic rhinitis in college students
Acta Genet
The prevalence of ragweed pollinosis in foreign and native students at a midwestern university and its implications concerning methods for determining inheritance of atopy
J Allergy
Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students
Allergy Proc
Asymptomatic bronchial hyperresponsiveness in rhinitis
J Allergy Clin Immunol
Airway responsiveness to methacholine and risk of asthma in patients with allergic rhinitis
Ann Allergy
Effect of an intranasally administered corticosteroid (budesonide) on nasal obstruction, mouth breathing and asthma
Am Rev Respir Dis
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