Perennial rhinitis: An independent risk factor for asthma in nonatopic subjects: Results from the European Community Respiratory Health Survey

doi:10.1016/S0091-6749(99)70370-2

Journal of Allergy and Clinical Immunology

Volume 104, Issue 2, August 1999, Pages 301-304

https://doi.org/10.1016/S0091-6749(99)70370-2 Get rights and content

Abstract

Background: Although clinical and experimental studies suggest that upper respiratory tract dysfunction may affect the lower airways, rhinitis is usually not studied as a potential risk factor for asthma. This is because both diseases share key elements of pathogenesis and are usually considered as different manifestations of the same underlying “atopic” state. Objective: We sought to assess whether asthma is associated with rhinitis in the absence of immunologic disorders in a population study. Methods: Data from 34 centers participating in the European Community Respiratory Health Survey were analyzed. Random samples of 20- to 44-year-old subjects were invited to complete a detailed questionnaire and undergo total and specific IgE measurements, skin prick tests to 9 allergens, and bronchoprovocation challenges with methacholine. Results: Subjects with perennial rhinitis (n = 1412) were more likely than control subjects (n = 5198) to have current asthma. After adjustment for sex, age, smoking habit, family history of asthma, geographic area, and season at the time of examination, asthma was strongly associated with rhinitis among atopic subjects (odds ratio [OR] = 8.1; 95% confidence interval [CI] = 5.4–12.1) but also among nonatopic subjects (OR = 11.6; 95% CI = 6.2-21.9). Moreover, the association remained very strong when the analysis was restricted to nonatopic subjects with IgE levels of 80 kIU/L or less (OR = 13.3; 95% CI = 6.7–26.5). In nonasthmatic subjects bronchial hyperresponsiveness was also more frequent in subjects with rhinitis than in those without rhinitis (OR = 1.7; 95%CI = 1.2-2.6 in nonatopic subjects with IgE levels of ≤80 kIU/L). Conclusion: The strong association between perennial rhinitis and asthma in nonatopic subjects with normal IgE levels is consistent with the hypothesis that rhinitis is an independent risk factor for asthma. (J Allergy Clin Immunol 1999;104:301-4.)

Section snippets

METHODS

Data were collected as part of the ECRHS (methods described elsewhere⁹). Briefly, participants at 48 study centers randomly selected samples of 20- to 44-year-old subjects who completed a short postal questionnaire about asthma and asthma-like symptoms. In 34 centers, randomly selected subsamples from the initial respondent samples were then invited to attend for further tests, including an extended interviewer-administered questionnaire, respiratory function testing with methacholine

RESULTS

Data were analyzed for 1412 subjects with perennial rhinitis and 5198 control subjects with complete information on asthma, BHR, atopy, and family history of asthma. Compared with control subjects, subjects with rhinitis were slightly younger (32.8 years vs 33.5 years; P = .001), the proportion of men was lower (47.0% vs 53.0%; P = .001), and the proportion of smokers (current or past smoker, 48.4% vs 59.5%), as well as the proportion of current heavy smokers (at least 20 cigarettes/day; 8.2%

DISCUSSION

Our results from a large population study show that the relationships between perennial rhinitis and asthma and between perennial rhinitis and BHR exist even in nonatopic subjects with total IgE measurements in the normal range.

As in all large population studies, data were collected by means of questionnaires, which is a potential limitation. An additional difficulty was related to the international design of this study. However, a high degree of standardization was obtained by the use of

Acknowledgements

We thank the late C. Baya and M. Hallen for their help during the study and K. Vuylsteek and the members of the Comité d’Actions Concertées for their support.

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^☆: Supported by the European Commission. The following grants helped fund the local studies. Australia: Allen and Hanbury’s, Australia; Belgium: Belgian Science Policy Office and the National Fund for Scientific Research; France: Ministère de la Santé, Glaxo France, Institut Pneumologique d’Aquitaine, Contrat de Plan Etat-Région Languedoc-Roussillon, CNMATS, CNMRT (90MR/10, 91AF/6), the Ministre délégué de la santé, and RNSP; Germany: GSF and the Bundesminister für Forschung und Technologie, Bonn; Greece: The Greek Secretary General of Research and Technology, Fisons, Astra, and Boehringer-Ingelheim; India: Bombay Hospital Trust; Italy: Ministero dell’Univesità e della Ricerca Scientifica e Tecnologica, CNR, Regione Veneto grant RSF n. 381/05.93; New Zealand: Asthma Foundation of New Zealand, Lotteries Grant Board, and the Health Research Council of New Zealand; Norway: Norwegian Research Council project no. 101422/310; Portugal: Glaxo Farmacêutica Lda, Sandoz Portugesa; Spain: Ministero Sanidad y Consumo FIS (grants #91/0016060/OOE-05E., #92/0319, #93/0393), Hospital General de Albacete, Hospital General Juan Ramón Jiménenz, and the Consejeria de Sanidad Principado de Asturias; Sweden: The Swedish Medical Research Council, the Swedish Heart Lung Foundation, the Swedish Association against Asthma and Allergy, The Swedish Society of Medicine, Astra, Glaxo-Wellcome, and Boehringer-Ingelheim; Switzerland: Swiss National Science Foundation grant 4026-28099; UK: National Asthma Campaign, British Lung Foundation, Department of Health, and the South Thames Regional Health Authority; USA: United States Department of Health, Education and Welfare Public Health Service Grant #2 S07 RR05521-28.

^☆☆: Reprint requests: Bénédicte Leynaert, PhD, Epidémiologie, Faculté de Médecine Xavier Bichat, BP 416, 75870 Paris Cedex 18, France.

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Perennial rhinitis: An independent risk factor for asthma in nonatopic subjects: Results from the European Community Respiratory Health Survey☆,☆☆,★

Abstract

Section snippets

METHODS

RESULTS

DISCUSSION

Acknowledgements

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

The link between the nose and lung, perennial rhinitis and asthma—Is it the same disease?

Allergy

Relationships between rhinitis and asthma

Allergy

Is prevention a realistic goal?

Association of asthma with serum IgE levels and skin test reactivity to allergens

N Engl J Med