Childhood allergic rhinitis predicts asthma incidence and persistence to middle age: A longitudinal study

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Background

The association between allergic rhinitis and asthma is well documented, but the temporal sequence of this association has not been closely examined.

Objective

We sought to assess the associations between childhood allergic rhinitis and (1) asthma incidence from preadolescence to middle age and (2) asthma persistence to middle age.

Methods

Data were gathered from the 1968, 1974, and 2004 surveys of the Tasmanian Asthma Study. Cox regression was used to examine the association between childhood allergic rhinitis and asthma incidence in preadolescence, adolescence, and adult life. Binomial regression was used to examine the association between childhood allergic rhinitis and asthma beginning before the age of 7 years and persisting at age 44 years.

Results

Childhood allergic rhinitis was associated with a significant 2- to 7-fold increased risk of incident asthma in preadolescence, adolescence, or adult life. Childhood allergic rhinitis was associated with a 3-fold increased risk of childhood asthma persisting compared with remitting by middle age.

Conclusions

Childhood allergic rhinitis increased the likelihood of new-onset asthma after childhood and the likelihood of having persisting asthma from childhood into middle age.

Clinical implications

Asthma burden in later life might be reduced by more aggressive treatment of allergic rhinitis in early life.

Section snippets

Study population and data collection

The TAS began in 1968 when a population birth cohort (n = 8583), then aged 7 years and attending school in Tasmania, was surveyed. The cohort comprised 98.9% of children born in Tasmania in 1961. A questionnaire completed by the parents detailed the child's history of asthma, hay fever, eczema, allergy, and urticaria. At a medical examination in 1968, FEV1, forced vital capacity, and forced expiratory flow from 25% to 75% of the forced vital capacity were measured with a wedge-bellows

Prevalence of allergic disorders

In the cohort at the age of 7 years (n = 8583), the prevalence of “asthma ever” was 16.3% (n = 1399). A response to the allergic rhinitis question was obtained for 96.4% (n = 8275). Of these, 12.8% (95% CI, 12.1% to 13.5%; n = 1061) had allergic rhinitis, which was significantly more common in boys (13.9% vs 11.7%, χ21 = 8.7, P = .003). Of this 1061, infantile or flexural eczema was reported by the parents in 27.1% (95% CI, 24.5% to 29.8%; n = 228), food or medicine allergy in 15.7% (95% CI,

Discussion

Childhood allergic rhinitis and childhood asthma were strongly associated, independent of other childhood allergic disorders, impaired lung function at the age of 7 years, and socioeconomic status. Furthermore, childhood allergic rhinitis was associated with a 7-fold increased risk of incident asthma in preadolescence, a 4-fold increased risk in adolescence, and a 2-fold increased risk in adult life, independent of those same covariates. Incident asthma risk in adult life was also independent

References (42)

  • J. Corren

    The impact of allergic rhinitis on bronchial asthma

    J Allergy Clin Immunol

    (1998)
  • A.J. Lowe et al.

    Atopic disease and breast-feeding-cause or consequence?

    J Allergy Clin Immunol

    (2006)
  • M.R. Sears et al.

    Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study

    Lancet

    (2002)
  • A.L. Wright et al.

    Epidemiology of physician-diagnosed allergic rhinitis in childhood

    Pediatrics

    (1994)
  • T.M. Huurre et al.

    Incidence and prevalence of asthma and allergic rhinitis: a cohort study of Finnish adolescents

    J Asthma

    (2004)
  • D. Strachan et al.

    Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC)

    Pediatr Allergy Immunol

    (1997)
  • A.M. Vignola et al.

    Relationships between rhinitis and asthma

    Allergy

    (1998)
  • R.J. Settipane et al.

    Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students

    Allergy Proc

    (1994)
  • A. Zapletal et al.

    [Significance of contemporary methods of lung function testing for the detection of airway obstruction in children and adolescents (author's translation)]

    Z Erkr Atmungsorgane

    (1977)
  • J.A. Burgess et al.

    Who remembers whether they had asthma as children?

    J Asthma

    (2006)
  • K.J. Rothman et al.
  • Cited by (0)

    The Tasmanian Asthma Study is supported by grants from the National Health and Medical Research Council of Australia, the Asthma Foundations of Victoria and Tasmania, the Clifford Craig Medical Research Trust, and the Royal Hobart Hospital Research Foundation. John Burgess is supported by a Research Scholarship from the University of Melbourne. Graham Byrnes, Melanie Matheson, John Hopper, and Shyamali Dharmage are supported by the National Health and Medical Research Council of Australia.

    Disclosure of potential conflict of interest: M. J. Abramson has consulting arrangements with the Australian Asthma Study, which was sponsored by GlaxoSmithKline; received an honorarium from Boehringer Ingelheim for a presentation at Airways 2006; and received travel support from AstraZeneca. The rest of the authors have declared that they have no conflict of interest.

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