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SELECTED ARTICLES FROM THE RECENT LITERATURE 2007
10/9/07
Allergic rhinitis and onset of bronchial hyperresponsiveness: A population-based study.
Summary
The European Community Respiratory Health Survey is a large, population-based continuing assessment survey. This data obtained via the survey has demonstrated that rhinitis, be it allergic or nonallergic, is a risk factor for asthma. However, all data obtained to date has been via cross-sectional studies. More recently, a longitudinal, multicenter study demonstrated the relationship between the development of bronchial hyperresponsiveness, atopy, and allergic rhinitis. The first set of data were obtained between 1991 and 1993, and the second set between 1998 and 2002.
In 1991 to 1993, 3,719 subjects without bronchial hyperreactivity were analyzed for the onset of bronchial hyperreactivity to methacholine; 372 subjects with bronchial hyperreactivity evaluated in 1991 to 1993 were also assayed in 1998 to 2002, to look for "remission" in reactivity to methacholine.
The investigators found subjects with allergic rhinitis and positive skin tests to cats and mites who did not have bronchial hyperreactivity on entrance into the study between 1991 and 1993, were at particular increased risk of developing bronchial hyperreactivity when reevaluated between 1998 and 2002. On the other hand, in individuals who did exhibit bronchial hyperreactivity at the baseline evaluation, subjects without allergic rhinitis had a greater remission rate (51.8% compared to 35.3% of those with allergic rhinitis). Of particular importance is that rhinitis subjects treated with nasal steroids were more likely to exhibit "a remission in bronchial hyperreactivity" than those not so treated.
Reference
Shaaban R, Zureik M, Soussan D, et al., American Journal of Respiratory and Critical Care Medicine 2000; 176:659-666.
Editor's Comments
We have known for many years that rhinitis is a risk factor for asthma. This phenomenon occurs in both patients with allergic and nonallergic rhinitis. However, these data were obtained by cross-sectional analysis. This is the first study to my knowledge that has looked at a longitudinal evaluation. The most interesting fact gleaned from the study is that, at least in this context, the use of intranasal steroids was associated with a loss in bronchial hyperreactivity in rhinitis patients.
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