Unmasking the nature of Rhinitis
Published Online: July 29, 2014
Affecting more than a quarter of the population, Rhinitis is a common condition, and also often coexists with asthma. Previously, rhinitis has been classified in one-dimensional terms as “allergic/non-allergic” or “seasonal/perennial” which gives only limited understanding of the potential diversity of rhinitis encountered in clinical practice. The identification of more broadly defined subtypes of rhinitis can deliver a deeper understanding of the nature of rhinitis, how rhinitis relates to asthma, and aid evidence-based clinical management decisions. In a study recently published in The Journal of Allergy and Clinical Immunology, R. Kurukulaaratchy and colleagues explored different forms of rhinitis in an unbiased way using “major clinically defining characteristics”.
Using the Isle of Wight birth cohort (n=1456), which has been assessed up to 18-years of age, the authors of this study performed cluster analysis on adolescents with rhinitis symptoms at the age of 18 years (n=468). Cluster analysis is a statistical method which puts patients into groups according to the salient features of their disease, leading to a classification that is relevant to the individual.
Using this methodology, rhinitis could be categorized into four distinct groups with differing levels of disease severity, age of onset and association with asthma. The first group showed a moderate degree of rhinitis symptoms and required treatment, but had low risk of associated asthma. The second group consisted largely of girls with mild symptoms who developed rhinitis during adolescence. The third group developed severe rhinitis in childhood, and also had early-onset asthma, plus greater lung function abnormalities. The fourth group consisted largely of boys and although this group showed only moderate symptoms of rhinitis, they also had asthma and lung function abnormalities.
An important finding of this study is that not all forms of rhinitis are strongly associated with asthma. However, the association of these states was strongest where rhinitis was more severe. Furthermore, recognition that early-onset rhinitis is associated with more severe young adult airways disease should encourage a focus on early treatment efforts to possibly reduce later development of severe adult rhinitis and asthma. Recognition of these novel rhinitis subtypes should help individualize patients’ management according to their specific problems, rather than treating everyone in the same way.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.