Allergic rhinitis is considered a strong risk factor for the onset of asthma. However, few studies addressed this issue from afunctional point of view. The aim of this study was to follow up a group of patients with allergic rhinitis to investigate the onset of possible spirometric abnormalities and/or bronchial hyperreactivity (BHR).
Methods
Eighty-nine patients with moderate–severe persistent allergic rhinitis were prospectively and consecutively evaluated; 940 controls were also included in the study. Clinical examination, skin-prick test, spirometry, and methacholine challenge were performed in all patients every 2 years for 8 years.
Results
The number of patients with forced expiratory flow at 25 and 75% of pulmonary volume of<70% of predicted significantly increased during the observation time. At baseline, no subjects had BHR; whereas 34 patients had BHR after 8 years. Sensitization to mites, birch, and Parietaria as well as rhinitis duration are risk factors for these changes.
Conclusion
This study highlights the close link between upper and lower airways and suggests that spirometry should be performed in patients with allergic rhinitis.
Get full access to this article
View all access options for this article.
References
1.
Van CauwenbergerP., De BelderT., VermeirenJ., and KaplanA.Global resources in allergy (GLORIA): Allergic rhinitis and conjunctivitis.Clin Exp All Rev3: 46–50, 2003.
2.
BugianiM., CarossoA., MiglioreE.Allergic rhinitis and asthma comorbidity in a survey of young adults in Italy.Allergy60: 165–170, 2005.
3.
SettipaneR.J., HagyG.W., and SettipaneG.A.Long-term risk factors for developing asthma and allergic rhinitis: A 23-year follow-up study of college students.Allergy Proc15: 21–25, 1994.
4.
BraunstahlG.J., KleinjanA., OverbeekS.E.Segmental bronchial provocation induces nasal inflammation in allergic rhinitis patients.Am J Respir Crit Care Med161: 2051–2057, 2000.
5.
BraunstahlG.J., OverbeekS.E., FokkensW.J.Segmental bronchoprovocation in allergic rhinitis patients affects mast cell and basophil numbers in nasal and bronchial mucosa.Am J Respir Crit Care Med164: 858–865, 2001.
6.
PlaschkeP.P., JansonC., NorrmanE.Onset and remission of allergic rhinitis and asthma and the relationship with atopic sensitization and smoking.Am J Respir Crit Care162: 920–924, 2000.
7.
FrieriM.Interaction between rhinitis and asthma: State of the art.Allergy Asthma Proc24: 385–393, 2003.
8.
FrieriM.Inflammatory issues in allergic rhinitis and asthma.Allergy Asthma Proc26: 220–226, 2005.
9.
PellegrinoR., ViegiG., BrusascoV.Interpretative strategies for lung function tests.Eur Respir J26: 948–968, 2005.
10.
MillerM.R., HankinsonJ., BrusascoV.Standardisation of spirometry.Eur Respir J26: 319–338, 2005.
11.
HamidQ., SongY., KotsimbosT.C.Inflammation of small airways in asthma.J Allergy Clin Immunol100: 44–51, 1997.
12.
MarsegliaG.L., ToscaM., CirilloI., and CiprandiG.Role of forced expiratory flow at 25–75% as an early marker of small airways impairment in subjects with allergic rhinitis.Allergy Asthma Proc28: 74–78, 2007.
13.
FrieriM.Advances in understanding allergic asthma.Allergy Asthma Proc28: 614–619, 2007.
14.
BjermerL.Past and future perspectives in the asthma treatment.Respir Med95: 703–719, 2001.
15.
LipworthB.J., and ClarkD.J.Effects of airway calibre on lung delivery of nebulised salbutamol.Thorax52: 1016–1021, 1997.
16.
CiprandiG., CirilloI., VizzaccaroA.Seasonal and perennial allergic rhinitis: Is this classification adherent to real life? A population based study.Allergy60: 882–887, 2005.
17.
BousquetJ., KhaltaevN., CruzA.A.Allergic Rhinitis and Its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA2LEN and AllerGen).Allergy63: S8–S160, 2008.
18.
WallaceD.V., and DykewiczM.S.The diagnosis and management of rhinitis: An updated practice parameter.J Allergy Clin Immunol122: S1–S84, 2008.
19.
CiprandiG., CirilloI., and PistorioA.Impact of allergic rhinitis on asthma: Effects on spirometric parameters.Allergy63: 255–260, 2008.
20.
CirilloI., PistorioA., ToscaM.A., and CiprandiG.Impact of allergic rhinitis on asthma: Effects on bronchial hyperreactivity.Allergy64: 439–444, 2009.
21.
CiprandiG., CirilloI., PistorioA.Impact of allergic rhinitis on asthma: Effects on bronchodilation test.Ann Allergy Asthma Immunol101: 42–46, 2008.
22.
DreborgS. (Ed). EAACI Subcommittee on Skin Tests. Skin tests used in type I allergy testing. Position Paper.Allergy44: S22–S31, 1989.
23.
American Thoracic Society.Guidelines for methacholine and exercise challenge testing—1999.Am J Respir Crit Care Med161: 309–329, 2000.
24.
MarpleB.F.Allergic rhinitis and inflammatory airway disease: Interactions within the unified airspace.Am J Rhinol Allergy2: 249–254, 2010.
SlavinR.G.The upper and lower airways: The epidemiological and pathophysiological connection.Allergy Asthma Proc29: 553–556, 2008.
27.
CiprandiG., CirilloI., KlersyC.Role of FEF25–75 as an early marker of bronchial impairment in patients with seasonal allergic rhinitis.Am J Rhinol20: 641–647, 2006.
28.
GuerraS., SherrillD.L., MartinezF.D., and BarbeeR.A.Rhinitis as an independent risk factor for adult-onset asthma.J Allergy Clin Immunol109: 419–425, 2002.
29.
ShaabanR., ZureikM., SoussanD.Rhinitis and onset of asthma: A longitudinal population-based study.Lancet372: 1049–1057, 2008.
30.
CiprandiG., BuscagliaS., PesceG.P.Minimal persistent inflammation is present at mucosal level in asymptomatic rhinitic patients with allergy due to mites. J.Allergy Clin Immunol96: 971–978, 1995.
ChinnS., HeinrichJ., AntóJ.M.Bronchial responsiveness in atopic adults increases with exposure to cat allergen.Am J Respir Crit Care Med176: 20–26, 2007.
