The united allergic airway is a theory that connects allergic rhinitis (AR), chronic rhinosinusitis, and asthma, in which seemingly disparate diseases, instead of being thought of separately, are instead viewed as arising from a common atopic entity.
Objective
This article describes patients with such diseases; explores ideas suggesting a unified pathogenesis; elucidates the various treatment modalities available, emphasizing nasal corticosteroids and antihistamines; and provides an update of the literature.
Methods
A literature review was conducted.
Conclusion
The aggregation of research suggests that AR, asthma, and chronic rhinosinusitis are linked by the united allergic airway, a notion that encompasses commonalities in pathophysiology, epidemiology, and treatment.
SibbaldB., and RinkE.. Epidemiology of seasonal and perennial rhinitis: Clinical presentation and medical history.Thorax46: 895–901, 1991.
3.
WrightA.L., HolbergC.J., MartinezF.D.. Epidemiology of physician-diagnosed allergic rhinitis in childhood.Pediatrics94: 895–901, 1994.
4.
NathanR.A., MeltzerE.O., SelnerJ.C., and StormsW.. Prevalence of allergic rhinitis in the United States.J Allergy Clin Immunol99: S808–S814, 1997.
5.
DykewiczM.S., FinemanS., SkonerD.P.. Diagnosis and management of rhinitis: Complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology.Am Acad Allergy Asthma Immunol81: 478–518, 1997.
6.
Centers for Disease Control. Asthma in the US: Growing every year. Available online at www.cdc.gov/vitalsigns/asthma; accessed August 24, 2011.
7.
LeynaertB., NeukirchC., LiardR.. Quality of life in allergic rhinitis and asthma: A population-based study of young adults.Am J Respir Crit Care Med162: 1391–1396, 2000.
8.
BlaissM.S.. Allergic rhinitis: Direct and indirect costs.Allergy Asthma Proc31: 375–380, 2010.
9.
BernsteinJ.A.. Allergic and mixed rhinitis: Epidemiology and natural history.Allergy Asthma Proc31: 365–369, 2010.
10.
MarpleB.F.. Allergic rhinitis and inflammatory airway disease: Interactions within the unified airspace.Am J Rhinol Allergy24: 249–254, 2010.
11.
GuerraS., SherrillD.L., MartinezF.D., and BarbeeR.A.. Rhinitis is an independent risk factor for adult-onset asthma.J Allergy Clin Immunol109: 419–425, 2002.
12.
BosquetJ; and the ARIA Working Group. Allergic rhinitis and its impact on asthma.J Allergy Clin Immunol108: S147–S334, 2001.
13.
StevensonD.D., MathisonD.A., TanE.M., and VaughanJ.H.. Provoking factors in bronchial asthma.Arch Intern Med135: 777–783, 1975.
14.
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.
15.
HuovinenE., KaprioJ., LaitinenL.A., and KoskenvuoM.. Incidence and prevalence of asthma among adult Finnish men and women of the Finnish Twin Cohort from 1975 to 1990, and their relation to hay fever and chronic bronchitis.Chest115: 928–936, 1999.
16.
BramanS.S., BarrowsA.A., DeCotiisB.A.. Airway hyperresponsiveness in allergic rhinitis: A risk factor for asthma.Chest91: 671–674, 1987.
17.
CiprandiG., CirilloI., ToscaM.A., and VizzaccaroA.. Bronchial hyperreactivity and spirometric impairment in patients with perennial allergic rhinitis.Int Arch Allergy Immunol133: 14–18, 2004.
18.
CiprandiG., CirilloI., ToscaM.A., and VizzaccaroA.. Bronchial hyperreactivity and spirometric impairment in patients with seasonal allergic rhinitis.Respir Med98: 826–831, 2004.
19.
CiprandiG., CirilloI., PistorioA.. Impact of allergic rhinitis on asthma: Effects on bronchodilation testing.Ann Allergy Asthma Immunol101: 42–46, 2008.
20.
CiprandiG., CapassoM., and ToscaM.A.. Early bronchial involvement in children with allergic rhinitis.Am J Rhinol Allergy25: e30–e33, 2011.
21.
CiprandiG., SignoriA., and CirilloI.. Relationship between bronchial hyperreactivity and bronchodilation in patients with allergic rhinitis.Ann Allergy Asthma Immunol106: 460–466, 2011.
22.
TogiasA.. Mechanisms of nose-lung interaction.Allergy54: 95–105, 1999.
23.
BonayM., NeukirchC., GrandsaigneM.. Changes in airway inflammation following nasal allergic challenge in patients with seasonal rhinitis.Allergy61: 111–118, 2006.
24.
BraunstahlG.J., OverbeekS.E., KleinjanA.. Nasal allergen provocation induces adhesion molecule expression and tissue eosinophilia in upper and lower airways.J Allergy Clin Immunol107: 469–476, 2001.
25.
BraunstahlG.J., KleinjanA., OverbeekS.E.. Segmental bronchial provocation induces nasal inflammation in allergic rhinitis patients.Am J Respir Crit Care Med161: 2051–2057, 2000.
26.
GagaM., LambrouP., PapageorgiouN.. Eosinophils are a feature of upper and lower airway pathology in non-atopic asthma, irrespective of the presence of rhinitis.Clin Exp Allergy30: 663–669, 2000.
27.
Becky KellyE.A., BusseW.W., and JarjourN.N.. A comparison of the airway response to segmental antigen bronchoprovocation in atopic asthma and allergic rhinitis.J Allergy Clin Immunol111: 79–86, 2003.
28.
KurtE., AktasA., GulbasZ.. The effects of natural pollen exposure on inflammatory cytokines and their relationship with nonspecific bronchial hyperresponsiveness in seasonal allergic rhinitis.Allergy Asthma Proc31: 126–131, 2010.
29.
WelshP.W., StrickerW.E., ChuC.P.. Efficacy of beclomethasone nasal solution, flunisolide, and cromolyn in relieving symptoms of ragweed allergy.Mayo Clin Proc62: 125–134, 1987.
30.
HenriksenJ.M., and WenzelA.. Effect of an intranasally administered corticosteroid (budesonide) on nasal obstruction, mouth breathing, and asthma.Am Rev Respir Dis140: 1014–1018, 1984.
31.
CorrenJ., AdinoffA.D., BuchmeierA.D., and IrvinC.G.. Nasal beclomethasone prevents the seasonal increase in bronchial responsiveness in patients with allergic rhinitis and asthma.J Allergy Clin Immunol90: 250–256, 1992.
32.
AubierM., LevyJ., ClericiC.. Different effects of nasal and bronchial glucocorticosteroid administration on bronchial hyperresponsiveness in patients with allergic rhinitis.Am Rev Respir Dis146: 122–126, 1992.
33.
DahlR., NielsenL.P., KipsJ.. Intranasal and inhaled fluticasone propionate for pollen-induced rhinitis and asthma.Allergy60: 875–881, 2005.
34.
GrantJ.A., NicodemusC.F., FindlayS.R.. Cetirizine in patients with seasonal rhinitis and concomitant asthma: Prospective, randomized, placebo-controlled trial.J Allergy Clin Immunol95: 923–932, 1995.
35.
SpectorS.L., NicodemusC.F., CorrenJ.. Comparison of the bronchodilatory effects of cetirizine, albuterol, and both together versus placebo in patients with mild-to-moderate asthma.J Allergy Clin Immunol96: 174–181, 1995.
36.
AubierM., NeukirchC., PeifferC., and MelacM.. Effect of cetirizine on bronchial hyperresponsiveness in patients with seasonal allergic rhinitis and asthma.Allergy56: 35–42, 2001.
37.
CorrenJ., HarrisA.G., AaronsonD.. Efficacy and safety of loratadine plus pseudoephedrine in patients with seasonal allergic rhinitis and asthma.J Allergy Clin Immunol100: 781–788, 1997.
38.
Crystal-PetersJ., NeslusanC., CrownW.H., and TorresA.. Treating allergic rhinitis in patients with comorbid asthma: The risk of asthma-related hospitalizations and emergency department visits.J Allergy Clin Immunol109: 57–62, 2002.
39.
CorrenJ., ManningB.E., ThompsonS.F.. Rhinitis therapy and the prevention of hospital care for asthma: A case-control study.J Allergy Clin Immunol113: 415–419, 2004.
40.
FurukawaC.T.. The role of allergy in sinusitis in children.J Allergy Clin Immunol90: 515–517, 1992.
41.
IwensP., and ClementP.A.. Sinusitis in allergic patients.Rhinology32: 65–67, 1994.
42.
LinD.C., ChandraR.K., TanB.K.. Association between severity of asthma and degree of chronic rhinosinusitis.Am J Rhinol Allergy25: 205–208, 2011.
43.
BerrettiniS., CarabelliA., Sellari-FranceshiniS.. Perennial allergic rhinitis and chronic sinusitis: Correlation with rhinologic risk factors.Allergy54: 242–248, 1999.
44.
BaroodyF.M., MuchaS.M., DetineoM., and NaclerioR.M.. Nasal challenge with allergen leads to maxillary sinus inflammation.J Allergy Clin Immunol121: 1126–1132, 2008.
45.
PelikanZ., and Pelikan-FilipekM.. Role of nasal allergy in chronic maxillary sinusitis—Diagnostic value of nasal challenge with allergen.J Allergy Clin Immunol86: 484–491, 1990.
46.
HamilosD.L., LeungD.Y., WoodR.. Evidence for distinct cytokine expression in allergic versus nonallergic chronic sinusitis.J Allergy Clin Immunol96: 537–544, 1995.
47.
HutchesonP.S., SchubertM.S., and SlavinR.G.. Distinctions between allergic fungal rhinosinusitis and chronic rhinosinusitis.Am J Rhinol Allergy24: 405–408, 2010.
48.
SettipaneG.A.. Epidemiology of nasal polyps.Allergy Asthma Proc17: 231–236, 1996.
49.
SettipaneG.A., and ChafeeF.H.. Nasal polyps in asthma and rhinitis: A review of 6,037 patients.J Allergy Clin Immunol59: 17–21, 1977.
50.
BernsteinJ.M., AllenC., RichG.. Further observations on the role of Staphylococcus auerus exotoxins and IgE in the pathogenesis of nasal polyposis.Laryngoscope121: 647–655, 2011.
51.
SlavinR.G.. The upper and lower airways: The epidemiological and pathophysiological connection.Allergy Asthma Proc29: 553–556, 2008.
