Allergic rhinitis in children: association with asthma

Abstract

SummaryThe incidence of allergic rhinitis in paediatric bronchial asthma patients was about 80% according to a questionnaire survey. Watery nasal discharge and nose rubbing were common symptoms of paediatric allergic rhinitis, while nasal congestion and sneezing increased with age. Although there were slight differences depending on the age of patients, one‐third to nearly half were believed to have nasal symptoms and asthma attacks. The first wheezing episode preceded nasal symptoms in the majority of patients, but onset of allergic rhinitis occurred > 1 year before asthma in a little over 10%. The age of onset of allergic rhinitis was 1 year in these patients, which was clearly earlier than that observed in patients who first developed asthma (4 years). Furthermore, the incidence of cedar pollinosis was higher in patients who developed allergic rhinitis first than in those who developed asthma first, suggesting that asthma patients who develop allergic rhinitis first exhibit pronounced nasal hypersensitivity. Allergic inflammatory cells are present in the nasal mucosa of asthma patients who do not exhibit distinct allergic rhinitis symptoms, so nasal sensitization does not necessarily lead to allergic rhinitis symptoms, suggesting the existence of some other factor that induces nasal hypersensitivity. On nasal smear, the appearance of mast cells preceded a positive radioallergosorbent test (RAST), and the appearance of eosinophils and basophils was consistent with the degree of sensitization. Anti‐allergic agents appear efficacious in patients' mast cells positive on nasal smear cytology with negative house dust mite RAST, suggesting that nasal smear cytology may be useful when beginning medication.