Duration Of Rhinitis Research Articles

Asthma is associated with increased severity and duration of rhinitis: A study with the Allergic Rhinitis and its Impact on Asthma classes in the Constances cohort.

Few population-based studies have described allergic rhinitis (AR) according to the Allergic Rhinitis and its Impact on Asthma (ARIA) classification, and none have assessed the impact of asthma on this classification. Our aims were to 1) describe AR according to four ARIA classes and 2) within each of the four ARIA classes, compare participants with AR alone versus those with AR and asthma. Cross-sectional analyses were performed using data from the 2014 annual follow-up questionnaire of the French adult population-based cohort Constances. Current AR was defined by the report of sneezing, runny, or blocked nose in the last 12months and the report of nasal allergies. Following ARIA recommendations, rhinitis was classified according to its severity (mild or moderate-severe) and duration (intermittent or persistent). Ever asthma was also defined by a questionnaire. Among the 4675 participants with AR (57% women, mean age 50.2±12.7years), 44% were classified as mild/intermittent, 16% mild/persistent, 25% moderate-severe/intermittent, and 15% moderate-severe/persistent. Within each of the four ARIA classes, compared to participants with rhinitis alone, participants with rhinitis and asthma had significantly more severe symptoms, more conjunctivitis, a higher mean eosinophil count and more treatments with intra-nasal corticosteroids and oral antihistamines co-medication. This is a paradigm shift study as for the first time this large population-based study in adults showed that asthma status has a profound effect on the ARIA classification. Rhinitis alone and rhinitis with asthma represent two distinct phenotypes. These results reinforce the need to include asthma status in the ARIA classification and guidelines.

A Comparative Clinical Study on the effect of Vachadi Avaleha versus Mustakadi Avaleha in the management of Pratishyaya (~Recurrent Rhinitis) in school going children: A Single-blind Randomized Control Trial

Background: In Ayurveda, Pratishyaya (~Recurrent Rhinitis) is described in Shiro-roga (Head disease).Pratishyaya (~Recurrent Rhinitis) is a common disease of childhood and it is well known for its recurrence. Immature Dhatu (tissues) state in children makes them more susceptible to recurrent infections. Clinical features of Pratishyaya (~Recurrent Rhinitis) can be correlated with rhinitis. Aim & Objective: To study the effect of vachadi avaleha and mustakadi avaleha in management of pratishyaya (~recurrent rhinitis). To study comparative efficacy of vachadi avaleha and mustakadi avaleha in management of pratishyaya(~recurrent rhinitis). Material & Method: Study comprises total 60 patients of Pratishyaya (~recurrent rhinitis) randomly divided into two equal groups. Group A (Experimental group) was treated with Vachadi avaleha two times a day after meal with honey and Group B (Control group) was treated with Mustakadi Avaleha administered two times a day after meal for 90 days. Patients were assessed for subjective parameters like rhinorrhoea, sneezing, nasal congestion, recurrence of rhinitis, duration of rhinitis per episode. Patients were assessed on every 30th day till completion of study period. Result- The effect of Mustakadi Avaleha (Group B) is significant at p<0.05 for subjective criteria such as nasastrava (rhinorrhoea), kshavathu (sneezing), and nasavarodha (nasal congestion) of pratishyaya (~Recurrent Rhinitis). Conclusion: Vachadi Avaleha is not as significant as Mustakadi avaleha in Pratishyaya (~Recurrent Rhinitis).

Severity and duration of allergic conjunctivitis: are they associated with severity and duration of allergic rhinitis and asthma?

Objective. The association of allergic conjunctivitis (AC) with rhinitis and/or asthma is poorly understood. The objective of this study was to apply the Consensus Document for Allergic Conjunctivitis (DECA) criteria for the classification of AC to a population of patients with AC to assess the association between the severity and duration of AC and rhinitis and/or asthma. Methods. Patients with ocular symptoms of AC who participated in the 'Alergológica 2015' study were included. The demographics, classification according to the DECA criteria, etiology, and comorbidities were evaluated by age groups (less or equal than 14 and greater than 14 years). Results. A total of 2,914 patients (age range, 1-90 years) were included in the "Alergológica 2015" study. Of these, 965 patients (33.1%) were diagnosed with AC (77.5% > 14 years). AC was classified as severe, moderate, or mild in 1.8%, 46.4%, and 51.8%, respectively; and as intermittent or persistent in 51.6% and 48.4% of the patients. AC alone occurred in 4% of patients. AC was mainly associated with rhinitis (88.4%), asthma (38.2%), food allergy (8.3%) and atopic dermatitis (3.5%). In allergic respiratory disease rhinitis preceded AC and asthma developed later. The severity and duration of AC was significantly associated with severity and duration of rhinitis (p less than 0.001 for both age groups) and asthma (p less than 0.001 only in adults). Conclusions. The application of the new DECA classification for AC reveals a direct relationship between AC, rhinitis and asthma respect to severity and duration. These relationships suggest that AC should be considered an integral part of the "one airway, one disease" hypothesis.

Can nasal nitric oxide be a biomarker to differentiate allergic and non-allergic rhinitis?

BackgroundNasal nitric oxide (nNO), a noninvasive indicator for eosinophilic airway inflammation, has not been adequately studied in different types of rhinitis. The aim of this study was to compare nNO levels between allergic (AR) and non-allergic rhinitis (NAR). Patients were included based on their chronic nasal symptoms. Total nasal symptoms score (TNSS) were evaluated. nNO was measured transnasally with a flow of 5 ml/s from the nostril with an NO analyzer (NIOX MINO; Aerocrine, Sweden). Results were evaluated as parts per billion (ppb).ResultsFour hundred forty-three patients (277 F/166 M)—337 with AR (76%) and 106 with NAR (24%)—were assessed. Patients with AR had significantly higher TNSS, more severe disease, and longer duration of disease compared to NAR group. Allergic rhinitis had significantly higher nNO levels than NAR (370 ppb vs 290 ppb) (p = 0.001). Likewise, significant differences were observed in female gender, in patients with BMI ≥ 25 kg/m2 and those without sinusitis between the two groups. When nNO were further evaluated in comorbid asthma, patients with AR w/o asthma had the highest TNSS and had significantly higher nNO level (p < 0.001). NAR+A group, with the longest duration of rhinitis, was significantly older and had the lowest nNO level (p < 0.001).ConclusionsThis study showed that nNO levels were significantly higher in AR patients than NAR. Although there is no recommended standard threshold for nNO, this study confirmed the utility of nNO in differentiating AR and NAR in addition to its known fast and non-invasive advantages.

Developing nomograms for identifying allergic rhinitis among chronic rhinitis: A real-world study

BackgroundIt is difficult to discriminate allergic rhinitis (AR) and nonallergic rhinitis (NAR) in clinical practice due to the similar clinical manifestations. The study was to assess both the demographical and clinical features of AR and NAR in the real-world data of outpatients in China. MethodsIt was a cross-sectional real-world study. AR and NAR were defined based on both subjective symptoms and objective specific serum IgE test. General demographic characteristics as well as clinical information were documented. Patients were further classified according the seasons of initial visiting hospital (during pollen seasons or not). A scoring system presented as nomograms for presence of AR was performed. ResultsIn the pollen season group, age distribution, the duration of rhinitis, comorbidity of asthma, food allergies, and score of coughing were found significantly associated with AR. Additionally, in the non-pollen season group, we found that ethnicity, age distributions, duration of rhinitis, comorbidity of asthma, food allergies, and family history of allergy, together with scores of gritty eyes were associated factors of AR. Based on multivariate logistic model, we built two nomograms which included previously identified significant risk factors that could be acquired easily during clinical practice with predictive variables to assess their roles in predicting the risk of AR among outpatients with rhinitis. ConclusionsThe characteristics of patients with different phenotypes of chronic rhinitis are distinctive in different seasons and the developed nomogram in this study might be beneficial for clinical practice.

Impact of Particulate Matter on the Clinical Characteristics of Rhinitis.

To investigate the association between PM10 concentration and the severity of rhinitis symptoms. Retrospective cohort study. Retrospective analysis of the data of 590 participants prospectively enrolled in a regional population-based cohort study was performed. The ambient PM10 concentrations were measured at 12 different observatories located in three cities. All participants were screened for allergic sensitization by skin prick tests and asked to complete questionnaires regarding their rhinitis symptoms. The severity and duration of rhinitis were analyzed and compared at different levels of PM10 concentration. RESULTS: On multivariate analysis, the PM10 concentration significantly correlated with the severity of symptoms when adjusting for age, sex, presence of sensitized allergen, region, and the time of enrolment (β = 0.102, P = .021). Positive correlation was found between PM10 concentration and the duration of allergic rhinitis symptoms (β = 0.082, P = .077). In the stratified analysis on the atopic status, there was a significant correlation between PM10 concentration and the severity and duration of rhinitis symptoms in those without allergic sensitization (β = 0.104; P = .032 and β = 0.104; P = .011, respectively). The significant correlation between the annual PM10 concentration and severity and duration of rhinitis symptoms suggests the necessity of intensive management of rhinitis patients exposed to elevated levels of ambient PM10 concentration. 3 Laryngoscope, 131:E1753-E1759, 2021.

Could FeNO Predict Asthma in Patients with House Dust Mites Allergic Rhinitis?

Background and Objectives: The evolution of allergic rhinitis to asthma is a part of “atopic march”. The aim of this study was to analyze possible predictive markers for asthma occurrence in patients with allergic rhinitis to house dust mites (HDM). Materials and Methods: Fifty-eight patients with persistent allergic rhinitis (PAR) were included. The clinical, biological evaluation and fractionated exhaled nitric oxide (FeNO) measurement were performed at enrolment. The patients were clinically evaluated after one year to determine asthma occurrence. Results: The severity of rhinitis symptoms, levels of total immunoglobulin E (IgE), ICAM-1, VCAM-1, E-selectin and IL-6, but not IL-8 and TNF-α were higher in patients with allergic rhinitis who developed asthma compared to non-asthmatics, but the differences were not significant to considered them as predictive factors for asthma occurrence. The risk of asthma was independently influenced by patients aged over 30 years ((OR-3.74; CI95% 0.86–16.31; p = 0.07), a duration of allergic rhinitis over 12 months ((OR-4.20; CI95% 0.88–20; p = 0.07) and a basal FeNO over 28 parts per billion (pbb) ((OR-18.68; CI95% 3.79–92.05; p < 0.001). Conclusion: Clinical and biological parameters may predict asthma occurrence in patients with persistent allergic rhinitis to HDM. Adult patients with a longer duration of rhinitis symptoms and a high level of FeNO have a greater risk to develop asthma.

Evaluation of olfactory function in children with allergic rhinitis and nonallergic rhinitis

ObjectivesAllergic rhinitis (AR) occurs when the symptoms of rhinitis arise as a result of allergen-induced nasal mucosal inflammation. In the presence of rhinitis symptoms without infection or an allergic reaction in the nose, non-allergic rhinitis (NAR) is considered. Adults with these diseases have increased frequency of olfactory dysfunction. The aim of the present study is to assess olfactory function in children with AR and NAR. MethodsA total of 77 children (aged six to 18 years) with AR and NAR were included in the study. The control group consisted of 45 healthy children. Sniffin' Sticks test was applied to both groups. The association between odor scores and demographic, clinical, and laboratory results was investigated. ResultsForty two patients had allergic rhinitis. No significant difference was observed between patients with rhinitis and healthy controls with respect to odor scores. No association was observed between odor scores and the severity of rhinitis and the laboratory results of the patient groups. Odor identification and total odor scores of the patients with rhinitis lasting for longer than three years were significantly lower than those in the patient group with rhinitis lasting for one to three years. In the AR and control groups, the odor scores were found to increase with age. ConclusionsWhen compared with healthy children, children with allergic rhinitis and non-allergic rhinitis were not found to have reduced olfactory function. The duration of rhinitis may be associated with the olfactory dysfunction in children with rhinitis.

Need for medication and stuffy nose predict the severity of allergic rhinitis.

Need for medication and stuffy nose predict the severity of allergic rhinitis.

Clinical and allergic sensitization characteristics of allergic rhinitis among the elderly population in Istanbul, Turkey.

Prevalence of allergic rhinitis (AR) in elderly population in Turkey is not known. Studies on the prevalence and features of allergy in older adults are needed to identify safe and effective diagnostic/therapeutic methods for elderly AR patients. We aimed to identify the clinical and allergic characteristics of sensitization to aeroallergens among individuals aged ≥60years with allergic rhinitis admitted to an allergy outpatient clinic in Istanbul. Of 109 patients, 33.9% were atopic. Sixty-five percent of subjects were sensitized to Dermatophagoides pteronyssinus, 17% to a grass-pollen mixture, 8% to Aspergillus fumigatus, and 8% to Blattella germanica. There was no difference between mono- and polysensitized patients in terms of the duration of rhinitis and symptom severity. No significant difference was observed between the two groups according to age, sex, smoking status, AR onset (<40 or ≥40years), or duration/severity of disease. There was no significant difference between the two groups in the prevalence of asthma and conjunctivitis, (p=0.256). Atopic dermatitis/eczema was more prevalent in those with AR (p=0.046). Clinical characteristics of AR in the elderly could be different from those in non-allergic patients, and the prevalence of allergy may be higher than expected.

Intranasal budesonide in children affected by persistent allergic rhinitis and its effect on nasal patency and Nasal Obstruction Symptom Evaluation (NOSE) score

Background:Intranasal steroids are recognized as an effective treatment for allergic rhinitis (AR) although their effect on nasal patency has never been evaluated with an objective instrument such as anterior rhinomanometry in children. Moreover this effect has been widely assessed with total Nasal Symptom Scores (NSS) including all symptoms of allergic rhinitis and not with scores specifically focused on nasal obstruction such as the Nasal Obstruction Symptom Evaluation score (NOSE).Materials and methods:Sixty children (42 males and 18 female) aged 6–10 years, affected by persistent AR, were randomized and divided in two groups of 30 children to be included in an unblinded trial: one group treated with intranasal budesonide and isotonic nasal saline for 2 weeks and the other group treated only with isotonic nasal saline for 2 weeks. Each child underwent rhinomanometry and completed the NSS and the NOSE scores before and after treatment.Results:At the baseline nasal patency and NSS total score, NOSE total scores were correlated (r = −0.29, p < 0.001; r = −60, p < 0.001). After 2 weeks of treatment improvements in nasal patency, NSS and NOSE were seen (Δ NSS 4.13 ± 1.38 vs 1.33 ± 1.93, p < 0.001; Δ NOSE 34 ± 17.97 vs 9 ± 18.21, p < 0.001; Δ nasal patency −26.13 ± 25.25 vs −11.83 ± 11.31, p < 0.001). Correlations were found between rhinitis duration and Δ nasal patency and Δ NOSE (r = −0.84, p < 0.001; r = 0.43, p < 0.01).Conclusion:Intranasal budesonide is effective in increasing nasal patency in children. Moreover the NOSE score was strongly correlated with nasal flow and, hence, this score should be regarded as a valid and reliable instrument in children.

Airway wall thickness of allergic asthma caused by weed pollen or house dust mite assessed by computed tomography

Little was known about Airway wall thickness of asthma patients with different allergen allergy. So we explored the possible difference of Airway wall thickness of asthma patients mono-sensitized to weed pollen or HDM using high-resolution computed tomography. 85 severe asthma patients were divided into weed pollen group and HDM group according to relevant allergen. 20 healthy donors served as controls. Airway wall area, percentage wall area and luminal area at the trunk of the apical bronchus of the right upper lobe were quantified using HRCT and compared. The values of pulmonary function were assessed as well. There were differences between HDM group and weed pollen group in WA/BSA,WA% and FEF25-75% pred, and no significant difference in FEV1%pred, FEV1/FVC and LA/BSA. In weed pollen group, WA/BSA was observed to correlate with the duration of rhinitis, whereas in HDM group, WA/BSA and LA/BSA was observed to correlate with the duration of asthma. In weed pollen group, FEV1/FVC showed a weak but significant negative correlation with WA%, but in HDM group FEV1/FVC showed a significant positive correlation with WA% and a statistical negative correlation with LA/BSA. FEV1/FVC and FEF25-75% pred were higher and WA/BSA and LA/BSA were lower in healthy control group than asthma group. FEV1%pred and WA% was no significant difference between asthma patients and healthy subjects. There are differences between HDM mono-sensitized subjects and weed pollen mono-sensitized subjects, not only in airway wall thickness, but also small airway obstruction.

Allergic rhinitis phenotypes based on bronchial hyperreactivity to methacholine.

Allergic rhinitis (AR) and asthma may be associated, bronchial hyperreactivity (BHR) is quite common in AR patients. Methacholine (MCH) is a stimulus able to elicit BHR, as many other ones. Phenotyping AR is an up-to-date issue. The aim of this study was to evaluate whether MCH bronchial challenge is able to differentiate patients with AR. A total of 298 patients (277 males, mean age 28.9 years), suffering from AR were evaluated. Sensitization, rhinitis duration, values for bronchial function (forced vital capacity [FVC], forced expiratory volume [FEV]1, forced expiratory flow [FEF]25-75, and FEV1/FVC ratio), MCH bronchial challenge, visual analog scale (VAS) for nasal and bronchial symptoms perception, and fractioned exhaled nitric oxide (FeNO) were evaluated. BHR-positive patients (22.8%) had significantly more frequent mite allergy (p = 0.025), longer AR duration (p < 0.001), lower FEV1 (p = 0.003), FEV1/FVC (p < 0.001), FEF25-75 (p < 0.001), higher (p < 0.001), and higher VAS values for both nasal and bronchial symptoms (p < 0.001 for both) in comparison with BHR-negative patients. FeNO can be considered a good predictor for BHR in AR patients (area under the curve, 0.90) with 27.0 ppb as cutoff. The present study demonstrates that BHR to MCH could define two distinct phenotypes in AR patients. It could be clinically relevant as BHR-positive patients have initial impairment of lung function, impaired FeNO values, and worsening of respiratory symptoms perception.

Sleep apnea risk in subjects with asthma with or without comorbid rhinitis.

As many as 80% of patients with asthma suffer from allergic rhinitis (AR), and rhinitis symptoms are associated with sleep complaints The aim of this cross-sectional study was to assess the prevalence of obstructive sleep apnea syndrome risk in patients with asthma and to explore the association between comorbid rhinitis and obstructive sleep apnea syndrome risk. Subjects with asthma were recruited by general practitioners during a control visit. Physicians compiled a questionnaire that assessed the presence of AR according to ARIA (Allergic Rhinitis and Its Impact on Asthma) guidelines and factors influencing the risk of obstructive sleep apnea syndrome (gastroesophageal reflux disease, obesity, smoking). Subjects completed a questionnaire evaluating the presence and severity of AR and the STOP-BANG questionnaire (snoring, tiredness during daytime, observed apnea, high blood pressure, body mass index, age, neck circumference, gender), a validated screening method to identify obstructive sleep apnea syndrome risk. Physicians were blinded to the subjects' questionnaires, ensuring objectivity of the method. The analyses were conducted on 1,941 subjects (males 58%, mean age 48.2 ± 15.2 y): 740 with asthma alone and 1,201 with asthma and AR. STOP-BANG revealed that 52.6% of the subjects were at increased risk of obstructive sleep apnea syndrome: 47.3% of subjects with asthma alone and 55.9% of patients with asthma and AR. Rhinitis was associated with a 1.44 times higher odds ratio for having obstructive sleep apnea syndrome risk. Rhinitis duration and severity were associated with obstructive sleep apnea syndrome risk, although the latter deserved greater importance. The results showed that, once a correction for each of these factors was performed, subjects with AR with an odds ratio of 1.99 were reported to be at risk of obstructive sleep apnea syndrome. The probable increased risk of obstructive sleep apnea syndrome is associated with the concomitant presence of rhinitis, independent of obesity and other contributors to risk of obstructive sleep apnea syndrome.

Allergic rhinitis in the elderly: A pilot study of the role of vitamin D

Background: Allergic rhinitis in the elderly is poorly understood as very few studies have investigated this patient group. Vitamin D insufficiency and deficiency are very common, and vitamin D appears to play a role in respiratory disease. We studied the role of vitamin D in elderly subjects with perennial allergic rhinitis. Methods: Fifteen subjects with symptomatic perennial allergic rhinitis (Total Nasal Symptom Score, TNSS ≥5 out of 12) received vitamin D (4,000 I.U./day) and placebo each for 6 weeks in a crossover design. TNSS (instantaneous and in the previous three weeks) and Rhinitis Related Quality of Life Questionnaire (RQLQ) were evaluated at five study visits (baseline, and 3, 6, 9, and 12 weeks later). Associations between serum vitamin D and demographics, TNSS, and RQLQ were also assessed. Results: Baseline serum vitamin D was 29.7±10.6 ng/ml. After the six-week vitamin D supplementation, its serum levels increased significantly (to 39.7±8.9 ng/ml, p<0.01), whereas serum calcium remained unchanged. Instantaneous TNSS, three-week TNSS, and RQLQ were unchanged compared to placebo. There was no association between serum vitamin D and age, body mass index, duration of rhinitis, or medication score. However, in subjects with poorly controlled nasal symptoms, there was a significant inverse association with serum vitamin D and the three-week TNSS (r=-0.81, p=0.008). Conclusions: Vitamin D supplementation for six weeks did not improve nasal symptoms or RQLQ in elderly subjects with perennial allergic rhinitis. These results and the inverse association between vitamin D and nasal symptoms will require confirmation in larger studies.

Análisis de la curva flujo-volumen en niños y adolescentes con rinitis alérgica sin asma

There is epidemiological, functional and pathologic evidence that relates upper and lower airways, clinically known as a single respiratory tract. Patients with allergic rhinitis without asthma may present subclinical abnormal spirometry parameters. To describe the results of the flow-volume curve in a group of patients with allergic rhinitis without asthma and analyze the possible associations between anthropometric, clinical and biochemical outcome measures with abnormal spirometry results. Observational, descriptive study including children and adolescents aged 6 to 18 years old with symptoms of allergic rhinitis without asthma. Age, gender, body mass index and duration of rhinitis were determined as per the subject's medical record. Allergen skin tests, flow-volume curve spirometry, determination of eosinophil count in blood and in nasal secretions, and total serum IgE were performed. A total of 84 patients were studied; 21 (25%; 95% CI: 15.1-34.8) presented at least one altered spirometry outcome measure. The FEV1/FVC ratio was the most affected outcome measure (10/84; 12%; 95% CI: 4.3-19.4). The multiple logistic regression analysis determined that spirometry alterations were associated with the number of blood eosinophils (OR: 1.00229; 95% CI: 1.00022-1.00436; p= 0.03) and the body mass index (OR: 1.31282; 95% CI: 1.08611-1.58685; p= 0.0049). Our results showed spirometry alterations in a considerable percentage of children and adolescents with allergic rhinitis without asthma. The blood eosinophil count and the body mass index could be associated with a sub-clinical alteration of pulmonary function.

Impact of Allergic Rhinitis Symptoms on Quality of Life in Primary Care

Background: Allergic rhinitis (AR) impairs quality of life (QoL), sleep and work. The Allergic Rhinitis and its Impact on Asthma (ARIA) classification is widely used, but the impact of the different symptoms on QoL is not clear. Objective: To describe characteristics of patients consulting in primary care for AR and to study the impact of AR symptoms and the ARIA classes on QoL. Methods: A multicenter prospective observational cross-sectional study assessed the visual analogue scale (VAS) in the management of AR in 990 patients consulting general practitioners for AR. Patients were classified according to the four classes of ARIA. VAS, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and total symptom score (TSS) for nasal and non-nasal symptoms were evaluated. VAS and TSS measures were compared with RQLQ. Results: Mild intermittent rhinitis was diagnosed in 20% of patients, mild persistent rhinitis in 17%, moderate/severe intermittent rhinitis in 15% and moderate/severe persistent rhinitis in 48%. The presence of treatments did not affect VAS levels. Both severity and duration of rhinitis had an impact on QoL and VAS levels. Ocular symptoms (OR: 2.78, 95% CI: 1.965–3.939) including eyelid edema (OR: 2.07, 95% CI: 1.274–3.360) and asthenia (OR: 2.73, 95% CI: 1.922–3.877) had more impact on RQLQ than nasal obstruction (OR: 1.61, 95% CI: 1.078–2.405) and nasal pruritus (OR 1.45, 95% CI: 1.028–2.042). Sneezing and rhinorrhea did not impact RQLQ. Conclusions: This study confirmed that ocular symptoms and, to a lesser degree, nasal obstruction and pruritus have a significant impact on QoL.

Asthma and rhinitis

Asthma and rhinitis are commonly associated and they influence their respective control. New observations have contributed to better understand how to assess those conditions and how they influence each other. Recent studies found that not only the intensity, but also the duration of rhinitis could be correlated with the development of asthma and possibly its remission. The measure of exhaled nitric oxide (FeNO) has been used to show the presence of lower airway inflammation in rhinitic patients, with or without asthma. Furthermore, it has been shown that allergic rhinitis could affect asthma control in children as in adults, and consequently suggested that allergic rhinitis and asthma should be concomitantly approached in regard to their diagnosis and treatment. Additional observations showed improvements in various asthma outcomes with the treatment of rhinitis. These new data confirm the strong link between asthma and rhinitis, the importance of their interactions, and the need to identify and treat rhinitis adequately in asthmatic patients.

Correlation of serum eosinophil cationic protein with the severity of allergic rhinitis in childhood

To investigate the relationships between the severity of childhood allergic rhinitis (AR) and the peripheral blood eosinophil count, serum eosinophil cationic protein (ECP), total IgE (tIgE), and allergen-specific IgE (sIgE) levels. A total of 138 children with AR aged 3 to 17 (9.96 ± 3.78, x() ± s) years old were enrolled in the study. All children had persistent AR sensitized to house dust mites with a clinical history of 3 months to 12 (4.21 ± 2.72) years. The disease severity was evaluated using 10 cm-visual analogue scale (VAS), and the serum levels of ECP, tIgE and sIgE were determined using an ImmunoCAP system. Statistical analysis was conducted with SPSS11.0 software. Among 138 children with AR, the VAS scores for global severity of rhinitis and nasal obstruction symptom were 5.32 ± 2.16 and 4.78 ± 2.45, respectively. Blood eosinophil count was 0.39 [0.24; 0.63] (M[P(25); P(75)]) ×10(9)/ml. Serum levels of ECP and total IgE were 10.60 [3.26; 30.80] µg/L and (2.50 ± 0.53) log kU/L, respectively. Serum levels of allergen-sIgE against Dermatophagoides pteronyssinus and Dermatophagoides farinae were 58.20[24.75; > 100] kUA/L and 54.95 [24.55; > 100] kUA/L, respectively. The VAS scores of nasal obstruction symptom, but not global severity of rhinitis, were positively related to the duration of AR (r = 0.215, P = 0.011) and the levels of serum ECP (r = 0.196, P = 0.022) in bivariate correlation analysis. There was also a significant correlation between the serum ECP level and the blood eosinophil count (r = 0.295, P = 0.000). No relationships of blood eosinophil count, and serum tIgE and sIgE levels with global severity of rhinitis as well as nasal obstruction symptom were found (all P > 0.05). These results suggested that the severity of nasal obstruction was positively correlated with the duration of rhinitis and the levels of serum ECP in childhood persistent AR due to house dust mites, indicating the disease severity might be related to chronic inflammatory process.

Spirometric Abnormalities in Patients with Allergic Rhinitis: Indicator of an “Asthma March”?

Allergic rhinitis (AR) may precede and promote the onset of asthma. However, few studies addressed this issue mainly concerning bronchial physiological parameters. The aim of this study was to assess forced expiratory flow at 25-75% (FEF(25-75)), forced expiratory volume at 1 second (FEV(1)), and response to bronchodilation test in a large group of AR patients. Sixteen hundred five adult AR patients were evaluated. Clinical examination, assessment of nasal obstruction perception by visual analog scale, spirometry, and bronchodilation test were performed in all patients. There were 8.4% of patients with abnormal FEV(1) values, 24.7% had impaired FEF(25-75), and 66.1% had reversibility with bronchodilation. A trend of spirometric impairment seems to exist in these patients. Age, gender, and duration of rhinitis may be risk factors for these findings. Different grades of bronchial impairment seem to exist. This study highlights the close link between upper and lower airways and suggests the possible existence of a progression from AR toward asthma, such as an "asthma march." Therefore, asthma should be suspected and carefully investigated in AR patients.