Physician-diagnosed Allergic Rhinitis Research Articles

Association Between Air Pollution and Prevalence of Allergic Rhinitis in Ulsan, Korea

PP-29-037 Background/Aims: The effect of air pollution on allergic rhinitis is still not clearly understood. This study aims to investigate relationship between air pollution exposure and the prevalence of allergic rhinitis in young people in the industrial metropolitan area. Methods: Data on physician-diagnosed allergic rhinitis (past 12 month) were collected in a cross-sectional questionnaire survey of 3722 infants and children (age, 1–18 years) in the Ulsan metropolitan area. All the residences of participants were georeferenced using a geographical information system to investigate the spatial relationship between air pollution and allergic rhinitis. To evaluate the risk of air pollution, annual pollution data obtained from 13 monitoring stations were linked with the prevalence data (n = 1450) within a 1.5- or 2-km radius of the stations. Results: Comparisons of spatial distributions of prevalence rates for allergic rhinitis and annual average pollutant concentrations over the region showed that the relatively high prevalence rate occurred around the coastal industrial area with high particulate matter (PM10) concentrations. A linear correlation analysis demonstrated the positive correlation relationship between PM10 levels and prevalence rates of allergic rhinitis (R = 0.680, P = 0.04). From the multiple logistic regression analysis after mutual adjustment by age, sex, and air-pollutant factors, PM10 and SO2 mainly from industrial-related emissions were found to be statistically significantly associated with physician-diagnosed allergic rhinitis (aOR: 1.06, 95% CI: 1.02–1.11 for PM10; aOR: 1.62, 95% CI: 1.12–2.34 for SO2). Conclusion: Exposure to high levels of industrial-related air pollutants can be an important environmental risk factor for allergic rhinitis in young people.

울산지역 대기오염과 알레르기 비염 유병률과의 관계

This study aims to investigate the relationship between air pollution exposure and the prevalence of allergic rhinitis in a young population in the Ulsan metropolitan region (UMR). Data on physician-diagnosed allergic rhinitis (past 12 months) in 1,449 infants and children aged 1-18 years who lived within 1.5 or 2 km of air quality monitoring sites were collected in a cross-sectional health interview survey conducted between January-February 2006 in the UMR. Comparisons of the spatial distribution of the prevalence rates for allergic rhinitis and annual average pollutant concentrations over the region showed that a relatively high prevalence rate occurred around the coastal industrial area, with high PM10 concentrations. A linear correlation analysis demonstrated a positive correlation relationship between them (R = 0.680, p = 0.04). Multiple linear regression analysis revealed that the combined effect of the PM10 and <TEX>$SO_2$</TEX> variables accounts for approximately 81% of the variance (R-square: 0.81) in the prevalence rate. From the multiple logistic regression analysis after adjustment by age, sex, and air-pollutant factors, the PM10 and <TEX>$SO_2$</TEX> which were mainly from industrialrelated emissions were found to be significantly associated with an increased risk of allergic rhinitis (aOR: 1.76, 95% CI: 1.15-2.70 for PM10 ; aOR: 1.63, 95% CI: 1.12-2.35 for SO2).

Respiratory health in children, and indoor exposure to (1,3)-β-d-glucan, EPS mould components and endotoxin

For a long time, exposure to mould and dampness-derived microbial components was considered a risk factor for the development of respiratory diseases and symptoms. Some recent studies suggested that early childhood exposure to mould components, such as (1,3)-β-D-glucan and extracellular polysaccharides (EPSs), may protect children from developing allergy. We investigated the association of exposure to (1,3)-β-D-glucan, EPS and endotoxin with asthma and allergies in 6-yr-old children. This investigation was the follow-up to a nested case-control study among three European birth cohorts. Children from two ongoing birth cohort studies performed in Germany (n = 358) and one in the Netherlands (n = 338) were selected. Levels of (1,3)-β-D-glucan, EPS and endotoxin were measured in settled house dust sampled from children's mattresses and living-room floors when the children were, on average, 5 yrs of age. At the age of 6 yrs, health outcome information was available for 678 children. In the two German subsets, domestic EPS and endotoxin exposure from children's mattresses were significantly negatively associated with physician-diagnosed asthma (OR per interquartile range increase 0.60 (95% CI 0.39-0.92) and 0.55 (95% CI 0.31-0.97), respectively). In addition, EPS exposure was inversely related to physician-diagnosed allergic rhinitis (OR 0.50, 95% CI 0.31-0.81). For the Dutch population, no associations were observed between exposure to microbial agents and respiratory health outcomes. We found inverse associations between domestic exposure to EPS and endotoxin from children's mattresses, and doctor-diagnosed asthma and rhinitis in German, but not in Dutch, school children. The reasons for the differences between countries are not clear.

Home Dampness and Molds as Determinants of Allergic Rhinitis in Childhood: A 6-Year, Population-based Cohort Study

The authors assessed the relation between exposure to dampness and molds in dwellings and the development of allergic rhinitis in childhood in a 6-year, population-based prospective cohort study of 1,863 children aged 1-7 years at baseline in 1991 (follow-up rate, 77%) from Espoo, Finland. The studied exposures were history of water damage, presence of moisture and visible mold, and perceived mold odor in the home, based on parent-administered questionnaire. A total of 246 (13.2%) children developed physician-diagnosed allergic rhinitis during the study period, resulting in an incidence rate of 440 cases per 10,000 person-years (95% confidence interval (CI): 387, 499). In logistic regression adjusting for confounding, any mold or dampness exposure indicator at baseline (adjusted odds ratio = 1.55, 95% CI: 1.10, 2.18), at follow-up (adjusted odds ratio = 1.62, 95% CI: 1.21, 2.18), or both (adjusted odds ratio = 1.96, 95% CI: 1.29, 2.98) was an important independent determinant of the risk of allergic rhinitis. Of the individual indicators, water damage and moisture on the surfaces were consistent determinants of allergic rhinitis. The results of this cohort study, which assessed exposure before the onset of allergic rhinitis, strengthen considerably the evidence of the role of indoor dampness problems as determinants of allergic rhinitis in children.

Occupational exposures as risk factors for asthma and allergic diseases in a Turkish population

There has been no community-based epidemiological study on the relation of occupational exposures with asthma, rhinitis, and eczema in Turkey. We examined the relationship between occupational exposures and adult-onset asthma, wheezing, allergic rhinitis, and eczema in a Turkish adult population. The data was collected from 1,047 adults, selected randomly from five distant family health centers. Questionnaires were filled by family practitioners with the help of interviews. The data included physician-diagnosed asthma, allergic rhinitis, eczema, wheezing, and occupational exposures. Wheezing in all the subjects was associated with past exposure to irritants (OR: 1.7, 95%CI: 1.0-2.9), wood/coal smoke (OR: 2.3, 95%CI: 1.0-5.3), metal dust (OR: 2.6, 95%CI: 1.2-5.7), volatile fumes (OR: 2.5, 95%CI: 1.1-5.3), and paper dust (OR: 3.7, 95%CI: 1.5-8.9). Past exposure to dust (OR: 4.1, 95%CI: 1.2-14.2) and to irritants (OR: 6.5, 95%CI: 2.0-20.4) were associated with increased prevalence of wheezing in nonsmokers, whereas current exposure to irritants was associated with decreased prevalence of wheezing (OR: 0.1, 95%CI: 0.01-0.9) in these subjects. In subjects who were regular smokers, exposure to metal dust (OR: 2.8, 95%CI: 1.2-6.5), volatile fumes (OR: 2.3, 95%CI: 1.0-5.3), and paper dust (OR: 3.3, 95%CI: 1.3-8.6) were the main causes for wheezing. Physician-diagnosed eczema was associated with occupational exposure to chemical fumes (OR: 3.7, 95%CI: 1.3-10.6). The present study showed that occupational exposures were associated with wheezing and eczema prevalence in the studied population. Nonsmokers could be more vulnerable to respiratory effects of occupational exposures due to healthy smokers effect.

Is physician‐diagnosed allergic rhinitis a risk factor for the development of asthma?

There is strong evidence that there is a relationship between allergic rhinitis (AR) and asthma, but it is unclear whether there is a causal relation between AR and asthma. The aim of this study was to assess prospectively whether AR is a risk factor for the diagnosis of asthma in a large primary care population. We performed a historic cohort study of life-time morbidity that had been recorded prospectively since 1967 in four general practices. Two groups of subjects were selected: (i) patients with diagnosis of AR, (ii) a control group matched using propensity scores. We assessed the risk of physician-diagnosed asthma in patients with physician-diagnosed AR compared to subjects without a diagnosis of AR (controls). The study population consisted of 6491 subjects (n = 2081 patients with AR). Average study follow-up was 8.4 years. In patients with AR, the frequency of newly diagnosed asthma was 7.6% (n = 158) compared to 1.6% (n = 70) in controls (P < 0.001). After adjusting the effect of AR on asthma diagnosis for registration time, age, gender, eczema and socioeconomic status, having AR was a statistically significant risk factor for asthma (hazard ratio: 4.86, P < 0.001, 95% confidence interval: 3.50-6.73, controls as reference). A diagnosis of AR was an independent risk factor for asthma in our primary care study population. Having physician-diagnosed AR increased the risk almost fivefold for a future asthma diagnosis.

Risk factors for allergic rhinitis in Costa Rican children with asthma

Risk factors for allergic rhinitis (AR) in asthmatics are likely distinct from those for AR or asthma alone. We sought to identify clinical and environmental risk factors for AR in children with asthma. We performed a cross-sectional study of 616 Costa Rican children aged 6-14 years with asthma. Candidate risk factors were drawn from questionnaire data, spirometry, methacholine challenge testing, skin testing, and serology. Two outcome measures, skin test reaction (STR)-positive AR and physician-diagnosed AR, were examined by logistic regression. STR-positive AR had high prevalence (80%) in Costa Rican children with asthma, and its independent risk factors were nasal symptoms after exposure to dust or mold, parental history of AR, older age at asthma onset, oral steroid use in the past year, eosinophilia, and positive IgEs to dust mite and cockroach. Physician-diagnosed AR had lower prevalence (27%), and its independent risk factors were nasal symptoms after pollen exposure, STR to tree pollens, a parental history of AR, inhaled steroid and short-acting beta2 agonist use in the past year, household mold/mildew, and fewer older siblings. A physician's diagnosis was only 29.5% sensitive for STR-positive AR. Risk factors for AR in children with asthma depend on the definition of AR. Indoor allergens drive risk for STR-positive AR. Outdoor allergens and home environmental conditions are risk factors for physician-diagnosed AR. We propose that children with asthma in Costa Rica and other Latin American nations undergo limited skin testing or specific IgE measurements to reduce the current under-diagnosis of AR.

Prevalence of allergic rhinitis among the adult population in Turkey

Conclusion: The prevalence of self-reported and physician-diagnosed allergic rhinitis (AR) exhibits significant variability across the seven geographical regions in Turkey. Our findings may contribute to the formulation of public health policy and development of preventive and therapeutic strategies for AR in Turkey. Objective: The purpose of this study was to assess the prevalence of AR in the Turkish adult population, with emphasis on descriptive parameters in seven distinct geographical regions in Turkey. Methods: The volunteers were evaluated with a custom-designed questionnaire for AR. Sample size for the study was calculated by allowing for 2% error in prevalence along with a 95% confidence interval (CI). At the end of the study, we reached 4125 volunteers. The data were analyzed with χ2, ANOVA, and Tukey (post hoc) tests. Results: A total of 4125 volunteers participated in the study; 2200 were female and 1925 were male. On the basis of self-reporting, 23.1% of the study population was considered to have AR (males 22.3%, females 23.8%). On the other hand, the prevalence of physician-diagnosed AR was 20.1% (males 19.7%, females 20.4%). The prevalence of self-reported AR was 23.8% in the urban and 18.4% in the rural areas.

Rhinitis as predictor of adult-onset asthma

Sneezing and wheezing are common bedfellows. 1 Bousquet J Khaltaev N Cruz AA et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008; 63: 8-160 Crossref PubMed Scopus (3561) Google Scholar Because a large proportion of people with asthma have symptoms of rhinitis either attributable to allergic sensitisation or to viral infections, it is hard to know whether sneezing leads to wheezing or whether wheezing and sneezing are part of the same process. However, several studies indicate that rhinitis can precede new onset of asthma. 2 Guerra S Sherrill DL Martinez FD Barbee RA Rhinitis as an independent risk factor for adult-onset asthma. J Allergy Clin Immunol. 2002; 109: 419-425 Summary Full Text Full Text PDF PubMed Scopus (487) Google Scholar , 3 Wright AL Holberg CJ Martinez FD Halonen M Morgan W Taussig LM Epidemiology of physician-diagnosed allergic rhinitis in childhood. Pediatrics. 1994; 94: 895-901 PubMed Google Scholar , 4 Leynaert B Bousquet J Neukirch C Liard R Neukirch F Perennial rhinitis: an independent risk factor for asthma in nonatopic subjects: results from the European Community Respiratory Health Survey. J Allergy Clin Immunol. 1999; 104: 301-304 Summary Full Text Full Text PDF PubMed Scopus (412) Google Scholar Rafea Shaaban and colleagues, 5 Shaaban R Zureik M Soussan D et al. Rhinitis and onset of asthma: a longitudinal population-based study. Lancet. 2008; 372: 1049-1057 Summary Full Text Full Text PDF PubMed Scopus (438) Google Scholar in today's Lancet, reinforce this idea by showing that rhinitis, even in the absence of atopy, was a strong predictor of adult-onset asthma in the European Community Respiratory Health Survey, which included more than 6000 patients in 14 countries. The strongest risk occurred in patients with allergic rhinitis who were sensitised to several inhalant allergens, particularly house-dust mites. Erika von Mutius: reshaping the landscape of asthma researchWhen Erika von Mutius tried to outsmart the funding authorities, she had no idea that when her plan back-fired it would lead to “the big-break” in her medical career. “I had just spent 2 years running a study into the effect of air pollution on croup in children, but I'd had no experience of how to run a project and felt it had just all been a mess, so when my boss asked me to run another project I was desperate to avoid it. I therefore applied for an outrageously high sum of money so the authorities would reject me. Full-Text PDF Rhinitis and onset of asthma: a longitudinal population-based studyRhinitis, even in the absence of atopy, is a powerful predictor of adult-onset asthma. Full-Text PDF

Birth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopy

Cesarean delivery can alter neonatal immune responses and increase the risk of atopy. Studies of the relation between cesarean delivery and allergic diseases in children not selected on the basis of a family history of atopy have yielded inconsistent findings. We sought to examine the relation between birth by cesarean delivery and atopy and allergic diseases in children at risk for atopy. We examined the relation between mode of delivery and the development of atopy and allergic diseases among 432 children with a parental history of atopy followed from birth to age 9 years. Asthma was defined as physician-diagnosed asthma and wheeze in the previous year, and allergic rhinitis was defined as physician-diagnosed allergic rhinitis and naso-ocular symptoms apart from colds in the previous year. Atopy was considered present at school age if there was 1 or more positive skin test response or specific IgE to common allergens. Stepwise logistic regression was used to study the relation between cesarean delivery and the outcomes of interest. After adjustment for other covariates, children born by cesarean section had 2-fold higher odds of atopy than those born by vaginal delivery (odds ratio, 2.1; 95% CI, 1.1-3.9). In multivariate analyses birth by cesarean section was significantly associated with increased odds of allergic rhinitis (odds ratio, 1.8; 95% CI, 1.0-3.1) but not with asthma. Our findings suggest that cesarean delivery is associated with allergic rhinitis and atopy among children with a parental history of asthma or allergies. This could be explained by lack of contact with the maternal vaginal/fecal flora or reduced/absent labor during cesarean delivery.

Findings from a 1000-patient internet-based survey assessing the impact of morning symptoms on individuals with allergic rhinitis

Background: Although the severity of allergic rhinitis symptoms might depend on the degree of exposure to the triggering allergen, it has also been noted that symptom severity varies over the course of the day. Objectives: The aims of this study were to investigate the reported impact (influence on behavior and/or feelings) of morning symptoms on individuals with allergic rhinitis and determine their perception of the effectiveness of allergy treatment. Methods: In January 2005, online interviews basedon a 16-item questionnaire were presented to adults (aged ≥18 years) with physician-diagnosed allergic rhinitis in the United States. Participants were recruited from the Roper Public Affairs and Media US national online panel. The survey sample was balanced to reflect the US population by Census Division, ethnicity, sex, and presence of children living at home. Data were weighted by sex (65% female, 35% male) based on previous research of the adult population suffering from allergies. Results: The first 1000 respondents (sex, female,550 [55%]; age, ≥55 years, 378 [38%], race, white, 883 [88%]) that met all inclusion/exclusion criteria were included in the study results. There was no significant difference in the regional distribution of participants: South (34%), Midwest (25%), West (22%), and Northeast (19%). The majority of the sample (83%) reported experiencing morning symptoms of allergic rhinitis; 49% reported that their symptoms were most severe during the morning hours. The most common symptom on awakening was nasal congestion, reported by 85% of those with symptoms when they first woke tip. Of those with symptoms on awakening, the majority reported that these affected their feelings (96`/0) or behavior (87%). Among respondents who experienced symptoms on awakening, the majority reported that their symptoms affected the rest of their day “somewhat” or ”a great deal” (51% and 24%, respectively). Of those respondents using allergy medication, 33% reported that its effectiveness wore off before the next dose most or all of the time. A majority of respondents reported feeling that it was very important for an allergy medication to maintain effectiveness until the next dose (68%), provide relief all day and into the next morning (62%), and enable them to wake tip with their symptoms render control (63%). Conclusions: Based on the results from this largeInternet-based survey, the morning symptoms of allergic rhinitis have a negative impact on individuals, both emotionally and in terms of disruption of daily activities. Medication used for treating allergic rhinitis was reported as not always effective for the whole time interval between doses. This suggests that it might be important, when considering management options in allergic rhinitis, to select medications that offer sustained effectiveness throughout the 24-hour period.

Impact of Nasal Condition on Self-assessed Disease Control and Treatment Satisfaction in Patients with Asthma Complicated by Allergic Rhinitis

Bodies of evidences have suggested that upper and lower airways are intricately interconnected with each other in patients with allergic airways diseases, however, few data are available concerning the impact of allergic rhinitis on self-assessed asthma condition and treatment satisfaction. The present study was conducted to clarify the association between nasal condition and self-assessment of asthma control and treatment satisfaction. Adult patients with asthma were consecutively recruited for a systematic self-administered questionnaire to obtain information on nasal condition, self-perceived condition of asthma, and asthma treatment satisfaction. 3,140 adult patients with asthma completed the questionnaire, and of these 634 patients (mean age:53.1, 389 female) had physician-diagnosed allergic rhinitis. There were significant correlations between nasal symptoms (sneeze, rhinorrhea, nasal obstruction) and self-perceived asthma condition (limited daily activity, wheeze, dyspnea/chest tightness, cough, sputum, sleep disturbance, overall asthma condition). Patients who considered their overall nasal condition as unfavorable or bad were more likely than those who considered their condition as good or favorable to be dissatisfied with asthma treatment (p<0.01). Nasal condition is closely associated with self-assessed asthma condition and asthma treatment satisfaction. Controlling allergic rhinitis is critical to attain optimal management of asthma in patients complicated by allergic rhinitis.

Symptoms of Allergic Rhinitis in Women during Early Pregnancy Are Associated with Higher Prevalence of Allergic Rhinitis in Their Offspring

Epigenetic control of gene expression profiles is a ubiquitous mechanism during cell differentiation, organogenesis and chronic inflammatory reactions. Recent studies have shown that allergen exposure during very early pregnancy increases bronchial hypersensitivity in offspring in a murine model of bronchial asthma. However, no such phenomena were reported in humans. In the present study, the role of epigenetic control in the onset of allergic diseases was investigated. A total of 400 pairs of mothers with physician-diagnosed allergic rhinitis (AR) and their offspring (age 7-18 months) who participated in a large-scale medical check-up were enrolled in this retrospective cohort study. Family history of allergic diseases and the presence or absence of AR symptoms during pregnancy were inquired about using a self-answered questionnaire. A logistic regression model adjusted for age, gender, birth month and father's history of allergic diseases was statistically analyzed. Offspring whose mothers had any AR symptoms during early pregnancy showed a significantly higher adjusted odds ratio for the onset of AR in offspring than those whose mothers had no symptoms during pregnancy (adjusted Odds Ratio: 6.26, p = 0.036). However, the symptoms of AR during late pregnancy showed no effects on the odds ratio. In contrast, the presence or absence of AR symptoms during early or late pregnancy showed no association with the prevalence of food allergy, atopic dermatitis or asthma in offspring. Our results suggest the presence of possible epigenetic mechanisms regulating the onset of AR in humans presumably through increased organ-specific hypersensitivity.

Prevalence and risk factors for allergic rhinitis in primary school children

Allergic rhinitis is a common chronic illness of childhood. The aim of the study was to evaluate the prevalence and risk factors of allergic rhinitis in 6-12-year-old schoolchildren in Istanbul. A total of 2500 children aged between 6 and 12 years in randomly selected six primary schools of Istanbul were surveyed by using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire between April and May 2004. Of them 2387 (1185 M/1202 F) questionnaires were appropriately completed by the parents with an overall response of 95.4%. The prevalence of physician-diagnosed allergic rhinitis was 7.9% (n=189). A family history of atopy (aOR=1.30, 95% CI=1.00-1.68), frequent respiratory tract infection (aOR=1.36, 95% CI=1.08-1.70) and sinusitis (aOR=2.29, 95% CI=1.64-3.19), antibiotic use in the first year of life (aOR=1.26, 95% CI=1.01-1.57), cat at home in the first year of life (aOR=2.21, 95% CI=1.36-3.61), dampness at home (aOR=1.31, 95% CI=1.04-1.65) and perianal redness (aOR=1.26, 95% CI=1.01-1.57) were significant for increased risk for allergic rhinitis. Frequent consumption of fruits and vegetables were inversely, and frequent consumption of lollipops and candies were positively associated with allergic rhinitis symptoms. Our study reconfirmed that family history of atopy, frequent respiratory tract infections, antibiotics given in the first year of life, cat at home in the first year of life, dampness at home, perianal redness and dietary habits are important independent risk factors for AR. Researchers worldwide should be focused to these factors and try to develop policies for early intervention, primary and secondary preventions for allergic diseases.

The determination of asthma, rhinitis, eczema, and atopy prevalence in 9- to 11-year-old children in the city of Izmir

The International Study of Asthma and Allergies in Childhood (ISAAC) phase II was designed to allow comparisons between populations in different countries and to investigate possible etiologic factors. This study was conducted to better delineate the prevalence and etiologic factors of asthma, rhinitis, and eczema in Izmir (Turkey) and to be included in the international comparisons by using a standard methodology of ISAAC phase II. The questionnaire was distributed to 2112 students in the 3rd, 4th, and 5th grades of 12 selected primary schools in urban and rural boroughs of Izmir. One thousand two hundred seventeen of these questionnaires were evaluated and physical examinations and skin-prick tests were performed on 1098 of these children. The prevalence values were 15.9% for recent wheezing and 4.8% for physician-diagnosed asthma. The prevalence of sneezing or runny or blocked nose in the past 12 months when the child did not have a cold or flu was 30%. The prevalence of physician-diagnosed allergic rhinitis was 17%. The prevalence of an itchy rash that was coming and going for at least 6 months was 7.2% and the prevalence of physician-diagnosed eczema was 4.9%. Atopic sensitization prevalence in the population was 8.8% with house-dust mite sensitization being the most frequent one. Secretion rales and sibilant wheezing rhoncus were detected in 2.7% of children by chest auscultation. In 1.1% of children flexural dermatitis was detected. Objective tests are necessary for epidemiologic studies of the aforementioned diseases.

Efficacy and safety of montelukast in adults with asthma and allergic rhinitis

Several clinical studies have confirmed the effectiveness of montelukast 10mg orally in adults with both asthma and allergic rhinitis. The objective of this phase IV study was to investigate the efficacy and safety of montelukast 10mg in adults with both asthma and allergic rhinitis in a real-life setting. Data from 5855 patients (mean age: 42.8+/-15.4 years) were collected and analyzed following treatment for 4-6 weeks. Efficacy was analyzed by comparing baseline values of: general, day- and night-time improvement in asthma symptoms, need for rescue medication or inhaled corticosteroids (ICSs), general and specific improvement in allergic rhinitis symptoms, reduction in rhinitis medication use, and general and specific quality of life (QoL) improvement with values collected at the end of the observation period of 4-6 weeks. Following treatment with 10mg montelukast 86.5% (n=4547) of patients reported a strong or marked improvement in day-time asthma symptoms and 88.5% (n=4367) reported improvement in night-time symptoms. A similarly high proportion of patients had a strong or marked improvement in all symptoms of allergic rhinitis (i.e. sneezing/itching (84%), rhinorrhea (81.7%), nasal congestion (79.3%), watery eyes (78.4%) and red or burning eyes (77.7%). The use of asthma and rhinitis medication was also reduced. 92.3% (n=5685) of all patients intended to continue montelukast therapy. Overall QoL was "very good" or "good" in 85.2% of patients (n=4991) and a "strong" or "marked" improvement in each of the four domains of sleep, work, everyday life and physical activity. Montelukast was well tolerated. Adverse drug reactions occurred in 14 out of 6158 patients. None of the adverse events was serious. Accordingly, montelukast 10mg is a safe and effective treatment for patients with both asthma and allergic rhinitis.

Respiratory symptoms, bronchial hyper‐responsiveness, and eosinophilic airway inflammation in patients with moderate‐to‐severe atopic dermatitis

Patients with atopic dermatitis (AD) often have symptoms suggestive of asthma or rhinitis. The prevalence and signs of respiratory disease in AD patients have been studied to a limited extent. To assess the prevalence and clustering of respiratory symptoms, bronchial hyper-responsiveness (BHR), and eosinophilic airway inflammation in patients with moderate-to-severe AD. Eighty-six consecutive patients with moderate-to-severe AD and 49 randomly selected control subjects without AD were studied by questionnaire, flow volume spirometry, histamine challenge to detect BHR, induced sputum test to detect eosinophilic airway inflammation, and skin prick tests (SPTs) and total serum immunoglobulin (Ig)E measurements to detect atopy. The patients with AD showed increased risk of physician-diagnosed asthma (36% vs. 2%, odds ratio (OR) 10.1, confidence interval (CI) 1.3-79.7, P=0.03), physician-diagnosed allergic rhinitis (AR) (45% vs. 6%, OR 4.5, CI 1.2-16.7, P=0.02), BHR (51% vs. 10%, OR 5.5, CI 1.5-20.1, P=0.01), and sputum eosinophilia (81% vs. 11%, OR 76.1, CI 9.3-623.5, P<0.0001) compared with the control subjects. In AD patients, elevated s-IgE and positive SPTs were associated with the occurrence of physician-diagnosed asthma and AR, BHR, and the presence of sputum eosinophilia. BHR and eosinophilic airway inflammation are more common in patients with AD than in control subjects. The highest prevalences were seen in patients with AD who were SPT positive and had high IgE levels. Longitudinal studies are needed to assess the outcome of patients with signs of airway disease, in order to identify those who need early initiation of asthma treatment.

Allergic Rhinitis and Pharmacological Management in Elite Athletes

Only a few studies have examined the occurrence of atopy and clinically apparent allergic disease and their pharmacological management in elite athletes. The aim of the study was to assess the frequency of allergic rhinitis and the use of antiallergic medication within the subgroups of elite athletes as compared with a representative sample of young adults of the same age. A cross-sectional survey was carried out in 2002. All the athletes (N = 494) financially supported by the National Olympic Committee comprised the study group. Of them, 446 (90.3%) filled in a structured questionnaire concerning asthma and allergies, the use of medication, characteristics of sport activities, and smoking habits. A representative sample of Finnish young adults (N = 1504) served as controls. The endurance athletes reported physician-diagnosed allergic rhinitis more often (36.1%) than other athletes (23.4%) or control subjects (20.2%). The use of antiallergic medication was reported by 33.3, 15.7, and 15.6% of those, respectively. Among both athletes and controls, females reported the use of antiallergic medication more often than males. Only half of those athletes reporting allergic rhinitis had used antiallergic medication during the past year. After adjusting for age and sex, OR (95% CI) for allergic rhinitis and the use of antiallergic medication were 2.24 (1.48-3.39) and 2.79 (1.82-4.28), respectively, in endurance athletes as compared with the controls. Endurance athletes have physician-diagnosed allergic rhinitis, and they use antiallergic medication more often than athletes in other events or control subjects. Only half of those athletes reporting allergic rhinitis take antiallergic medication. More attention needs to be paid to the optimal management of allergic rhinitis, especially in highly trained endurance athletes.

Effect of a concomitant diagnosis of allergic rhinitis on asthma‐related health care use by adults

Asthma and allergic rhinitis (AR) frequently coexist, but have usually been studied separately in health economic analyses. To determine the incremental effect of documented AR on health care resource use in adults with asthma. A retrospective cohort study using data from a UK general practice database for the period 1998-2001 enrolled subjects 16-55 years of age, with one or more asthma-related general practitioner (GP) visits during a 12-month follow-up period. The study outcomes were asthma-related hospitalizations, GP visits, and prescription drug costs during the 12-month follow-up period for patients with and without physician-diagnosed AR. Concomitant AR was documented in 4,611 (16.9%) of the total sample of 27,303 adults with asthma. Compared with those with asthma alone, patients with concomitant AR experienced more GP visits (5.2 vs. 4.2; P<0.0001) and more of them were hospitalized for asthma (0.76% vs. 0.45%; P<0.01) during the 12-month follow-up period. In multi-variable regression analyses, AR was predictive of hospitalization for asthma (odds ratio 1.52, 95% confidence interval (CI) 1.03-2.24) and was associated with an increase in the annual number of asthma-related GP visits (mean increase per patient 0.42, 95% CI 0.42-0.43) and annual asthma-related drug costs (mean increase GBP 5.1, 95% CI 5.0-5.3). Adults with asthma and documented concomitant AR experienced more asthma-related hospitalizations and GP visits, and incurred higher asthma drug costs than did adults with asthma alone. A unified treatment strategy for asthma and AR might reduce the costs of treating these conditions.

Mothers of very low birth weight infants have less atopy than mothers of full‐term infants

Studies on the pregnancy outcome of asthmatic mothers have suggested an increased rate of preterm deliveries. In contrast, our earlier study suggests that mothers of very low birth weight (VLBW) (<1500 g) infants less frequently had atopy than did mothers of full-term infants. We inquired about symptoms of atopy and doctor-diagnosed atopy in parents of 370 infants of VLBW (<1500 g) and 544 parents of full-term infants. Odds ratios for atopic symptoms and diagnosed atopy were calculated, and groups were compared with a trend test. Mothers of preterm infants of birth weight (BW) <1000 g significantly less often had physician-diagnosed allergic rhinitis (AR) (P=0.02). Among all the mothers, a trend test showed that maternal AR was significantly (P=0.03) higher in parallel with a higher infant BW. Fathers of infants with different BWs showed no differences in prevalence of atopic symptoms. We thus infer that maternal balance between T-helper type 1 (Th1) and Th2 cells, shifted towards Th2 in those with AR, may have a favourable effect on maintenance of pregnancy before gestational week 30.