Risk Of Rhinitis Research Articles

La dermatite atopique

Atopic dermatitis (AD), or atopic eczema, is a pruriginous inflammatory dermatosis with a genetic predisposition evolving in recurrent flare-ups on a background of chronicity, affecting essentially infants and small children. The clinical phenotype of AD results from interactions between genes and susceptibility, a defect in the cutaneous barrier function (abnormalities in filaggrin and the proteins of the epidermic differentiation complex) and dysfunction of the innate and/or adaptive immune response. With its multifactorial origin, it is dependent on the TH2 lymphocyte system, with a tendency to produce immunoglobulin E (IgE) and the risk of asthma, rhinitis, or allergic conjunctivitis define an atopic susceptibility. Staphylococcus aureus colonization plays a vital role in the perpetuation of the inflammatory phenomena. The disease often regresses in older children. Its prevalence is on the rise in industrialized countries. Diagnosis is clinical, facilitated by certain criteria initially proposed by Hanifin and Rajka and then simplified by Williams. The allergological investigation is reserved for cases that are stubborn, severe, or associated with respiratory symptoms. AD is a dermatosis that evolves in erratic and often unpredictable flare-ups. AD flare-up treatment is based on local corticosteroid therapy. Maintenance therapy attempts to correct the cutaneous dryness with hydrating products whose efficacy has now been proven. Optimal management includes the family's and/or the child's comprehension of the treatment, explaining to them that the goal to reach is not only to relieve the child, but also to attempt to modify the course of the disease. AD is thus a star disease and a public health problem. The major progress made in the comprehension of the physiopathological mechanisms of AD promise targeted therapies from new biotechnologies.

Low-fat yoghurt intake in pregnancy associated with increased child asthma and allergic rhinitis risk: a prospective cohort study

Dairy products are important sources of micronutrients, fatty acids and probiotics which could modify the risk of child asthma and allergy development. To examine the association of dairy product intake during pregnancy with child asthma and allergic rhinitis at 18 months and 7 years in the Danish National Birth Cohort, data on milk and yoghurt consumption were collected in mid-pregnancy (25th week of gestation) using a validated FFQ (n 61 909). At 18 months, we evaluated asthma and wheeze using interview data. We assessed asthma and allergic rhinitis using a questionnaire at the age of 7 years and through registry linkages. Current asthma was defined as self-reported ever asthma diagnosis and wheeze in the past 12 months. All associations were evaluated using multivariate logistic regression. At 18 months whole milk was inversely associated with child asthma (≥5·5 times/week v. none: 0·85, 95 % CI 0·75, 0·97); the reverse was true for semi-skimmed milk (≥5·5 times/week v. none: 1·08, 95 % CI 1·02, 1·15). For yoghurt, children of women who ate low-fat yoghurt >1 serving/d had 1·21 (95 % CI 1·02, 1·42) greater odds of a medication-related ever asthma diagnosis compared with children of women reporting no intake. They were also more likely to have a registry-based ever diagnosis and report allergic rhinitis. Low-fat yoghurt intake was directly related to increased risk of both child asthma and allergic rhinitis, while whole milk appeared protective for early-life outcomes only. Nutrient components or additives specific to low-fat yoghurt may be mediating the increase in risk.

Association of interleukin-13 SNP rs1800925 with allergic rhinitis risk: A meta-analysis based on 1,411 cases and 3169 controls

Studies investigating the association between interleukin-13 (IL-13) single nucleotide polymorphism (SNP) rs1800925 and allergic rhinitis risk have reported conflicting results. The aim of the present study was to conduct a meta-analysis assessing the possible association of IL-13 SNP rs1800925 with allergic rhinitis risk. The relevant studies were identified through a search of PubMed, Embase, ISI Web of Knowledge and Chinese National Knowledge Infrastructure until December 2011 and selected on the basis of the established inclusion criteria for publications. Five studies were included in the present meta-analysis (1411 cases and 3169 controls). The combined results based on all studies showed that IL-13 SNP rs1800925 was not associated with increased allergic rhinitis risk (T versus C: odds ratio (OR)=1.06, 95% confidence interval (CI)=0.94–1.20; C/T versus C/C: OR=1.12, 95% CI=0.97–1.29; T/T versus C/C: OR=1.00, 95% CI=0.69–1.44; C/T+T/T versus CC: OR=1.10, 95% CI=0.96–1.27; T/T versus C/C+C/T: OR=0.91, 95% CI=0.64–1.31). This meta-analysis supported that IL-13 SNP rs1800925 was not associated with allergic rhinitis.

Environmental pollutants and allergic rhinitis

To review the current knowledge of the pathophysiology, epidemiology, and management of environmental pollutants and allergic rhinitis. Both active cigarette smoking and passive exposure to cigarette smoke are associated with chronic rhinitis and sinusitis. Matrix metalloproteinase 9, which is thought to contribute to the pathophysiology of allergy, is elevated in children with passive cigarette smoke exposure compared with controls. Ground-level ozone and particulate matter exposure is associated with an allergic-type response and may increase sensitization to other allergens. Certain occupational exposures can cause nasal irritation and local cytotoxic effects. Evidence suggests that rhinitis symptomatology may often precede the development of occupational asthma. Environmental factors have been noted to induce sinonasal mucosal irritation and often contribute to the multifactorial cause of chronic rhinitis and allergic rhinitis. Cigarette smoke is a common irritant that impacts the innate immune function of the sinonasal epithelial cells, and creates local irritation and cytotoxic effects. Both active smoking and exposure to second-hand smoke increase the risk of chronic rhinitis. Many other environmental pollutants are associated with chronic rhinitis, including ozone, particulate matter, and occupational irritants. The management of chronic rhinitis associated with environmental exposures is similar to the management of other types of chronic rhinitis. Although often not feasible, avoidance is probably the most effective course.

Increased exhaled nitric oxide predicts new‐onset rhinitis and persistent rhinitis in adolescents without allergic symptoms

The fraction of nitric oxide in exhaled air (FE(NO)) is increased in rhinitis and asthma. We have previously suggested that elevated FE(NO) levels in the absence of asthma symptoms may be a sign of 'early asthma'. In the present study, we hypothesize that elevated exhaled NO levels may also precede rhinitis symptoms. To investigate in a cohort of adolescents whether or not increased exhaled NO levels at the age of 13-14 years predicted new-onset or persistent rhinitis within a 4-year period. A total of 959 randomly selected adolescents (13-14 years) completed a questionnaire on respiratory symptoms at baseline and follow-up, 4 years later. Exhaled NO was measured at baseline. After exclusion of subjects with asthma diagnosis or asthma symptoms at baseline, 657 participants were eligible for the present study. Higher FE(NO) levels at baseline were associated with increased risk for new-onset (P = 0.009) and persistent rhinitis (P = 0.03) within a 4-year period. The risk of new-onset rhinitis was 2.32 (1.23, 4.37) [OR (95% CI)] times higher if FE(NO) > 90th percentile of the group without rhinitis at baseline. This increased risk for new-onset rhinitis was significant [2.49 (1.24, 5.01)] after excluding subjects with allergic symptoms. The risk of persistent rhinitis was 5.11 (1.34, 19.57) times higher if FE(NO) > 90th percentile of the group without rhinitis at baseline. Elevated exhaled nitric oxide levels predicted incident and persistent rhinitis in this population-based study of adolescents. Moreover, these findings were consistent after excluding subjects with allergic symptoms. Thus, it appears that elevation of exhaled NO precedes airway symptoms and predicts development of rhinitis in subjects without allergic symptoms or family history of allergic disease.

Association of sensitization to food and inhalant allergens in patients of asthma and rhinitis

Of 1860 patients screened, 1097 (58.9 %) gave history of food allergy. Of the history positive patients 470 were skin prick tested . 29.3 % (138/470) exhibited positive reactions to one or more food(s). Rice elicited SPT positive reaction in maximum ( 6.2 %) cases followed by blackgram (5.9 %), lentil (5.5 %), citrus fruits (5.3 %), pea (3.8 %), maize (3.8%) and banana (3.6 %). Among food sensitised cases 35.5% ( 49/138 ) of patients also showed positive skin reaction to one or more pollen extracts. A majority of the food sensitized patients (52.1 %) were skin test positive to insect allergens while only 14.7 % showed positivity with fungal extracts. Positive skin reaction with food co-existed with positive SPT to insects extracts. Sensitisation to food allergen (potential food allergy) was significantly associated with asthma (P=0.0065) whereas inhalant allergens (pollen, fungal and insects) were strongly related to rhinitis (P<0.01). However sensitisation with pollens was less common in patients of asthma with rhinitis. Sensitisation to food allergens was significantly associated with asthma alone ( P=0.0001). But food sensitivity is significantly less common in cases of asthma associated with rhinitis (P<0.028). Correlations between sensitisation to aeroallergens and ten common foods were analyzed. Conclusions The results suggest that concommittant sensitisations to food with pollen and insect may enhance the risk of asthma and rhinitis or contribute towards exacerbation of symptoms. The synergistic action of these factors may influence the development and progression of atopic manifestation.

Life style and home environment are associated with racial disparities of asthma and allergy in Northeast Texas children

A high prevalence and racial disparities in asthma and allergy have been observed in American children. This study aimed to identify risk factors for asthma and allergy among children, and their contribution to racial disparities in allergy prevalence. A population-based cross-sectional study was carried out among children aged 1–8 years in Northeast Texas 2008–2009. The health conditions, life style and home environment of 3766 children were surveyed by parental questionnaires through e.g. daycares, elementary school, and medical clinics. Among participants who indicated their ethnicity, 255 were Mexican-Americans, 178 Afro-Americans and 969 Caucasians. Afro-American children had a significantly higher prevalence of asthma and eczema. Caucasian had the highest prevalence of rhinitis. Compared to Mexican-American children, Afro-American and Caucasian children were breast fed shorter time, more often went to day care center, had pets and environmental tobacco smoke exposure at home more often. For all children, being at a day care center, being exposed to dampness and environmental tobacco smoke at home were strong risk factors for asthma and allergy. Central air conditioning system was associated with an increased prevalence of wheeze among Mexican-American children, while pets were associated with an increased risk of rhinitis among Afro-American and Caucasian children. Caucasian children were generally not healthier than relatively poor Mexican-American children. Differences in the prevalence of asthma and allergy between races cannot be explained by socioeconomic status only. Life style and home environmental exposures are important risk factors for asthma and allergy in Northeast Texas children.

Early-life risk factors and incidence of rhinitis: Results from the European Community Respiratory Health Study—an international population-based cohort study

Rhinitis is an increasingly common condition with a heavy health care burden, but relatively little is known about its risk factors. To examine the association between early-life factors and the development of rhinitis in the European Community Respiratory Health Study (ECRHS). In 1992-1994, community-based samples of 20-44-year-old people were recruited from 48 centers in 22 countries. On average, 8.9 years later, 28 centers reinvestigated their samples. Onset of rhinitis was reported by 8486 participants in interviewer-led questionnaires. Cox regression was used to assess independent predictors of rhinitis at ages ≤5, 6-10, 11-20, and ≥21years. The crude lifelong incidence of rhinitis was 7.00/1000/year (men) and 7.95/1000/year (women) (P= .002). Women developed less rhinitis in later childhood (hazard ratios [HR], 0.63; 95% CI, 0.47-0.85) and more rhinitis in adulthood (HR, 1.36; 95% CI, 1.11-1.66) than did men. In atopic subjects, siblings were associated with lower risk of rhinitis throughout life (pooled HR, 0.94; 95% CI, 0.91-0.98 per 1 sibling). Early contact with children in the family or day care was associated with less incidence of rhinitis, predominantly before age 5 years (HR, 0.84; 95% CI, 0.72-0.99). Early childhood pets or growing up on a farm was associated with less incidence of rhinitis in adolescence (HR, 0.50; 95% CI, 0.37-0.68). Combining these factors showed evidence of a dose-response relationship (trend P= .0001). Gender is a strong risk factor for rhinitis, with age patterns varying according to atopic status. Protective effects of early contact with children and animals were suggested for incident rhinitis, with risk patterns varying by age window and atopic status.

Intake of antioxidants during pregnancy and the risk of allergies and asthma in the offspring

The potential immune functions related to the damages induced by oxygen-free radicals suggest that antioxidants may have a role in the development of allergies. The objective was to investigate the association between maternal intake of antioxidants during pregnancy and the risk of asthma, rhinitis and eczema in 5-year-old children. This study was on the basis of the Finnish Type 1 Diabetes Prediction and Prevention Nutrition Study, a population-based birth cohort study with 5-year follow-up. Complete information on maternal food frequency questionnaire data and ISAAC (International Study of Asthma and Allergies in Childhood)-based allergic outcomes were available for 2441 children. Cox proportional regression and logistic regression were used for the analyses. Maternal intake of any of the antioxidants was not significantly associated with the risk of asthma, rhinitis or eczema in the offspring, except for dietary intake of magnesium, which was independently associated with protection against eczema (OR 0.78; 95% CI 0.62-0.97). Maternal intake of dietary magnesium during pregnancy may protect against the risk of eczema in the offspring. We did not confirm previous observations concerning other antioxidants. This may be due to the variable amount of antioxidant intake across studies and also indicative of the hypothesis that there may be a critical time window in pregnancy during which antioxidants might modify the risk of allergies in the offspring.

Factores de risco e prevalência de asma e rinite em crianças em idade escolar em Lisboa

Aims A cross-sectional study was carried out with the objective of identifying nutrition habits and housing conditions as risk factors for respiratory problems in schoolchildren in Lisbon. Material and Methods Between October and December 2008, parents of 900 students of the basic schools of Lisbon were invited to answer a questionnaire of the International Study of Asthma and Allergies in Childhood Program (ISAAC). The response rate was 40%. Logistic regression was used in the analysis of results. Results The prevalence of asthma, allergic rhinitis and wheeze was 5.6%, 43.0% and 43.3%, respectively. Risk factors independently associated with asthma were wheezing attacks, and dry cough at night not related to common cold in the last 12 months. Wheezing crises were found to affect children daily activities. Risk factors for wheeze were hay fever and the presence of a pet at home. A risk factor for rhinitis was cough at night. The frequent consumption of egg was also associated with increased risk of rhinitis. Conclusion Contrarily to asthma, the prevalence of allergic rhinitis and wheeze increased in comparison with previous ISAAC studies. Wheezing attacks were associated with asthma and hay fever was identified as a risk factor of manifesting wheezing symptoms. Having pets at home was pointed out as a significant risk factor for rhinitis, but not smoking exposure, mould, plush toys, diet (except egg consumption), breastfeeding or other conditions.

Parental smoking, nasal resistance and rhinitis in children

To determine whether parent-reported perennial rhinitis or objectively measured nasal resistance is more common in children from smoking families. To assess tonsillar size, nasopharyngeal airway and upper airway surgery frequency in children with smoking and non-smoking parents. Ninety-five children (age 3-6 years, median 68 months) participated in this prospective cross-sectional clinical study. History of nasal symptoms was obtained, and all underwent an ear-nose-throat examination, anterior rhinomanometry and a lateral cephalogram. Regular smoking by either parent and their child's snoring was inquired about with a parental questionnaire. We compared children with a parental smoker and children without a parental smoker in the family. Smoking in the family led to increased risk for perennial rhinitis in the children up to 2.76-fold (aOR, 95%CI 1.00-7.67), but with no difference in nasal resistance between children from smoking and non-smoking households. Neither tonsillar size, nasopharyngeal airway nor upper airway surgery was associated with parental smoking. Parental smoking is associated with symptoms of perennial rhinitis in children. The possible role of environmental tobacco smoke should be taken into account in parent counselling and in evaluation of children being treated for symptoms of rhinitis and nasal obstruction.

Quantitative assessments of indoor air pollution and respiratory health in a population-based sample of French dwellings

Background Various volatile organic compounds (VOCs) have been related to respiratory health effects, but have generally been assessed individually without taking into account the fact that such pollutants are highly correlated to one other. Aims We investigated the effects of exposure to various VOC, and considered their combined effect on adult asthma and rhinitis. Method A national cross-sectional representative survey conducted by the Indoor Air Quality Observatory objectively assessed 20 VOCs in 490 main dwellings in France. A standardized questionnaire determined the prevalence of asthma and rhinitis among 1012 inhabitants of the dwellings (≥15 years). Marginal models for binary outcome were used to relate VOCs exposure to asthma and rhinitis, controlling for potential confounders. A global score representing the number of VOCs in each dwelling with an elevated concentration (using the 3 rd quartile value of the distribution as a threshold value) was then derived as a measure of the combined effect of VOCs. Specific scores were built using a similar approach, grouping VOCs by family. Results Asthma (8.6%) was significantly associated with N-undecane and 1,2,4-trimethylbenzene and rhinitis (38.3%) with ethylbenzene, trichloroethylene, m/p- and o-xylene. The global VOC score was associated with a significant risk of asthma and rhinitis (odds ratio (OR) of 1.40 and 1.22, respectively, for 5 additional VOCs with high exposure level). Both specific scores for aromatic hydrocarbons and aliphatic hydrocarbons were associated with a significantly risk of asthma (OR=1.12; 95% confidence interval (CI): 1.01–1.24 and OR=1.41; 95% CI=1.03–1.93, respectively). The specific VOC score for halogenated hydrocarbons was associated with a significant risk of rhinitis (OR=1.28; 95% CI: 1.07–1.54). Conclusion We have shown that high concentrations of VOCs in homes were associated with an increasing prevalence of asthma and rhinitis in adults.

Risk factors and prevalence of asthma and rhinitis among primary school children in Lisbon

AimsA cross-sectional study was carried out with the objective of identifying nutrition habits and housing conditions as risk factors for respiratory problems in schoolchildren in Lisbon. Material and methodsBetween October and December 2008, parents of 900 students of the elementary schools of Lisbon were invited to answer a questionnaire of the International Study of Asthma and Allergies in Childhood Program (ISAAC). The response rate was 40 %. Logistic regression was used in the analysis of results. ResultsThe prevalence of asthma, allergic rhinitis and wheeze was 5.6 %, 43.0 % and 43.3 %, respectively. Risk factors independently associated with asthma were wheezing attacks, and dry cough at night not related to common cold in the last 12 months. Wheezing crises were found to affect children daily activities. Risk factors for wheeze were hay fever and the presence of a pet at home. A risk factor for rhinitis was cough at night. The frequent consumption of egg was also associated with increased risk of rhinitis. ConclusionContrarily to asthma, the prevalence of allergic rhinitis and wheeze increased in comparison with previous ISAAC studies. Wheezing attacks were associated with asthma and hay fever was identified as a risk factor of manifesting wheezing symptoms. Having pets at home was pointed out as a significant risk factor for rhinitis, but not smoking exposure, mould, plush toys, diet (except egg consumption), breastfeeding or other conditions.

Gender differences in indoor allergen exposure and association with current rhinitis

Differences between boys and girls in allergic manifestations are well known, and this difference is possibly not attributed to physiological differences alone. We, therefore, investigated whether boys and girls could be exposed to different allergen levels at home and whether indoor allergen levels could be differently associated with rhinitis in boys and girls at 10 years of age. Cat, dog and house dust mite (HDM) allergen levels in mattress dust and interview data regarding current allergic disease were available for 797 10-year-old children (360 girls) in The Environment and Childhood Asthma Study in Oslo. Girls had higher concentrations of cat and dog allergens in their mattresses compared with boys, also in homes without cats [geometric mean 95% confidence intervals (95% CI): 0.37 (0.31, 0.44) for girls and 0.26 (0.23, 0.30) microg cat allergen/g dust for boys, P=0.002], and without dogs [girls: 0.74 (0.63, 0.86) and boys: 0.55 (0.48, 0.62) microg dog allergen/g dust, P=0.003]. No difference was observed for HDM allergen (Der p 1) levels. Of the 190 (23.8%) children reporting current rhinitis, 144 (75.8%) were sensitized to at least one allergen. The adjusted odds ratio for current rhinitis increased with 1.20 (95% CI: 1.01, 1.42) per 1 microg/g dust increase in Der p 1 for girls (P=0.037), but not for boys (P=0.91). Girls had higher levels of cat and dog allergens in mattress dust compared with boys, whereas no difference was observed for Der p 1 allergen. Nevertheless, only increasing levels of Der p 1 and not cat and dog allergens significantly increased the risk of current rhinitis in girls, whereas no significant association was observed for boys.

International variations in associations of allergic markers and diseases in children: ISAAC Phase Two

Circulating allergen-specific IgE (sIgE) and skin prick tests (SPT) are used to define atopy. Downregulation of local inflammatory responsiveness has been proposed to explain a low prevalence of positive SPTs in less affluent countries. We analysed the association between SPTs, total and allergen-specific IgE and their relationships to allergic symptoms in centres with diverse living conditions. Cross-sectional studies of stratified random samples of 8 to 12-year-old children (n = 7461) used the standardized methodology of Phase Two of the International Study of Asthma and Allergies in Childhood (ISAAC). Symptoms of asthma, rhinitis and eczema were ascertained by parental questionnaires. Skin examination, hypertonic saline bronchial challenge, six aeroallergen SPTs and measurements of serum total IgE and sIgE were performed. In nonaffluent countries, a higher proportion of children with positive SPT had no detectable sIgE (range 37-61%) than in affluent countries (0-37%). Total serum IgE was associated with all disease outcomes among children with both positive SPT and sIgE (P < 0.001), but only with self-reported eczema in children with negative SPTs and negative sIgE. The international pattern of discordance between SPT and sIgE results did not support the downregulation hypothesis. Among children with no evidence of sensitization to common aeroallergens, increased total IgE contributes little to the risk of wheeze and rhinitis in the general population but may play a role in eczema.

Otitis, rhinitis, and atopy in relation to domestic endotoxin and β-glucan exposure among children in Singapore

Exposure to microbial cell wall agents (MCWAs) has been related to the risk for atopy, otitis, and rhinitis. To relate domestic exposure to two important MCWAs-β-glucan and endotoxin-to the risk for otitis, rhinitis, atopy, and allergy in a sample of children from Singapore. Subjects (n=98) were recruited from July 2006 to December 2008. Blood samples were taken to determine nonspecific IgE and skin prick tests were performed. Dust samples were collected from the bedrooms of the subjects and analyzed for the content of β-glucan and endotoxin, using the Limulus method. Levels of IgE were significantly higher among children with rhinitis, and these children also had a larger proportion of atopics. There were no differences in β-glucan values between children with otitis, children with rhinitis, and controls. Endotoxin levels were lower in the homes of children with otitis, with a tendency for the levels to be lower in those with rhinitis. Among children with a high level of β-glucan, there was a higher proportion of those with high IgE values and atopy. The results suggest that a low level of endotoxin is a risk factor for otitis and that a high level of β-glucan is a risk factor for atopic sensitisation. Reactions to domestic indoor exposure are determined by several indoor agents and their relative exposure levels.

Acetaminophen Use and Risk of Rhinitis and Eczema in Schoolchildren: A Meta-Analysis

Acetaminophen Use and Risk of Rhinitis and Eczema in Schoolchildren: A Meta-Analysis

School air quality related to dry cough, rhinitis and nasal patency in children

Controls for indoor air quality (IAQ) in schools are not usually performed throughout Europe. The aim of this study was to assess the effects of IAQ on respiratory health of schoolchildren living in Norway, Sweden, Denmark, France and Italy. In the cross-sectional European Union-funded HESE (Health Effects of School Environment) Study, particulate matter with a 50% cut-off aerodynamic diameter of 10 microm (PM(10)) and CO(2) levels in a day of normal activity (full classroom) were related to wheezing, dry cough at night and rhinitis in 654 children (10 yrs) and to acoustic rhinometry in 193 children. Schoolchildren exposed to PM(10) >50 microg x m( -3) and CO(2) >1,000 ppm (standards for good IAQ) were 78% and 66%, respectively. All disorders were more prevalent in children from poorly ventilated classrooms. Schoolchildren exposed to CO(2) levels >1,000 ppm showed a significantly higher risk for dry cough (OR 2.99, 95% CI 1.65-5.44) and rhinitis (OR 2.07, 95% CI 1.14-3.73). By two-level (child, classroom) hierarchical analyses, CO(2) was significantly associated with dry cough (OR 1.06, 95% CI 1.00-1.13 per 100 ppm increment) and rhinitis (OR 1.06, 95% CI 1.00-1.11). Nasal patency was significantly lower in schoolchildren exposed to PM( 10) >50 microg x m(-3) than in those exposed to lower levels. A poor IAQ is frequent in European classrooms; it is related to respiratory disturbances and affects nasal patency.

Rhinitis guidelines and implications for occupational rhinitis

To review the most recent rhinitis guidelines in the aspects pertaining the link between rhinitis and work, and to summarize the specific literature on occupational rhinitis published in 2007 and 2008. Recently there has been a growing scientific interest in work-related rhinitis. Health personnel, cleaners, bakers, apprentices in high-risk occupations, and workers exposed to multiple agents are at increased risk of rhinitis, especially in the very first years of employment. Flour allergens are often involved and may induce nonallergic and enhance allergic airway inflammation. The specific nasal challenge remains the gold standard for diagnosis. Acoustic rhinometry and nasal lavage are validated tools for monitoring nasal response. Occupational rhinitis seems to have an impact on quality of life of affected workers and allergic rhinitis impairs work productivity. This review updated recent findings on epidemiology, mechanisms, diagnosis, management, and prevention of occupational rhinitis. This article also provides new information on the impact of occupational rhinitis on quality of life and on the impact of rhinitis on work productivity. Occupational rhinitis should be considered in daily clinical practice and research.

Rhinitis associated with pesticide exposure among commercial pesticide applicators in the Agricultural Health Study

Objectives:Rhinitis is common, but the risk factors are not well described. To investigate the association between current rhinitis and pesticide use, we used data from 2245 Iowa commercial pesticide applicators...