Rhinitis linked to adult-onset asthma

Rhinitis linked to adult-onset asthma

Adult-onset asthma can be predicted by the presence of rhinitis, both allergic and non-allergic, according to an article released on September 19, 2008 in The Lancet.

To investigate the potential implications of both allergic and non-allergic rhinitis on adult-onset asthma, Rafea Shaaban, Mahmoud Zureik, and Benedicte Leynaert, of the INSERM Epidemiology Team, Paris, France, and colleagues, examined data from the European Community Health Survey. Adult patients between the ages of 20 and 44 years with allergic and non-allergic rhinitis were tracked over 8.8 years. In total, 6,461 patients were examined in 29 centers in 14 different countries, mostly in Western Europe. None of the participants had asthma at the start of the study.

Each patient was examined for rhinitis. Then, any potential allergies were tested by a skin-prick test for the following exposures: house dust mites, cats, two types of fungus, grass, birch, the flowering plant Parietartia, olive, or ragweed. Based on these results, the patients were classified into one of four groups: the control group, with no allergies and no rhinitis; atopy only, with no rhinitis; non-allergic rhinitis; and allergic rhinitis.

In the 8.8 years of follow up, asthma had developed in 1.1% of the control group, 1.9% of the atopy only group, 3.1% of the non-allergic rhinitis, and 4.0% of the allergic rhinitis groups. After adjustment for country, sex, baseline age, body-mass index, lung capacity, family history of asthma, and smoking, those with allergies were 1.63 times as likely than controls to have asthma. those with non-allergic rhinitis were more than 2.5 times as likely to have asthma, those with allergic rhinitis had 3.5 times the risk of asthma. Notably, sensitization to dust mites was the only allergy associated independently with asthma. All of the associations were seen in men and women.

The authors point out that, especially given the magnitude of this study, this association between asthma and rhinitis is a powerful direction for future asthma research.   "This large prospective study provides strong evidence for an increased  risk of asthma in adults with allergic rhinitis, and to a lesser extent non-allergic rhinitis...Several  clinical trials in asthmatic patients with allergic rhinitis were associated with a reduction in  asthma symptoms. However, only interventional studies could be used to conclude that the treatment of allergic rhinitis is effective in reducing the incidence of asthma."

Dr Erika von Mutius, University Children's Hospital, Munich, Germany, contributed an accompanying comment which points out the potential implications of this work: "The idea that allergic rhinitis could cause asthma raises the possibility of  preventing asthma by preventing atopic sensation, which could in turn prevent allergic  rhinitis."

Rhinitis and onset of asthma: a longitudinal population-based study 

Rafea Shaaban, Mahmoud Zureik, David Soussan, Catherine Neukirch, Joachim Heinrich, Jordi Sunyer, Matthias Wjst, Isa Cerveri, Isabelle Pin, Jean Bousquet, Deborah Jarvis, Peter G Burney, Francoisenedicte Leynaert

Lancet 2008; 372: 1049-57

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