Allergy

The heterogeneity hidden in allergic rhinitis and its impact on co-existing asthma in adults: a population-based survey

Antonicelli L, Marchetti P, Accordini S, Bono R, Carosso A, Casali L, Cazzoletti L, Corsico A, Ferrari M, Fois A, Nicolini G, Olivieri M, Pirina P, Verlato G, Villani S, de Marco R. Int Arch Allergy Immunol 2015; 168(3): 205–212

Allergic rhinitis and asthma

The prevalence of allergic rhinitis (AR) is increasing, particularly in Western countries. Co-morbidities of the upper and lower airways are well documented: 10–40% of patients with rhinitis have asthma, and >80% of patients with asthma have rhinitis. 1In a new study in International Archives of Allergy and Immunology, Leonardo Antonicelli and colleagues have reported that epidemiologically, the diagnosis of AR may include heterogeneous airway diseases that affect interactions with asthma. 2

AR is estimated to affect more than 500 million people worldwide. 1

Survey of respiratory conditions

As part of the Gene Environment Interactions in Respiratory Diseases study, 5162 Italian adults were surveyed using a postal questionnaire.
Respondents indicated whether they had any of the following respiratory conditions: 2

• Nasal allergies, including hay fever
  
• Sinusitis
  
• Nasal polyps
  
• Cough and phlegm (occurring most days for a minimum of 3 months per year for at least 2 years)
  
• Asthma.

Patients who self-reported having physician-diagnosed asthma were queried about indicators of asthma severity: 2

• Number of asthma attacks in the last 12 months
  
• Presence of chronic obstructive pulmonary disease, chronic bronchitis or emphysema
  
• Use of anti-asthmatic medications in the last 12 months.

Potentially confounding factors considered in the analysis included gender, age, smoking habits, education and the season of response (spring, summer, autumn, winter). 2

AR was reported by 25.4% (95% confidence interval [CI] 24.2–26.6) of respondents. 2

The overall reported incidence of physician-diagnosed asthma in the AD population was 23.8%, of which 17.5% had current symptoms. 2

AR subgroups with impact on asthma

The survey results indicated that there were two subsets of patients within the AR population that impact on asthmatic symptoms:2

Group 1: Patients with AR and sinusitis (5.7% of total respondents) had increased risk of cough and phlegm compared with AR-only patients (relative risk ratio (RRR) = 2.59, 95% CI 1.89–3.54). 2

Group 2: Patients with AR and nasal polyposis (1.2% of total respondents) had a higher prevalence of current asthma than the AR-only group (31.2% vs 15.8%; p<0.001). 2 Multivariate analysis indicated that the AR + nasal polyps group also had a significantly increased risk of having at least one asthma attack in the past year (RRR = 2.30, 95% CI 1.19–4.46), and having had a respiratory disease-associated hospital admission in the previous 3-month period (RRR = 5.61, 95% CI 1.81–23.92) compared with AR-only patients.2 Incidence of cough and phlegm was also higher than AR-only patients. 2

Conclusions

The authors hypothesise that the presence of nasal polys may distinguish two different asthma phenotypes in patients with AR: an ‘early-onset allergic asthma phenotype’ and a ‘late-onset eosinophilic asthma phenotype’, and that these phenotypes differ in their responsiveness to steroid treatment. 2

Report on: The heterogeneity hidden in allergic rhinitis and its impact on co-existing asthma in adults: a population-based survey. Antonicelli L, Marchetti P, Accordini S, Bono R, Carosso A, Casali L, Cazzoletti L, Corsico A, Ferrari M, Fois A, Nicolini G, Olivieri M, Pirina P, Verlato G, Villani S, de Marco R. Int Arch Allergy Immunol 2015; 168(3): 205–212.

Reference list

1. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, 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 Suppl 86: 8–160.
   
2. Antonicelli L, Marchetti P, Accordini S, Bono R, Carosso A, Casali L, et al. The heterogeneity hidden in allergic rhinitis and its impact on co-existing asthma in adults: a population-based survey. Int Arch Allergy Immunol 2015; 168(3): 205-212.