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PubMedDate not supplied

[Allergic rhinitis and ashtma: 2 illnesses. The same disease?].

Disturbances of the upper and lower airways frequently coexist, and the association between allergic rhinitis and asthma is an example of that. The relationship between allergic rhinitis and asthma probably occurs because both, nasal and bronchial mucosas are elements of a "united airway", and on the other hand, allergic rhinitis and asthma are manifestations of a common allergic disease. Allergic rhinitis and asthma are not only statistically associated, but have pathophysiological and clinical similarities. Allergic rhinitis is itself a risk factor for the development of asthma, but additionally may confound the diagnosis of asthma and may exacerbate coexisting asthma. The management of allergic rhinitis, mainly with the use of intranasal corticosteroids, improve asthma symptoms and lung function in asthmatic patients. Several mechanisms have been proposed to link the nose and bronchi, which include: postnasal drip of inflammatory cells and pro-inflammatory molecules; a possible nasobronchial neural reflex; an increased exposure of the lower airways to dry and cold air as well as aeroallergens because the mouth breathing secondary to nasal obstruction; and an increased susceptibility to rhinovirus infection secondary to an increased ICAM-1 expression in the nasal mucosa of patients with allergic rhinitis. A better understanding of the rhinitis-asthma relationship nature might allow the creation of better strategies for the integral treatment of patients with these diseases.

Allergens↗
PubMedDate not supplied

[Allergic Rhinitis and its Impact on Asthma (ARIA) in Latin America].

Allergic rhinitis is the commonest chronic respiratory disorder in children and young adults having an important impact for those suffering this condition, as well as for the public health. Allergic rhinitis is frequently associated to other co-morbidities, particularly asthma and conjunctivitis but, also, sinusitis and otitis media. Most of patients suffering rhinitis are cared by GPs and pediatricians and there are evidences that allergic rhinitis is undertreated, particularly the moderate/severe persistent forms. Clinical guidelines have become an important tool providing recommendations for diagnosis and treatment of different medical conditions. They help the process of decision making for GPs and pediatricians, and many of them, contain an update on basic science and epidemiology. In respiratory medicine, guidelines on asthma and rhinitis are available; however, they do not look at the patients globally and focus the disorder on an organ-specific basis without recommendations on co-morbidities. ARIA, Allergic rhinitis and its impact on asthma, has not been developed only to update specialists in allergy/immunology, otorhinolaryngology and neumology on rhinitis and its comorbidities but, also, to provide recommendations for non-specialists. A new classification and severity of allergic rhinitis is proposed replacing the classic perennial and seasonal forms for persistent and intermittent, mild to moderate/severe. ARIA is an initiative in collaboration with the World Health Organization and the master document has been endorsed by many national and international scientific societies and organizations. ARIA is an evidence-based document also stressing on pediatric aspects and providing recommendations for low-income countries.

Algorithms↗
PubMed2003

Prevalence and treatment of allergic rhinitis in Italian conscripts.

BACKGROUND: Previous surveys on Italian conscripts showed a low prevalence of allergic rhinitis. This study investigated the prevalence and the treatment of allergic rhinitis in the "conscript model" during a four-year period (1999-2002). METHODS: 28,327 18-year old males were screened and referred to La Spezia Military Navy Hospital for call-up visit. Detailed history, clinical examination, skin prick test, spirometry, and metacholine challenge were performed in subjects with suspected diagnosis of respiratory allergy. RESULTS: Allergic rhinitis was diagnosed in 2,876 conscripts (10.15%). Most of them showed an association with asthma (67.2%). Prevalence of allergic rhinitis increased five-fold in comparison with a previous survey. Sneezing was the most common nasal symptom. The use of antihistamines and intranasal corticosteroids increased significantly. However, about one third of the rhinitis subjects did not receive any treatment at all. CONCLUSIONS: Prevalence of allergic rhinitis in Italian conscripts has increased. Treatment of allergic rhinitis was correctly based on antihistamines and corticosteroids, but many rhinitis subjects remained still untreated.

Adolescent↗
PubMed2003

Pulmonary function parameters in patients with allergic rhinitis.

Rhinitis patients may have abnormal airway function as demonstrated by an obstruction in large or small airways and increased bronchial reactivity to inhaled nonspecific provocating agents. The nonspecific bronchial hyperreactivity (BHR) is particularly important in patients with rhinitis because they are more prone to develop asthma. However, the factors associated with BHR in rhinitis patients have not yet been explained. Therefore, we performed this study to determine the differences in airflow rates, and bronchial and nasal resistance between nonasthmatic rhinitis patients with or without BHR, and to evaluate the relationship between these parameters and bronchial reactivity to methacholine. A total of 66 patients with allergic rhinitis but not asthma were selected for the study and divided into two groups; Group 1 (40 patients with allergic rhinitis and negative mechacholine provocation test) and Group 2 (26 patients with allergic rhinitis and positive methacholine provocation test). Pulmonary function tests, methacholine provocation tests, anterior rhinomanometry, and skin prick tests were performed on the patients. The study groups were homogeneous with regard to gender, age, duration of illness, and smoking ratio. Expiratory airflow parameters including FVC, FEV1, PEFR, and FEF25 were similar in both groups, however FEV1/FVC, FEF25-75, FEF50, and FEF75 were significantly lower in Group 2. Additionally, sRaw was significantly higher in Group 2 and negatively correlated with the expiratory airflow parameters for small airways. Total nasal resistance was not different between the groups. There was no correlation between nasal resistance and BHR to methacholine or airway resistance. The present study suggests that nonasthmatic rhinitis patients with BHR may have mild but significant changes in the small airways. Clinical and functional follow-up of these patients should assess the long-term consequences of these parameters and their clinical importance.

Adolescent↗
PubMed2005

Management of allergic rhinitis.

Due to its high and increasing prevalence, its impact on quality of life, the association with multiple comorbidities and the considerable socio-economic burden, allergic rhinitis is a major respiratory disorder and represents a global health concern. The ARIA working group has proposed a new classification for allergic rhinitis into intermittent or persistent, based on the duration of symptoms. The severity of allergic rhinitis is graded according to the impact of the disease on the quality of life. The diagnosis of allergic rhinitis involves a thorough history and clinical examination. In patients suspected of having persistent AR a complete and systematic nasal examination is an absolute requirement. Anterior rhinoscopy provides limited information. Nasal endoscopy is more useful, not to confirm AR but in particular to exclude other conditions, such as polyps, foreign bodies, tumours and septal deformations. To confirm the allergic origin of rhinitis symptoms, allergy tests must be performed. The first choice test is the skin prick test. Patients with allergic rhinitis should be evaluated for asthma and patients with asthma should be evaluated for rhinitis. A stepwise therapeutic approach is recommended based on the duration and severity of disease. The treatment of allergic rhinitis consists of allergen avoidance, pharmacotherapy and immunotherapy.

Algorithms↗
PubMed1984

Perennial rhinitis. A common childhood complaint.

Symptoms of rhinitis in 595 children who attended an allergy clinic over a four-year period were examined to determine the relative frequencies of perennial rhinitis and seasonal rhinitis (hay fever). Perennial rhinitis was much more common than seasonal rhinitis at all ages, and only 12% of children with rhinitis had symptoms restricted to the grass pollen season. The detection of eosinophils in nasal smears from subjects with rhinitis was uncommon (10% of cases), while mast cells were found in one third of cases. Rhinitis was the most common symptom of atopic disease.

Child↗
PubMed2001

House dust mite avoidance measures for perennial allergic rhinitis.

BACKGROUND: In developed countries, it is estimated that 15% of the general population suffer from one or more allergic disorders, of which allergic rhinitis is the most common. Perennial rhinitis is most often due to allergy to the house dust mite. In such patients, house dust mite avoidance is logical, but there is considerable uncertainty regarding the efficacy and effectiveness of interventions designed to reduce dust mite exposure. OBJECTIVES: To assess the benefit (and harm) of measures designed to reduce house dust mite exposure in the management of house dust mite sensitive allergic rhinitis. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, Central, MEDLINE and EMBASE. No restrictions on the language of publication were employed. The bibliography of each paper and other published reviews were checked for further references. We wrote to first authors of all included trials in an attempt to identify further published and unpublished trials. SELECTION CRITERIA: Randomised controlled trial (with or without blinding), in which house dust mite control measures have been evaluated in comparison with placebo or other dust mite avoidance measures, in patients with clinician diagnosed allergic rhinitis and confirmed allergy to dust mite. DATA COLLECTION AND ANALYSIS: Two reviewers independently checked titles and abstracts identified by the searches and full text copies of all papers of potential relevance were considered. Trials were graded for methodological quality using the Cochrane approach. Data extraction was performed in a standardised manner. Meta-analysis was neither possible, nor considered appropriate, because of the heterogeneity of the patient groups studied; a narrative overview of the results is therefore presented. MAIN RESULTS: Four trials satisfied the inclusion criteria, all of which were small and of poor quality. Two trials investigated the efficacy of acaricides, a third investigated the role of high-efficiency particulate air (HEPA) filters, whilst a fourth investigated the efficacy of a bedroom environmental control program that comprised use of a barrier mattress cover, fortnightly washing of bed covers, removal of soft furnishings and daily cleaning. Each of the four trials showed the interventions to result in significant reductions in house dust mite load when compared with control. Trial results suggest that the interventions may be effective in reducing some rhinitis symptoms, though it is not possible to provide a reliable summary estimate about the magnitude of such symptom reduction. No serious adverse effects were reported from the interventions. REVIEWER'S CONCLUSIONS: Trials to date have been small and of poor methodological quality making it difficult to offer any definitive recommendations on the role, if any, of house dust mite avoidance measures in the management of house dust mite sensitive perennial allergic rhinitis. The results of these studies suggest that interventions designed to reduce house dust mite exposure in patients with house dust mite allergic perennial rhinitis may be of some benefit in reducing rhinitis symptoms. Data at present is only available for acaricides, HEPA filters and a bedroom-based environmental control program; therefore, if considered appropriate, these should be the interventions of choice.

Animals↗
PubMed2003

The dilemma of occupational rhinitis: management options.

Occupational rhinitis is a common heterogeneous group of inflammatory conditions in the nose, caused by exposure to airborne irritants and sensitizers in the occupational environment. The mechanism can be allergic, neurogenic or toxic. Data from several epidemiologic studies indicate that animal dander, organic dusts, latex and chemicals can cause occupational rhinitis, but because of methodological problems as well as weaknesses in the definition of occupational rhinitis, occupational exposure is probably an underestimated cause of rhinitis. The effect of rhinitis on the mental aspects of quality of life and substantial costs due to loss of productivity make it important to diagnose and treat occupational rhinitis. Diagnosis relies on a history of exposure, skin prick testing and, if possible, nasal provoacation. Avoidance of exposure, protective measures at the workplace and medical treatment, with agents such as second generation antihistamines and nasal corticosteroids, can make it possible to avoid progress of the disease from rhinitis to asthma. The efficacies of montelukast, a leukotrienne receptor antagonist, and omalizumab, an anti-immunoglobulin E monoclonal antibody in the treatment of occupational rhinitis are yet to be evaluated

Allergens↗
PubMed2003

The etiology and management of pregnancy rhinitis.

Pregnancy rhinitis is defined as nasal congestion in the last 6 or more weeks of pregnancy, without other signs of respiratory tract infection and with no known allergic cause, with complete resolution of symptoms within 2 weeks after delivery. Pregnancy rhinitis occurs in approximately one-fifth of pregnancies, can appear at almost any gestational week, and affects the woman and possibly also the fetus. The pathogenesis of pregnancy rhinitis is not clear, but placental growth hormone is suggested to be involved. Smoking and sensitization to house dust mites are probable risk factors. It is often difficult to make a differential diagnosis from sinusitis: nasendoscopy of a decongested nose is the diagnostic method of choice. In some cases ultrasound or x-ray may be necessary. Sinusitis should be treated aggressively with increased doses of beta-lactam antibiotics and antral irrigation. Nasal decongestants give good temporary relief from pregnancy rhinitis, but they tend to be overused, leading to the development of rhinitis medicamentosa. Corticosteroids have not been shown to be effective in pregnancy rhinitis, and their systemic administration should be avoided during pregnancy. Nasal corticosteroids may be administered to pregnant women when indicated for other sorts of rhinitis. Nasal alar dilators and saline washings are safe means to relieve nasal congestion, but the ultimate treatment for pregnancy rhinitis remains to be found.

Adrenal Cortex Hormones↗
PubMed1999

Lack of correlation between nonspecific nasal and bronchial reactivity in allergic rhinitis subjects.

A link between allergic rhinitis and asthma has long been suspected, allergic rhinitis being considered a precursor of asthma. The hypothesis is that if such a link exists, then nonspecific nasal and bronchial reactivity are already correlated in acute rhinitis patients. To test for this correlation, we compared nonspecific nasal and bronchial reactivity in two groups of rhinitis subjects: 37 rhinitis pollinosis patients tested during the pollen season and 35 rhinitis pollinosis patients tested outside the pollen season. We also assessed how smoking affects this link. In each subject, allergy, nonspecific nasal, and nonspecific bronchial reactivity were tested, and smoking was categorized. We found no correlation between nonspecific nasal and bronchial reactivity in the two nonasthmatic rhinitis groups. During active allergic inflammation (pollinosis season) no shift toward a stronger link between upper and lower airways can be found compared with the latent period (out of pollinosis season). Unexpectedly, among smokers we found a significant relationship between nonspecific nasal and bronchial reactivity. Thus, there is not yet sufficient evidence for a straightforward link between nasal and bronchial hyperreactivity in nonasthmatic pollinosis rhinitis subjects. The development of asthma seems to be crucial for this link.

Adult↗
PubMed2005

Unawareness and undertreatment of asthma and allergic rhinitis in a general population.

UNLABELLED: The aim of this study was to determine the extent of unawareness and undertreatment of asthma and allergic rhinitis in an adolescent and adult population in Copenhagen, Denmark. METHODS: Patients with asthma and rhinitis were recruited by a standardised asthma and rhinitis screening questionnaire. Out of a random sample of 10,877 subjects aged 14-44 years, 1149 subjects were treated or reported symptoms of asthma or rhinitis and agreed to participate. Those subjects were assessed on history, lung function tests, and skin prick tests. Disease severity and optimal treatment were decided according to the GINA and ARIA guidelines. RESULTS: A total of 726 participants suffered from asthma and/or allergic rhinitis. Concomitant upper and lower airways disease was found in 47%. Seventy-five per cent were allergic and 44% with a known allergy had been tested previously. Asthma was undiagnosed and untreated in 50% of all the asthmatics. According to the guideline recommendation, 76% of asthmatics were undertreated. Rhinitis was undiagnosed in 32% of patients and 83% with moderate to severe rhinitis were undertreated. Patient knowledge about self-care and education was low. CONCLUSIONS: In this population a large proportion of patients were unaware of having asthma or rhinitis. The pharmaceutical treatment and management practice were inadequate. Our study emphasises the need for additional intervention.

Adolescent↗
PubMed1999

Perennial rhinitis: An independent risk factor for asthma in nonatopic subjects: results from the European Community Respiratory Health Survey.

BACKGROUND: Although clinical and experimental studies suggest that upper respiratory tract dysfunction may affect the lower airways, rhinitis is usually not studied as a potential risk factor for asthma. This is because both diseases share key elements of pathogenesis and are usually considered as different manifestations of the same underlying "atopic" state. OBJECTIVE: We sought to assess whether asthma is associated with rhinitis in the absence of immunologic disorders in a population study. METHODS: Data from 34 centers participating in the European Community Respiratory Health Survey were analyzed. Random samples of 20- to 44-year-old subjects were invited to complete a detailed questionnaire and undergo total and specific IgE measurements, skin prick tests to 9 allergens, and bronchoprovocation challenges with methacholine. RESULTS: Subjects with perennial rhinitis (n = 1412) were more likely than control subjects (n = 5198) to have current asthma. After adjustment for sex, age, smoking habit, family history of asthma, geographic area, and season at the time of examination, asthma was strongly associated with rhinitis among atopic subjects (odds ratio [OR] = 8.1; 95% confidence interval [CI] = 5.4-12.1) but also among nonatopic subjects (OR = 11.6; 95% CI = 6.2-21.9). Moreover, the association remained very strong when the analysis was restricted to nonatopic subjects with IgE levels of 80 kIU/L or less (OR = 13.3; 95% CI = 6. 7-26.5). In nonasthmatic subjects bronchial hyperresponsiveness was also more frequent in subjects with rhinitis than in those without rhinitis (OR = 1.7; 95%CI = 1.2-2.6 in nonatopic subjects with IgE levels of </=80 kIU/L). CONCLUSION: The strong association between perennial rhinitis and asthma in nonatopic subjects with normal IgE levels is consistent with the hypothesis that rhinitis is an independent risk factor for asthma.

Adult↗
PubMed2004

Sleep disordered breathing and daytime quality of life in children with allergic rhinitis during treatment with intranasal budesonide.

BACKGROUND: Nasal obstruction is recognized as an important cause of sleep disordered breathing. Congestion of the nasal mucosa and obstruction are common symptoms of allergic rhinitis. Daytime sleepiness is a common finding in symptomatic allergic rhinitis. Effective therapy of the nasal congestion of allergic rhinitis should alter sleep patterns in patients with symptomatic allergic rhinitis. OBJECTIVE: To measure objective changes in polysomnograms (sleep studies) of children with allergic rhinitis before and after therapy with intranasal budesonide and to measure changes in the quality of life of these patients during treatment. METHODS: Open clinical trial with objective measurements (polysomnography) and subjective data (Rhinitis Quality of Life Questionnaire [RQLQ]). Evaluations were performed before, during, and at completion of therapeutic intervention. RESULTS: The 14 studied children tolerated the procedures and treatment without problems. The mean number of sleep arousals per hour (all apneas and hypopneas) decreased from a baseline of 8.4 to 1.2 (P = .005) after treatment. The change was mainly in hypopneic episodes (7.5-0.9, P = .003). Objective responses on the RQLQ showed improvements consistent with improved sleep and lessened rhinitis symptoms. CONCLUSIONS: Decreasing the nasal congestion associated with allergic rhinitis can improve sleep measured by objective sleep studies and lead to improvement in daytime quality of life.

Administration, Intranasal↗
PubMed2003

Occupational rhinitis.

OBJECTIVE: To define occupational rhinitis, classify its various causes, review the steps in diagnosis, and describe the nonpharmacologic and pharmacologic management principles. DATA SOURCES: A review of MEDLINE articles in English on occupation rhinitis for January 1, 1970, through December 31, 2001, was performed. In addition, references were identified from bibliographies of relevant articles and books. STUDY SELECTION: The expert opinion of the author was used to select the relevant articles for the review. RESULTS: Occupational rhinitis is the episodic, work-related occurrence of sneezing, nasal discharge, and nasal obstruction. It frequently coexists with asthma but may present alone. Occupational rhinitis can be caused by heightened olfactory awareness, nonspecific inflammation of the nose, exposure to a high concentration of irritating and soluble chemical gases, or IgE mechanisms. The history and physical examination are the most important components to the workup of the patient. A site visit to the specific work area may give helpful insights to the patients' exposure. In the case of IgE-mediated allergic occupational rhinitis, skin testing or serologic testing may be useful. Greater objectivity to the diagnosis can be obtained through nasal challenge and the rapidly developing technique of rhinomanometry. Nonpharmacologic management (environmental control) and pharmacotherapy, such as that used in allergic rhinitis, should both be instituted. CONCLUSIONS: Although it does not have the same impact as occupational asthma, occupational rhinitis causes distress, discomfort, and work inefficiency. Attention to principles of management involving nonpharmacologic and pharmacologic measures will spare the patient the symptoms of occupational rhinitis.

Humans↗
PubMed2002

Rethinking our approach to allergic rhinitis management.

OBJECTIVE: This article reviews the recommendations by the World Health Organization's new guidelines, "Allergic Rhinitis and Its Impact on Asthma" (ARIA), and the paradigm for treating allergic rhinitis based on disease classification. After reading this article, readers should understand the ARIA guidelines and the salient issues involving the challenges inherent in the management of allergic rhinitis. DATA SOURCES: Relevant and appropriately controlled clinical studies and results of patient surveys were used. Only literature in the English language was reviewed. STUDY SELECTION: Material was taken from academic/scholarly journals, published abstracts, and presentations at a major congress. RESULTS: The ARIA guidelines' new classification categorizes patients' allergic rhinitis as either intermittent or persistent with gradations from mild to moderate-severe. These guidelines propose a stepwise approach to management guided by symptom severity and evaluation of treatment response, with the underlying concept for treatment being to select therapies that address individual patients' symptoms. Although few data were available at the time of their inception, the guidelines recognize that antileukotriene medications may play an important role in the treatment of allergic rhinitis. Results of recent clinical trials support the use of antileukotriene medications in allergic rhinitis, alone or concomitantly with an antihistamine. CONCLUSIONS: Targeting specific and multiple mechanisms of allergic rhinitis and individualizing all available and effective treatments to each patient, with specific medications for specific symptoms, will be of particular benefit to patients with allergic rhinitis.

Adult↗
PubMed2001

IgE levels are the same in chronic fatigue syndrome (CFS) and control subjects when stratified by allergy skin test results and rhinitis types.

BACKGROUND: Chronic fatigue syndrome (CFS) has an uncertain pathogenesis. Allergies have been suggested as one cause. OBJECTIVE: The aim of this study was to compare serum immunoglobulin (Ig)E in CFS and control subjects to determine whether IgE levels were elevated in CFS. This would be suggestive of increased atopy in CFS. METHODS: IgE was measured by quantitative ELISA (sandwich) immunoassay in 95 CFS and 109 non-CFS control subjects. Subjects were classified by positive or negative allergy skin tests (AST) and rhinitis questionnaires (rhinitis score, RhSc) into four rhinitis types: nonallergic rhinitis (NAR with positive RhSc and negative AST); allergic rhinitis (AR with positive AST and RhSc); atopic/no rhinitis (AST positive/RhSc negative); and nonatopic/no rhinitis (both AST and RhSc negative) subjects. RESULTS: IgE was not significantly different between control (128 +/- 18 IU/mL, mean +/- SEM) and CFS (133 +/- 43 IU/mL) groups, or between control and CFS groups classified into the four rhinitis types. IgE was significantly higher in subjects with positive AST whether or not they had positive RhSc or CFS symptoms. CONCLUSIONS: Elevated IgE and positive AST indicate allergen sensitization, but are not necessarily indicators of symptomatic allergic diseases. There was no association between IgE levels and CFS, indicating that atopy was probably not more prevalent in CFS. Therefore, TH2-lymphocyte and IgE-mast cell mechanisms are unlikely causes of CFS.

Fatigue Syndrome, Chronic↗
PubMed2003

Allergic rhinitis and polymorphisms of the interleukin 1 gene complex.

BACKGROUND: Allergic rhinitis is a chronic inflammatory disease with a genetic background. Inflammatory reactions are regulated by cytokines. Cytokine genes are polymorphic and have been implicated as candidate genes in allergy. OBJECTIVES: To study the significance of the interleukin 1 (IL-1) gene complex in allergic rhinitis. METHODS: Population-based, cross-sectional study. We studied the polymorphisms of 3 IL-1 gene complex genes, IL1A (+4845G>T), IL1B (-511 degrees C>T), and IL1RN (variable number of tandem repeats; IVS2, 86 bp, duplicates 2 to 5), in patients with allergic rhinitis. The study group consisted of 405 nonasthmatic individuals of whom 56 had allergic rhinitis. RESULTS: The genotype distribution differed significantly in all cytokine genes studied between subjects with and without allergic rhinitis. The difference was mainly due to an increased number of IL1A allele G homozygotes (67.9% vs 43.2%; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.5-5.1), IL1B heterozygotes (72.2% vs 47.4%; OR, 2.8; 95% CI, 1.5-5.3), and IL1RN allele 2 homozygotes (18.5% vs 7.5%; OR, 2.8; 95% CI, 1.3-6.2) in allergic rhinitis. Haplotype analysis revealed a significant difference in the distribution of IL-1 gene complex haplotypes between subjects with and without allergic rhinitis (P = 0.005, 10 df). CONCLUSIONS: The IL-1 gene complex polymorphism is strongly associated with allergic rhinitis in nonasthmatic individuals.

Adult↗
PubMed2002

The relationship among markers of allergy, asthma, allergic rhinitis, and eczema in Costa Rica.

The association between allergy markers and asthma and allergic rhinitis is stronger in countries with a Western lifestyle than in rural areas of Africa and Asia. We examined the relationship among allergy markers, asthma, rhinitis, and eczema in a case-control study of 198 schoolchildren, 10-13 years of age, living in Costa Rica, a Latin American country. The geometric mean total serum immunoglobulin E (IgE) level in subjects with and without asthma was 465.0 and 143.0 IU/ml, respectively (difference = 322 IU/ml, 95% CI = 141.8-616.1 IU/ml, p < 0.001), and that in subjects with and without allergic rhinitis was 442.5 and 144.3 IU/ml, respectively (difference = 298.2 IU/ml, 95% CI = 125.7-581.0 IU/ml, p < 0.001). After adjusting for age, gender, and skin test reactivity to allergens, we found a linear relationship between serum total IgE level and the log odds ratio (OR) of having asthma. In a multivariate analysis, there was a linear relationship between skin test reactivity to allergens and the log OR of having allergic rhinitis. The OR of having allergic rhinitis was almost three times higher in children who had four positive skin tests than in non-reactors. Skin test reactivity to greater than five aeroallergens was an independent predictor of eczema in a multivariate analysis (OR = 3.1, 95% CI = 1.1-8.4). Although the geometric mean total serum IgE levels of Costa Rican children with either asthma or allergic rhinitis are higher than those of children with asthma or allergic rhinitis in most industrialized countries, the relationship among markers of allergy, asthma, rhinitis, and eczema in Costa Rica is similar to that found in countries with a Western lifestyle and different from that found in rural areas of Asia and Africa.

Allergens↗