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PubMed2005

Burden of rhinitis in children with asthma.

Although the clinical association of allergic rhinitis and asthma has been recognized for centuries, in recent years the association appears to be stronger than was reported previously. However, data for children are less clear, and some studies indicate that results observed in developing countries may differ from those observed in Western populations. We therefore intended to document the association of rhinitis with pediatric asthma in terms of caregivers' perception, physician practice, and file records. Asthmatic children aged 3-16 years with at least 1-year follow-up in an allergy-asthma outpatient clinic were invited to participate in the study during a 10-month interval. In addition to a face-to-face questionnaire-based interview, file records were evaluated retrospectively to obtain information relating to asthma and rhinitis. Of 396 patients included in the study, 369 with consistent replies were included in the analyses. The mean age of the study group was 10.6 +/- 0.2 (mean +/- SEM) years, and a greater proportion of the respondents were male (63.7%), atopic (78.3%), and mildly asthmatic (50.7%). House dust mite and grass pollens were the most commonly sensitized allergens (50.7% and 46.9%, respectively). Although only 5.4% of our study population regarded themselves as rhinitic and 23.8% had been diagnosed with allergic rhinitis according to the file records, almost 57.7% of patients had required medications for rhinitis within the last year, and 68.8% had findings consistent with allergic rhinitis. Furthermore, 41.2% and 58.8% reported that their rhinitis symptoms caused a significant burden in their daily life and exacerbated their asthma, respectively, and almost 50% felt that their rhinitis had not been given significant consideration by their physician. In conclusion, although we report a large discrepancy between caregivers' perception of rhinitis, documentation in file records, and treatments for rhinitis, the allergic rhinitis prevalence determined in the survey and the medication use for rhinitis appeared to be in agreement. We recommend a greater effort be made to identify, label, and educate children with rhinitis and their families in asthma outpatient clinics.

Adolescent↗

PubMed1988

Eosinophilic nonallergic rhinitis.

Eosinophilic nonallergic rhinitis is one of the major forms of nonallergic rhinitis. It is characterized by the presence of many eosinophils in nasal secretions, a negative history for allergen exacerbation, and negative skin tests. It is often associated with nasal polyps and shares their exquisite sensitivity to corticosteroid therapy, both systemic with prednisone or topical with flunisolide. Patients with rhinitis can be separated into diagnostic categories and assigned scores on the basis of history of allergic reactions, status of nasal mucosa, response to skin tests, and IgE titer. Based on these criteria, in a study of 142 patients with rhinitis, those with allergic or probable allergic rhinitis could clearly be separated from those with nonallergic rhinitis. Thirty-four percent had allergic rhinitis (mean score 5.4), 15% had probable allergic rhinitis (mean score 3.8), 37% had vasomotor rhinitis (noneosinophilic, nonallergic rhinitis; mean score 0.75), and 15% had eosinophilic nonallergic rhinitis (mean score 0.71). Eighty-three percent of patients with eosinophilic nonallergic rhinitis responded to antihistamines and 93% responded to the topical corticosteroid flunisolide, making the total response 90%. The response of the latter patients to these medications was statistically better than the response of those patients with allergic rhinitis.

Eosinophilia↗

PubMed2004

Association between asthma and rhinitis according to atopic sensitization in a population-based study.

BACKGROUND: Although asthma and rhinitis often occur together, the reason for this common comorbidity is still a matter of debate. OBJECTIVE: We sought to assess whether the coexistence of asthma and rhinitis could be explained by common risk factors. METHODS: International cross-sectional study of representative samples of young adults, who completed a detailed questionnaire and underwent lung function tests, bronchoprovocation challenge, IgE measurements, and skin prick tests. RESULTS: In all countries, asthma and bronchial hyperreactivity were more frequent in subjects with rhinitis than in those without (odds ratio [OR], 6.63; 95% CI, 5.44-8.08; and OR, 3.02 95% CI, 2.66-3.43, respectively). Seventy-four percent to 81% of subjects with asthma reported rhinitis, depending on sensitization to specific allergens. Conversely, the risk of asthma increased from 2.0% in subjects without rhinitis to 6.7% in subjects with rhinitis only when exposed to pollen, 11.9% in subjects with rhinitis when exposed to animals, and 18.8% in subjects with rhinitis either when exposed to pollen or to animals. The association between rhinitis and asthma remained significant after adjustment for total IgE, parental history of asthma, and allergen sensitization (OR, 3.41; 95% CI, 2.75-4.2 suggesting that the coexistence of asthma and rhinitis is not solely due to atopic predisposition to these 2 diseases. CONCLUSIONS: Although there were some variations in the association between asthma and rhinitis according to sensitization to individual allergens, the strong association between asthma and rhinitis was not fully explained by shared risk factors, including atopy. Our findings are consistent with the hypothesis that rhinitis might increase the risk of asthma.

Adult↗

PubMedDate not supplied

[Airway hyperreactivity in patients with allergic and non-allergic rhinitis].

BACKGROUND: Epidemiologically there is an association between allergic rhinitis and asthma due to a common inflammatory process. Asthma can affect 40% of the patients with rhinitis and 80% of asthmatics present rhinitis. The relationship between the two diseases is explained by the term of "a united airway". Some patients with allergic rhinitis have nonspecific bronchial hyper-responsiveness, specially during the exacerbation stage. These patients have a unique physiologic characteristic that differs from the asthmatic and healthy subjects developing bronchoconstriction not related to clinical bronchospasm, therefore, allergic rhinitis is considered a risk factor for the asthma development. OBJECTIVE: To determine if there is bronchial hyper-responsiveness in patients with allergic and not allergic rhinitis, by correlating with the eosinophilia in nasal mucosa. MATERIAL AND METHODS: We studied a total of 32 patients with an age range from 18 to 38 years, of both sexes (11 men and 17 women) of the Hospital Regional Lic. Adolfo Lopez Mateos, ISSSTE. They were submitted to clinical history, laboratory studies (blood count cell, serum IgE levels, eosinophils of nasal mucosa), roentgenograms (paranasal sinus and esophagus-gastroduodenal series) and allergy skin tests with 32 allergens. It was taken biopsy of nasal mucosa for the search of eosinophils and it was carried out bronchial challenge with distilled water. Twenty-eight patients concluded the study, they were divided in two groups: a group of 15 patients with diagnosis of allergic rhinitis and another group of 13 patients with diagnosis of non allergic rhinitis. RESULTS: Fifty-six spirometry studies were performed and only 4 patients (26.6%) with diagnosis of allergic rhinitis presented fall of the FEV1 in the bronchial challenge in comparison with the group of non allergic rhinitis in which there were no changes in the FEV1 later to the bronchial challenge. This difference was statistically significant (-4.3 and 0.15, respectively with a p < 0.0370, CI 95%). Moreover, only in the group of allergic rhinitis eosinophils were found in the biopsy of nasal mucosa (93.3%). CONCLUSIONS: Nonspecific bronchial hyper-responsiveness is present in patients with allergic rhinitis. The presence of nasal eosinophils is a persistent inflammation parameter suggesting the allergic origin in these patients.

Adult↗

PubMedDate not supplied

Prevalence and risk factors of allergic rhinitis and cedar pollinosis among Japanese men.

BACKGROUND: Although recent reports show a worldwide increase in allergic diseases during the past 10-20 years, few epidemiological studies on secular trend and the age-specific prevalence of allergic rhinitis have been carried out in Japan. We conducted a study to clarify the age-specific prevalence of allergic rhinitis and cedar pollinosis to provide baseline data for a prospective study and to investigate the association of rhinitis with both environmental and personal factors among 2,307 Japanese men. METHODS: Allergic rhinitis was determined from self-reported allergic rhinitis or from the seasonal symptoms of the nose. Seasonal rhinitis was defined as symptoms evoked in the subjects from February to May. Cedar pollinosis was defined as the presence of cedar-specific IgE positivity among subjects with seasonal rhinitis. RESULTS: The prevalences of allergic rhinitis, seasonal rhinitis, and cedar pollinosis were 35.5, 28.8, and 11.0%, respectively. Age was a negative risk factor for all allergic conditions. Allergic family history and residence along a main street were strong risk factors for all allergic rhinitis. CONCLUSIONS: The current prevalence of each rhinitis was higher than previously reported. The risk factors were similar for each allergic rhinitis except for a past history of atopy.

Adult↗

PubMed2006

Allergic rhinitis: evidence for impact on asthma.

BACKGROUND: This paper reviews the current evidence indicating that comorbid allergic rhinitis may have clinically relevant effects on asthma. DISCUSSION: Allergic rhinitis is very common in patients with asthma, with a reported prevalence of up to 100% in those with allergic asthma. While the temporal relation of allergic rhinitis and asthma diagnoses can be variable, the diagnosis of allergic rhinitis often precedes that of asthma. Rhinitis is an independent risk factor for the subsequent development of asthma in both atopic and nonatopic individuals. Controlled studies have provided conflicting results regarding the benefits for asthma symptoms of treating comorbid allergic rhinitis with intranasal corticosteroids. Effects of other treatments for comorbid allergic rhinitis, including antihistamines, allergen immunotherapy, systemic anti-IgE therapy, and antileukotriene agents, have been examined in a limited number of studies; anti-IgE therapy and antileukotriene agents such as the leukotriene receptor antagonists have benefits for treating both allergic rhinitis and asthma. Results of observational studies indicate that treating comorbid allergic rhinitis results in a lowered risk of asthma-related hospitalizations and emergency visits. Results of several retrospective database studies in the United States and in Europe indicate that, for patients with asthma, the presence of comorbid allergic rhinitis is associated with higher total annual medical costs, greater prescribing frequency of asthma-related medications, as well as increased likelihood of asthma-related hospital admissions and emergency visits. There is therefore evidence suggesting that comorbid allergic rhinitis is a marker for more difficult to control asthma and worsened asthma outcomes. CONCLUSION: These findings highlight the potential for improving asthma outcomes by following a combined therapeutic approach to comorbid allergic rhinitis and asthma rather than targeting each condition separately.

Adult↗

PubMed2004

Prostaglandins, leukotrienes and perennial rhinitis.

Prostaglandins and leukotrienes are implicated in conditions of both the upper and lower airways. In the former they are deranged in nasal polyposis, intrinsic rhinitis and allergic rhinitis while in the latter they are involved in the pathogenesis of asthma. The aim of the present study was to measure mucosal eicosanoid levels in the three types of rhinitis and compare with controls. In addition, the effect of topical steroids on eicosanoid levels in rhinitis was examined. The levels of prostaglandins E(2) (PGE(2)) and D(2) (PGD(2)) and of leukotrienes E(4) (LTE(4)) and B(4) (LTB(4)) were measured in nasal biopsies from the inferior turbinates of patients suffering from perennial rhinitis and a control group. Rhinitis patients were classified into three categories: perennial allergic rhinitis (PAR), non-allergic rhinitis with eosinophilia (NARES) and noneosinophilic non-allergic rhinitis (NENAR) on the basis of symptoms, secretion eosinophilia, nasal resistance and allergy testing. Patients with rhinitis were randomized into two groups. One received fluticasone propionate nasal spray (FPANS) and the other a placebo (PNS) over a period of six weeks prior to the biopsies. One hundred and one patients with PAR, NARES or NENAR were recruited sequentially and the control group consisted of 21 patients with no evidence of rhinitis but with nasal obstruction due to septal deviation. Untreated rhinitics had significantly lower levels of PGE(2), PGD(2) and LTE(4) than non-rhinitic controls. Six-weeks' treatment with FPANS significantly increased the levels of those eicosanoids in patients with PAR and NARES but they were still significantly below normal. Levels of LTB(4) in all three rhinitis groups were not significantly different from controls and treatment with topical steroids had no effect. Their findings are contrary to current thinking that increased levels of eicosanoids, in particular cysteinyl-leukotrienes, play an important role in the pathogenesis of chronic, non-infective upper airway inflammation.

Airway Resistance↗

PubMed1999

Treatment of chronic rhinitis by an allergy specialist improves quality of life outcomes.

BACKGROUND: Allergic rhinitis is associated with significant impairment in quality of life and therefore has a significant impact on the indirect health care costs associated with treatment of chronic rhinitis in the United States. It has been stated that early intervention in the treatment of chronic rhinitis by an allergy specialist improves health outcomes but few unbiased studies have been conducted to substantiate this claim. OBJECTIVE: This study measured quality of life outcomes in the treatment of chronic rhinitis by an allergy specialist. METHODS: Quality of life changes were assessed using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and the "Short-Form" 36-item questionnaire (SF-36) in patients before and after treatment of chronic rhinitis symptoms by a board-certified allergist. Patients with chronic rhinitis were asked by a 3rd year medical student to complete these questionnaires prior to any contact with the allergist. Treatment by the allergist included counseling on avoidance measures when appropriate and a new medication regimen. Patients were contacted by the 3rd year medical student 3 to 5 months later to complete follow-up RQLQ and SF-36 surveys. All data analysis was conducted independently by the 3rd year medical student. RESULTS: Complete sets of pre-treatment and post-treatment surveys were obtained from 19 patients. Perennial allergic rhinitis was diagnosed for 13 patients, perennial allergic rhinitis with a seasonal component was diagnosed for three patients, vasomotor rhinitis was diagnosed for two patients and mixed allergic and non-allergic rhinitis was diagnosed for one patient. Statistically significant improvement was observed in four of the nine health concepts measured by the SF-36 questionnaire. Significant changes above the minimal important difference (MID) were observed post-treatment in six of eight RQLQ dimensions. CONCLUSIONS: This study indicates that intervention by a board-certified allergist significantly improves many areas of health-related quality of life. Further studies comparing health care outcomes and costs of treating chronic rhinitis by primary care physicians to early intervention by allergy specialists are warranted.

Adult↗

PubMed2006

[Allergy in general practice in Arhus County. Quality assessment of diagnosis, treatment and instructions to patients: II. Rhinitis].

INTRODUCTION: The aim of this study was to evaluate adult patients in general practice suspected of having rhinitis. MATERIALS AND METHODS: A total of 72 patients suspected of having rhinitis underwent a secondary specialist investigation, resulting in 55 final specialist diagnoses of rhinitis. Through interviews of patients and a questionnaire mailed to the primary physician, information on diagnostic strategy, final diagnosis, suggested treatments and patients' knowledge about rhinitis were determined. RESULTS: One third of the 72 patients examined for possible rhinitis would have benefited from a supplementary specialist examination, where one group was made up of patients with negative allergy tests and chronic symptoms of either non-rhinitis disease or vasomotoric rhinitis and the other group was made up of patients with severe seasonal allergic rhinitis, who would benefit from immunotherapy. The suggested medical treatments followed modern treatment principles. Of the patients with a final diagnosis of rhinitis, only one third were informed about treatment principles with inhalation steroids, while half of the patients knew about the basic principles of antihistamine treatment. Of 53 patients with rhinitis, 6 were prepared to change medical treatment without first contacting their physician. CONCLUSION: Patients with chronic or recurrent symptoms should be referred to specialists more often, and patients who might benefit from allergen-specific treatment, such as immunotherapy or allergen prevention, should be evaluated by an allergy specialist. Patients with rhinitis should be given more information on disease mechanisms and treatment principles.

Adult↗

PubMed1999

IgE-mediated reactions and hyperreactivity in pregnancy rhinitis.

OBJECTIVES: To determine whether respiratory allergy or hyperreactive nasal mucosa is exceptionally common in women with pregnancy rhinitis, and to evaluate other possible risk factors such as clinical asthma or rhinitis, smoking, age, parity, and sex of the child. PATIENTS AND METHODS: From an antenatal questionnaire study, 165 women, 83 (50%) of whom had had pregnancy rhinitis, were examined 6 months after delivery, and multiple antigen simultaneous testing chemiluminescent assay (MAST CLA) (10 airborne allergens) was performed. After histamine provocations, rhinostereometry and acoustic rhinometry were performed in 25 of them. Serum levels of soluble intercellular adhesion molecule-1 were determined 4 times during and once after pregnancy in 5 women with pregnancy rhinitis and 17 without pregnancy rhinitis. RESULTS: Thirty-nine women (24%) were sensitized to 1 or more allergen. The pregnancy rhinitis group showed significantly higher levels of IgE to house dust mites. There were also more smokers in the pregnancy rhinitis group. Clinical asthma or rhinitis, age, parity, and sex of the child did not differ significantly between the 2 groups. Mucosal swelling increased with rising concentrations of histamine, as measured with rhinostereometry, but there was no significant difference between the 2 groups in any of the variables. Serum soluble intercellular adhesion molecule-1 was not elevated in the pregnancy rhinitis group. CONCLUSIONS: This study found no increased frequency of allergy in general in women who have had pregnancy rhinitis. However, IgE against house dust mite was more frequent in the pregnancy rhinitis group. Smoking seems to be a risk factor, but age, parity, sex of the child, and hyperreactive nasal mucosa do not. Soluble intercellular adhesion molecule-1 was not elevated during pregnancy rhinitis.

Adult↗

PubMed1997

The risk of occupational rhinitis.

OBJECTIVE: Reports on the aetiology and risk of occupational rhinitis in different occupations are scarce. METHOD: The purpose of this study was to find the occupations with an increased risk of occupational rhinitis. Age and gender differences in occupational rhinitis and occupational asthma were also compared, and the most common causes of occupational rhinitis were analysed. DESIGN: This study covered the cases of occupational rhinitis and asthma reported to the Finnish Register of Occupational Diseases during the years 1986-1991. The cases on the Register were linked to the longitudinal census data file from the Finnish censuses. RESULTS: During 1986-1991, 1244 new cases of occupational rhinitis (474 women and 497 men) and 1867 new cases of occupational asthma (916 women and 951 men) were reported to the Register. Animal dander, flours, wood dusts, textiles, phthalic acid anhydrides and storage mites were important causes of occupational rhinitis. The highest relative risk of occupational rhinitis was among furriers, the age-standardized rate ratio (SRR) was 30.0. Bakers and livestock breeders had also a markedly elevated relative risk (SRR = 22.0). Men had the highest incidence of occupational rhinitis at the age of 25-29 years and among women the incidence gradually increased and reached the peak in the group 40-44 years of age. CONCLUSION: Furriers, bakers, and livestock breeders had the most elevated relative risk of occupational rhinitis. Occupational rhinitis cases reported at a younger age than asthma, suggesting that rhinitis often precedes asthma.

Adolescent↗

PubMed2004

Mechanisms of vasomotor rhinitis.

Nonallergic non-infectious perennial rhinitis (NANIPER) is a heterogeneous disorder comprising several pathophysiological entities. The etiology of some of these disorders (e.g. drug-induced rhinitis, nonallergic rhinitis with eosinophilia syndrome [NARES], occupational rhinitis, hormonal rhinitis, emotion-induced rhinitis, physical/chemical irritant-induced rhinitis) is well established. In contrast, the aetiology of idiopathic forms of rhinitis (also known as vasomotor rhinitis) is largely unknown. Mechanistic studies have suggested that non-IgE-mediated inflammatory and/or neurogenic processes may be involved. There is evidence that localized inflammation is the underlying cause of symptoms in drug-induced rhinitis and NARES, since eosinophilia is an important pathophysiological component in these conditions. In contrast, neurogenic reflex mechanisms initiated by environmental factors appear to be involved in idiopathic rhinitis. It has been suggested that there may be an imbalance of the sympathetic and parasympathetic nervous systems, with parasympathetic hyper-activity and sympathetic hypo-activity resulting in nasal congestion and rhinorrhoea. Indirect evidence suggests that C-fibres may also play an important role in the pathophysiology of idiopathic rhinitis.

Drug-Related Side Effects and Adverse Reactions↗

PubMed2002

Rhinitis in 10-year-old children and early life risk factors for its development.

AIM: To study the prevalence, characteristics of and risk factors for childhood rhinitis. METHODS: In a whole population birth cohort study (n = 1,456) the prevalence and characteristics of rhinitis among 10-y-old children were examined. At this age 1373 children (94%) completed standardized questionnaires, 1,043 (72%) skin-prick testing, 953 (65%) serum inhalant immunoglobulin E antibody screening and 784 (54%) methacholine bronchial challenges. RESULTS: At the age of 10 y the prevalence of hayfever ever was 18.6% and current nasal symptoms (rhinitis) 22.6%. Rhinitis at 10 y was largely seasonal and associated with low morbidity, although 62.7% of cases required pharmacological treatment. Atopy (positive skin test) and other allergic states were associated with rhinitis (p < 0.001). Wheeze or diagnosed asthma was higher with coexistent rhinitis. Among wheezing children physician-diagnosed asthma (p < 0.024) and inhaled corticosteroid use (p < 0.001) were greater with the presence of rhinitis. Significant bronchial hyperresponsiveness (methacholine concentration giving a 20% fall in forced expiratory volume in I s <4.0 mg ml(-1)) was greater if rhinitis was present even when the child did not wheeze (p < 0.001). Risk factor analysis for rhinitis identified the independent significance for atopy (p < 0.001) and eczema (p = 0.009) at the age of 4 y plus paternal rhinitis (p < 0.001), maternal rhinitis (p = 0.033) and maternal food allergy (p = 0.016). CONCLUSION: Rhinitis is common at the age of 10 y, with strong associations with atopy, wheezing, asthma and bronchial hyperresponsiveness. An inherited predisposition towards atopy appears to predominate over environment in the aetiology of this state.

Bronchial Hyperreactivity↗

PubMedDate not supplied

[Vasomotor skin tests in non-eosinophilic and eosinophilic long-term (perennial) nonallergic rhinitis].

INTRODUCTION: It has generally been assumed that "perennial" non-allergic rhinitis is a heterogeneous syndrome consisting of at least two groups: non-eosinopilic and eosinophilic. Opposite to non-eosinophilic group, eosinophilic group is characterized by nasal secretion eosinophilia, frequent evolution to nasal polyposis or complete ASA triad (nasal polyposis, intrinsic asthma and intolerance of non-steroidal anti-inflammatory drugs) and by a good response to treatment with anti-histamines and corticosteroids. These characteristics obviously separate eosinophilic from non-eosinophilic rhinitis and point out the importance of nasal secretion eosinophilia for the evolution and therapy of rhinitis. However, the distinction between eosinophilic and non-eosinophilic rhinitis can only be made by nasal cytology. Skin tests with vasomotor agents were carried out to characterize vasomotor skin reactivity in "perennial" non-allergic rhinitis and determine whether the patients with non-eosinophilic rhinitis differ from patients with eosinophilic rhinitis. METHODS: On the basis of the examination of nasal smears of eosinophils, 74 patients with "perennial" non-allergic rhinitis were divided into non-eosinophilic (n = 63) and eosinophilic group (n = 11). Nasal eosinophilic was considered significant when 20% and more of the cells in nasal smear were eosinophils. Skin reactivity to intracutaneous test with different concentrations of papaverine, metacholine, histamine and compound 48/48 was measured, as well as specific skin reactivity to control saline solution. Pathological skin reactivity to vasomotor agents was defined as hyporeactivity to papaverine (5 mg/mL), when wheal-and-flare skin reaction diameter was less than 15 mm; hyper-reactivity to metacholine (0.02, 0.2 and 2.0 mg/mL), when two of three wheal-and-flare skin reaction diameters were greater than 15, 25 and 31 mm, respectively; hyper-reactivity to histamine (0.01, 0.1, 1.0 and 10.0 micrograms/mL), when three of four wheal-and-flare skin reaction diameters were greater than 7, 13, 25 and 40 mm, respectively; and hyper-reactivity to compound 48/80 (0.01, 0.1, 1.0 and 10.0 micrograms/mL, when three of four wheal-and-flare skin reaction diameters were greater than 9, 16, 26 and 38 mm, respectively. RESULTS: Seventy four patients with "perennial" non-allergic rhinitis were included in the study. There were 51 females, age range from 18 to 57 yrs. (mean 37 yrs.) and 23 males, age range from 18 to 73 yrs. (mean 44 yrs.). The difference between the number of females and males was significant (p = 1.1 x 10(-3)), while no significant difference regarding the age between females and males was found (p = 0.122). Significant percentage of eosinophils was found in 15% of "perennial" non-allergic rhinitis patients, and they were classified into eosinophilic group (n = 11). In this group, the percentage of eosinophils varied from 20% to 80%, mean 35%. In non-eosinophilic group (n = 63), it ranged from 0% to 10%, mean 1%. No significant difference concerning sex and age between the two groups of the rhinitis patients was observed (Table 1). There was no significant intergroup difference for pathological skin reactivity to papaverine, metacholine, histamine, compound 48/80 and saline (Table 2). Total pathological skin reactivity to vasomotor agents, single and in combination, was found in 78% of non-eosinophilic and in 91% of eosiniophilic rhinitis patients (Table 3). In both, non-eosinophilic and eosinophilic groups, frequencies of total pathological skin reactivity to vasomotor agents was significantly greater than frequencies of total normal skin reactivity (p = 1.1 x 10(-5) and p = 0.007 respectively). However, the difference of total pathological skin reactivity to vasomotor agents between the two groups was not significant (p = 0.552). (ABSTRACT TRUNCATED)

Adolescent↗

PubMedDate not supplied

[Rhinitis and cough syndrome. Are epidemiologic, clinical and functional characteristics useful in the differential diagnosis with bronchial asthma?].

UNLABELLED: Patients often visit family practitioners or respiratory specialists complaining of cough. In non-smokers, the most common cause is postnasal drip secondary to rhinitis. The second most common cause is bronchial asthma. OBJECTIVES: a) To know the epidemiological, clinical and functional features of patients who visit our outpatient pneumology clinic complaining of chronic cough as an isolated symptom, in whom bronchial asthma is suspected, but who have received a diagnosis of rhinitis. b) To analyze the differences between such patients and those in whom chronic cough has been attributed to bronchial asthma. PATIENTS AND METHODS: One hundred thirty-one patients with chronic cough were enrolled for study under the following protocol: 1) taking of a detailed case history (epidemiological and clinical data), 2) physical examination, 3) blood work-up, 4) paranasal sinus and chest X-rays, 5) spirometry at baseline and after 200 micrograms of salbutamol if obstruction was present, 6) methacholine challenge test, 7) skin tests for common respiratory tract allergens, 8) other techniques, depending on suspected diagnosis (CT chest scan, fiberoptic bronchoscopy, consultation with a gastroenterologist or otorhinolaryngologist). RESULTS: One hundred seventeen (89.3%) patients received a diagnosis of rhinitis. Chronic cough was attributed solely to rhinitis in 61 (46.5%) patients. Forty-four (33.5%) were diagnosed as bronchial asthma; 38 (29%) also had rhinitis. Chronic cough was attributed to a different diagnosis in 26 cases (19.8%). The 61 patients with rhinitis as the sole cause of chronic cough were aged 23.8 +/- 10.8 years (9-63 years); 33 (54% of the 61) were men and 28 (46% of the 61) were women. We found that patients with rhinitis more often suffered nasal symptoms (chi 2 = 22.4; p = 0.01), pharyngeal irritation (chi 2 = 9.63, p = 0.05), dry cough from the upper respiratory tract (chi 2 = 16.4, p = 0.001), atopy (chi 2 = 18.1, p < 0.001) and greater FVC (F = 5.28, p = 0.006) than did patients with asthma or other diagnoses. CONCLUSIONS: 1) Rhinitis was the most common cause of chronic cough in the studied patients in whom a diagnosis of bronchial asthma had been suspected. 2) Epidemiological characteristics did not aid differential diagnosis between rhinitis and bronchial asthma (with or without associated rhinitis). 3) A detailed medical history focusing on upper airway symptoms can be useful, although there may be cases of silent postnasal drip syndrome. 4) Paranasal x-rays help to rule out complications of rhinitis. 5) A positive bronchial challenge test does not necessarily indicate a diagnosis of bronchial asthma. 6) Allergy to pollen is the most common finding among atopic patients with rhinitis.

Adult↗

PubMed2000

Prevalence and predictors of rhinitis in Danish children and adolescents.

BACKGROUND: The prevalence of self-reported symptoms of allergic rhinitis is increasing in many countries, but the reasons for this trend are not well understood. Data from a 6-year follow-up study of a population sample of children and adolescents (n=408), aged 7-17 years at enrolment in 1986, were analyzed to investigate the prevalence and predictors of self-reported rhinitis. METHODS: Case history was used to assess the presence or absence of rhinitis (sneezing and running or blocked nose not associated with a cold), asthma, and eczema. Pulmonary function, skin prick test reactivity, and airway responsiveness to histamine were measured in all participants; a screening test for IgE antibodies to common allergens (Magic Lite SQ, Allergy Screen, ALK, Denmark) was performed in 237 (58%) of the participants. RESULTS: The point prevalence of rhinitis increased from the first to the second survey, 14% and 22%, respectively; 54 (13%) of the subjects reported rhinitis only at the second survey (new rhinitis). Confining the analysis to participants without symptoms of rhinitis at the first survey showed that self-reported eczema (relative risk [RR] 2.3, 95% confidence interval [CI] 1.2-4.7), airway hyperresponsiveness (RR 2.5, CI 1.8-3.0), atopy to grass pollen (RR 2.6, CI 1.7-3.3), atopy to dog dander (RR 2.4, CI 1.6-3.3), and atopy to house-dust mite (RR 2.7, CI 1.4-5.2) at the first survey predicted an increased risk of the presence of rhinitis at the second survey. A positive Allergy Screen test at enrollment was associated with an increased risk of self-reported rhinitis at follow-up (RR 2.4, CI 1.4-3.4). CONCLUSIONS: This longitudinal population study of children and adolescents showed an age-related increase in the point prevalence of self-reported rhinitis; furthermore, sensitization to common aeroallergens, airway hyperresponsiveness, and the presence of self-reported eczema were significantly associated with an increased risk of subsequent development of rhinitis.

Adolescent↗

PubMed2002

Rhinitis is associated with increased systolic blood pressure in men: a population-based study.

An association between impaired lower respiratory function and cardiovascular risk factors, such as hypertension, is often reported but it is unknown whether there is a relationship between upper airway disorders and cardiovascular risk factors, despite evidence that upper and lower respiratory tract disorders are closely linked. Our objective was to assess whether rhinitis is associated with arterial blood pressure and hypertension. In a population-based study of 330 adults aged 28-56 years, as part of the European Community Respiratory Health Survey, rhinitis was assessed by means of a questionnaire, and cardiovascular data were obtained using a questionnaire and by measuring blood pressure. Systolic blood pressure (SBP) was higher in men with rhinitis than in men without rhinitis (130.6 +/- 12.7 mm Hg versus 123.5 +/- 13.9 mm Hg; p = 0.002), and it was still the case after adjustment for cardiovascular and respiratory confounding factors. Hypertension was more frequent in men with rhinitis than in men without rhinitis, even after multivariate adjustment (odds ratio = 2.6, 95% confidence interval = [1.14-5.91]). The observation of SBP levels according to whether men have no rhinitis, seasonal rhinitis, or perennial rhinitis was compatible with a dose-response relationship (p for trend = 0.02). In conclusion, rhinitis is strongly associated with SBP and hypertension in men. Blood pressure should be regularly checked in men with rhinitis.

Adult↗

PubMed2003

Relation between blood pressure and rhinitis in a Japanese adolescent population.

Recent studies have reported an association between systolic blood pressure (BP) and rhinitis. The prevalence of allergic rhinitis is 20% to 30% in Japan. The present cross-sectional study was performed to assess the relation between BP and allergic rhinitis in a sample of 2,292 male adolescent high school students who attended the annual school health examination. Of the 2,292 students (mean age, 16 years), 26.6% were considered to have allergic rhinitis based on their responses to a questionnaire, 25.1% were diagnosed with allergic rhinitis by an otolaryngologist, and 12.6% were consistently diagnosed with allergic rhinitis by both questionnaire and an otolaryngologist. There was no difference in systolic BP between subjects with and without allergic rhinitis. Diastolic BP, however, was higher in subjects without allergic rhinitis than in those with allergic rhinitis as diagnosed by questionnaire alone or by both questionnaire and an otolaryngologist. When the subjects were divided into three BP categories (normal, high normal, and hypertension) according to the criteria in the JSH 2000, the rates of allergic rhinitis were similar in the three BP categories. These findings do not confirm a relation between allergic rhinitis and systolic BP.

Adolescent↗