- Sciences & innovation
- The respiratory allergens
- Links between rhinitis and asthma
People who suffer from allergic rhinitis are three times more likely to develop asthma than non-allergic individuals.
A certain number of studies have demonstrated the frequent coexistence of these two conditions. Although there are differences between allergic rhinitis and asthma, both are caused by a common inflammatory process affecting the upper and lower airways.
Therefore, managing allergic rhinitis may prevent the onset of asthma.
According to the ARIA guidelines
According to the ARIA guidelines:
- Asthma should be looked for in patients suffering from persistent allergic rhinitis
- Rhinitis should be looked for in patients suffering from asthma
It is now well established that the pathophysiological mechanisms of rhinitis contribute to or predispose a large number of patients to the development of asthma. Despite differences, asthma and rhinitis share common physiological, pathophysiological and epidemiological features.
The simultaneous exposure of the nasal mucosa and upper and lower respiratory tract to allergens allows allergic rhinitis and asthma to maintain a close relationship. Braunstahl et al.[1] were able to demonstrate recently that allergen stimulation of the nasal mucosa resulted in distal bronchial inflammation and, conversely, allergen stimulation of the bronchi could provoke inflammation of the nasal mucosa, measured objectively by eosinophil accumulation.
Cross-sectional and longitudinal epidemiological studies have made it possible to establish the relationship between asthma and rhinitis. Thus, Settipane,[2] studying a cohort of patients with rhinitis for 23 years, has been able to show a higher incidence of asthma in patients who had rhinitis during childhood.
The Rowe-Jones[3] study showed that 75% of patients with allergic asthma also had rhinitis; 20% of patients with perennial allergic rhinitis had asthma; and 25% of patients simultaneously develop asthma and rhinitis. This study also showed that patients suffering from seasonal allergic rhinitis were four times more likely to develop asthma.
In a long-term prospective study, Rachelefsky[4] was able to demonstrate the rhinitisasthma relationship in 60% of patients, and also showed the elevated frequency of other conditions comorbid with rhinitis. For example, allergic rhinitis is found in 56% of patients treated for chronic sinusitis. In one out of two cases, a patient who has chronic otitis also presents with allergic rhinitis.
Recently, B. Leynaert[5] showed via the international epidemiological study ECHRS that 80% of asthma patients also had rhinitis and that the risk of occurrence of asthma in patients with rhinitis increased as a function of the type of allergen sensitisation: there is a 6.7% risk in case of rhinitis induced by pollen; an 11.9% risk in case of rhinitis induced by animal dander; and a 19% risk in patients who suffer from allergic rhinitis induced by both pollen and animal dander.
