Links between allergic rhinitis and asthma

Most patients with asthma have rhinitis suggesting the concept of ‘one airway one disease’ or ‘united airways’.

Prevalence of asthma in:

- patients without rhinitis -- less than 2%
- patients with rhinitis -- 10-40%

Most patients with allergic or nonallergic asthma present with rhinitis symptoms. However, not all patients with rhinitis present with asthma.

Many patients with allergic rhinitis have an increased bronchial reactivity to methacholine.

It is not clear if treatment of one airway will improve symptoms of the other site.

The 1999 WHO workshop ‘Allergic Rhinitis and its Impact on Asthma’ recommended:

- patients with persistent allergic rhinitis should be evaluated for asthma by history, chest examination, and possibly assessment of airflow obstruction before and after bronchodilator

- history and examination of the upper respiratory tract for allergic rhinitis should be performed in patients with asthma

It is clear that asthma and allergic rhinitis have a lot in common, including the classification nomenclature: M MMS

Mild intermittent

Mild persistent
Moderate persistent
Severe persistent

Subcutaneous immunotherapy (SCIT) can be beneficial in both allergic rhinitis and atopic asthma. For the first time, the new 2007 asthma guidelines by the National Heart, Lung, and Blood Institute (NHLBI) recommend immunotherapy for treatment of asthma, quote from page 195:

“The Expert Panel recommends that allergen immunotherapy be considered for patients who have persistent asthma if evidence is clear of a relationship between symptoms and exposure to an allergen to which the patient is sensitive (Evidence B).”

References:

Links between allergic rhinitis and asthma still reinforced. P. Demoly, P. J. Bousquet (2008). Allergy 63 (3), 251–254.
Expert Panel Report 3 (EPR 3): Guidelines for the Diagnosis and Management of Asthma. National Heart, Lung, and Blood Institute (NHLBI).
70-page Summary: Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma - Summary Report 2007.
Rhinitis is common in asthma and impairs asthma control. Allergy. 2011.
Poor asthma control? – then look up the nose. The importance of co-morbid rhinitis in patients with asthma http://goo.gl/0nNZg
Image source: Wikipedia, a Creative Commons license.



Treatment Options for Allergic Rhinitis (click to enlarge the image).