ORLANDO, Fla. — Allergic rhinitis and asthma may be considered as manifestations of one syndrome that has a wide spectrum of severity, according to data presented here during the American Academy of Allergy, Asthma & Immunology 2012 Annual Meeting.
Ruby Pawankar, MD, PhD, from the Nippon Medical School in Tokyo said that IgE-mediated disease can either manifest as allergic rhinitis (AR), asthma or both, and increasing evidence on the links between AR and asthma comes from epidemiologic, immunologic and clinical studies.
“Epidemiologically, up to 40% of patients with AR had asthma, and up to 80% of patients with asthma experience nasal symptoms,” Pawankar said. “AR has been shown to increase the risk of asthma three-fold.”
For patients with both AR and asthma, treating symptoms of AR results in a decreased asthma-related hospitalization, according to study findings presented by Pawankar.
“That gives a window of opportunity that by treating AR in patients with asthma and AR, you are helping improve asthma symptoms, and this has been shown in several studies. Treating AR is a strong, important component of asthma control in patients who have comorbid disease.”
While asthma was once considered a disease of the Western world, she presented studies that indicate asthma is becoming more prevalent in countries like Japan, Vietnam and Taiwan.
Various studies from Asia presented by Pawankar showed the significant impact of asthma on children’s lives, including a disruption of school and inability to enjoy social activities. When the children had both AR and asthma, the total disruption was nearly 80% in all the parameters measured.
Additional comorbidites linked with AR include conjunctivitis, rhinosinusitis, nasal polyps, otitis media with effusion (OME) and sleep obstruction.
In fact, Pawankar said, 66% of patients with AR also present with conjunctivitis and these patients with comorbid AR and conjunctivitis can also present with eczema, urticaria, and ocular symptoms. One study reported than 71.4% of patients with AR actually suffer with multiple symptoms, including nasal and ocular symptoms.
“Studies have clearly shown that the ocular symptoms are as bad or worse than the nasal congestions or nasal obstruction seen with AR,” Pawankar said.
Regarding sinusitis, patients with AR and sinusitis have an creased risk of upper respiratory tract infections, and the duration of these infections is longer than in children without AR. As for OME, children with AR suffer from increased allergic reactions, especially during ragweed season, and can result in Eustachian tube obstruction.
“Studies have shown that many of these children with AR and OME also have asthma,” Pawankar said. “Inflammation of the Eustachian tube continues post-season and treatment should also continue beyond the end of the season.”
Pawankar said that many children could be diagnosed with a condition known chronic allergic respiratory syndrome because they could have multiple comorbid conditions, including AR, sinusitis, OME, asthma and obstructive sleep apenea.
“It doesn’t meant these patients have to have all these conditions, but the important message is that you have to look for all these comorbidities and treat these comorbidities in order to be able to reach better relief of the patient’s symptoms,” Pawankar said.
- Pawankar R. Course 1610. Upper airway disease and comorbities: comorbidities of allergic rhinitis; asthma, rhinosinusitis and otitis. Presented at: The AAAAI 2012 Annual Meeting; March 2-6, 2012; Orlando, Fla.
- Dr. Pawankar reports no relevant financial disclosures.