Volume 104, Issue 2 , Pages 301-304, August 1999
Perennial rhinitis: An independent risk factor for asthma in nonatopic subjects:☆☆☆★
Results from the European Community Respiratory Health Survey
Abstract
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. (J Allergy Clin Immunol 1999;104:301-4.)
Keywords: Rhinitis, asthma, bronchial hyperresponsiveness, atopy, population study
Abbreviations: BHR , Bronchial hyperresponsiveness, CI , Confidence interval, ECRHS , European Community Respiratory Health Survey, OR , Odds ratio
☆ Supported by the European Commission. The following grants helped fund the local studies. Australia: Allen and Hanbury’s, Australia; Belgium: Belgian Science Policy Office and the National Fund for Scientific Research; France: Ministère de la Santé, Glaxo France, Institut Pneumologique d’Aquitaine, Contrat de Plan Etat-Région Languedoc-Roussillon, CNMATS, CNMRT (90MR/10, 91AF/6), the Ministre délégué de la santé, and RNSP; Germany: GSF and the Bundesminister für Forschung und Technologie, Bonn; Greece: The Greek Secretary General of Research and Technology, Fisons, Astra, and Boehringer-Ingelheim; India: Bombay Hospital Trust; Italy: Ministero dell’Univesità e della Ricerca Scientifica e Tecnologica, CNR, Regione Veneto grant RSF n. 381/05.93; New Zealand: Asthma Foundation of New Zealand, Lotteries Grant Board, and the Health Research Council of New Zealand; Norway: Norwegian Research Council project no. 101422/310; Portugal: Glaxo Farmacêutica Lda, Sandoz Portugesa; Spain: Ministero Sanidad y Consumo FIS (grants #91/0016060/OOE-05E., #92/0319, #93/0393), Hospital General de Albacete, Hospital General Juan Ramón Jiménenz, and the Consejeria de Sanidad Principado de Asturias; Sweden: The Swedish Medical Research Council, the Swedish Heart Lung Foundation, the Swedish Association against Asthma and Allergy, The Swedish Society of Medicine, Astra, Glaxo-Wellcome, and Boehringer-Ingelheim; Switzerland: Swiss National Science Foundation grant 4026-28099; UK: National Asthma Campaign, British Lung Foundation, Department of Health, and the South Thames Regional Health Authority; USA: United States Department of Health, Education and Welfare Public Health Service Grant #2 S07 RR05521-28.
☆☆ Reprint requests: Bénédicte Leynaert, PhD, Epidémiologie, Faculté de Médecine Xavier Bichat, BP 416, 75870 Paris Cedex 18, France.
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Volume 104, Issue 2 , Pages 301-304, August 1999
