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Jan Hed, Clin Immunologist, MD, PhD
Karolinska Institutet, IMPI, Div of Clin Immunology
Huddinge University Hospital, Sweden
 
The statements below are based on conclusions from selected publications. Their intention is to highlight recent research and information that could be beneficial in allergy in vitro testing. They can include seemingly contradictory statements due to differences in selecting patient populations as well as in the study design.

  • The major symptoms of allergic rhinitis are: sneezing; a clear, watery rhinorrhoea; itching affecting the nose, eyes and palate; and nasal obstruction (for review, see 1)
  • Allergic rhinitis is ranked as the sixth most-prevalent chronic condition in the United States (for review,see 2).
  • It has been suggested that in western countries, approximately 25% of the population may, at some time in their lives, suffer from rhinitis (3, for review, see 4, 5).
  • Allergic rhinitis symptoms are common and persistent in the first four decades of life. Symptoms are unusual before three years of age and usually improve after the age of fifty (for review, see 6, 7).
  • Epidemiologic studies have consistently shown that asthma and rhinitis often coexist in the same patients (8, 9, for review, see 410).
  • The onset of rhinitis and asthma may be temporally related. Rhinitis frequently precedes asthma and may be a predictive factor for subsequent development of asthma (8,9, for review, see 10).
  • In a 23-year follow-up study, patients with rhinitis were three times more likely to have asthma than participants without rhinitis (8).
  • Patients with seasonal allergic rhinitis have an incidence of non-specific bronchial hyperresponisiveness up to 32%, which increases up to 48% during the pollen season (11, 12, 13, 14, 15).
  • Inflammatory cells, assessed by sputum induction, are present not only in the airways of patients with asthma, but also in the airways of patients with seasonal allergic rhinitis (16).
  • Patients with perennial allergic rhinitis appear to have higher levels of non-specific bronchial hyperresponsiveness than patients with seasonal nasal allergy (13) and also have a higher risk of developing asthma (9).
  • In contrast to IgE sensitization to indoor allergens (mite) (17,18), pollen sensitization has not been found to be an independent risk factor (19,20,21,22) to asthma.

References:

    1. Parikh A, Scadding GK. Seasonal allergic rhinitis. Br Med J 1997;314:1932-5. 
    2. Nacelerio RM. Allergic rhinitis. N Engl J Med 1991;325:860-9.
    3. Sibbald B, Rink E. Epidemiology and seasonal perennial rhinitis: clinical presentation and medical history. Thorax 1991;46:895-901.
    4. Djukanovic R, Wilson SJ, Howarth PH. Pathology of rhinitis and bronchial asthma. Clin Exp Allergy 1996;26(suppl 3):44-51.
    5. Sly RM. Changing prevalence of allergic rhinitis and asthma. Ann Allergy Asthma Immunol 1999;82:233-48.
    6. Urval KR. Overview of diagnosis and management of allergic rhinitis. Prim Care 1998;25:649-62.
    7. Nash DR. Allergic rhinitis. Ped Ann 1998;27:799-808.
    8. Settipane RJ, Hagy GW, Settipane GA. Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students. Allergy Proc 1994;15:21-5.
    9. Linna O, Kokkonen J, Lukin M. A 10-year prognosis for childhood allergic rhinitis. Acta Paediatr 1992;81:100-2.
    10. Corren J. Allergic rhinitis and asthma: How important is the link? J Allergy Clin Immunol 1997;99:S781-6.
    11. Madonini E, Briatico-Vangosa G, Pappacoda A, Maccagni G, Cardani A, Saporiti F. Seasonal increase of bronchial reactivity in allergic rhinitis. J Allergy Clin Immunol 1987;79:358-63.
    12. Ramsdale EH, Morris MM, Roberts RS, Hargreave FE. Asymptomatic bronchial hyperresponsiveness in rhinitis. J Allergy Clin Immunol 1985;75:573-7.
    13. Verdiani P, Di Carlo S, Baronti A. Different prevalence and degree of nonspecific bronchial hyperreactivity between seasonal and perennial rhinitis. J Allergy Clin Immunol 1990;86;576-82.
    14. Sotomayor H, Badier M, Vervloet D, Orehek J. Seasonal increase in carbachol airway responsiveness in patients allergic to grass pollen. Reversal by corticosteroids. Am Rev Respir Dis 1984;130:56-8.
    15. Pelucci A, Chiapparino A, Mastropasqua B, Marazzini L, Hernadez A, Foresi A. Effect of intranasal azelastine and beclomethasone dipropionate on nasal symptoms, nasal cytology, and bronchial responsiveness to metacholine in allergic rhinitis in response to grass pollen. J Allergy Clin Immunol 1995;95:515-23.
    16. Foresi A, Leone C, Pelucchi A , Mastropasqua B, Chetta A, D´Ippolito R et al. Eosinophils, mast cells, and basophils in induced sputum from patients with seasonal allergic rhinitis and perennial asthma: relationship to metacholine responsiveness. J Allergy Clin Immunol 1997;100:58-64.
    17. Sporik R, Holgate ST, Platts-Mills TA, Cogswell JJ. Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood. A prospective study. N Engl J Med 1990;323:502-7.
    18. Peat JK, Tovey E, Toelle BG, Haby MM, Gray EJ, Mahmic A et al. House dust mite allergens. A major risk factor for childhood asthma in Australia. Am J Respir Crit Care Med 1996;153:141-6.
    19. Gergen PJ, Turkeltaub PC. The association of individual allergen reactivity with respiratory disease in a national sample: data from the second National Health and Nutrition Examination Survey. 1976-80 (NHANES II). J Allergy Clin Immunol 1992;90:579-88.
    20. Peat JK, Tovey E, Gray EJ, Mellis CM, Woolcock AJ. Asthma severity and morbidity in a population sample of Sydney school-children: Part II - Importance of house dust mite allergen. Aust N Z J Med 1994;24:270-6.
    21. Sears MR, Herbison GP, Holdaway MD, Hewitt CJ, Flannery EM, Silva PA. The relative risks of sensitivity to grass pollen, house dust mite, and cat dander in the development of childhood asthma. Clin Exp Allergy 1989;19:419-24.
    22. Squillace SP, Sporik RB, Rakes G, Couture N, Lawrence A, Merriam S et al. Sensitization to dust mites as a dominant risk factor for asthma among adolescents living in central Virginia. Multiple regression analysis of a population-based study. Am J Respir Crit Car Med 1997;156:1760-4.