Allergic rhinitis and onset of bronchial hyperresponsiveness: a population-based study.
BACKGROUND
Patients with allergic rhinitis have more frequent bronchial hyperresponsiveness (BHR) in cross-sectional studies.


OBJECTIVE
To estimate the changes in BHR in nonasthmatic subjects with and without allergic rhinitis during a 9-year period.


METHODS
BHR onset was studied in 3,719 subjects without BHR at baseline, who participated in the follow-up of the European Community Respiratory Health Survey.


RESULTS
BHR was defined as a >or=20% decrease in FEV(1) for a maximum dose of 1 mg of methacholine. Allergic rhinitis was defined as having a history of nasal allergy and positive specific IgE (>or=0.35 IU/ml) to pollen, cat, mites, or Cladosporium. The cumulative incidence of BHR was 9.7% in subjects with allergic rhinitis and 7.0% in subjects with atopy but no rhinitis, compared with 5.5% in subjects without allergic rhinitis and atopy (respective odds ratios [OR] and their 95% confidence intervals [95% CI] for BHR onset, 2.44 [1.73-3.45]; and 1.35 [0.86-2.11], after adjustment for potential confounders including sex, smoking, body mass index and FEV(1)). Subjects with rhinitis sensitized exclusively to cat or to mites were particularly at increased risk of developing BHR (ORs [95% CI], 7.90 [3.48-17.93] and 2.84 [1.36-5.93], respectively). Conversely, in subjects with BHR at baseline (n = 372), 35.3% of those with allergic rhinitis, compared with 51.8% of those without rhinitis had no more BHR at follow-up (OR [95% CI], 0.51 [0.33-0.78]). BHR "remission" was more frequent in patients with rhinitis treated by nasal steroids than in those not treated (OR [95% CI], 0.33 [0.14-0.75]).


CONCLUSIONS
Allergic rhinitis was associated with increased onset of BHR, and less chance for remission except in those treated for rhinitis.
Shaaban
Rafea
R
INSERM U700, Epidémiologie des Maladies Respiratoires Faculté Xavier Bichat, BP 416, Paris, France. shaaban@bichat.inserm.fr
Zureik
Mahmoud
M
Soussan
David
D
Antó
Josep M
JM
Heinrich
Joachim
J
Janson
Christer
C
Künzli
Nino
N
Sunyer
Jordi
J
Wjst
Matthias
M
Burney
Peter G
PG
Neukirch
Françoise
F
Leynaert
Bénédicte
B
D000328:Adult; D000485:Allergens; D000818:Animals; D039741:Antigens, Dermatophagoides; D016535:Bronchial Hyperreactivity; D001985:Bronchial Provocation Tests; D002415:Cats; D002963:Cladosporium; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000276:immunology; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D006109:Poaceae; D011058:Pollen; D012221:Rhinitis, Allergic, Perennial / Q000276:immunology* / Q000503:physiopathology; D006255:Rhinitis, Allergic, Seasonal / Q000276:immunology* / Q000503:physiopathology; D011795:Surveys and Questionnaires
D000485:Allergens; D039741:Antigens, Dermatophagoides; D007073:Immunoglobulin E