Nasal hyperreactivity in allergic and non-allergic rhinitis: a potential risk factor for non-specific building-related illness.
Self-reported non-allergic nasal symptom triggers in non-allergic ('vasomotor') rhinitis overlap with commonly identified environmental exposures in non-specific building-related illness. These include extremes of temperature and humidity, cleaning products, fragrances, and tobacco smoke. Some individuals with allergic rhinitis also report non-allergic triggers. We wished to explore the phenotypic overlap between allergic and non-allergic rhinitis by ascertaining self-reported non-allergic nasal symptom triggers among allergic rhinitics. Sixty subjects without work-related respiratory exposures or symptoms, aged 19-68 years, stratified by age, gender and (skin test-proven) allergic rhinitis status, were queried with regard to self-reported non-allergic nasal symptom triggers (aggregate score 0-8). In this sample, the number of self-reported non-allergic triggers was bimodal, with peaks at 1 and 5. Forty-two percent of seasonal allergic rhinitic subjects reported more than three non-allergic triggers, compared with only 3% of non-allergic non-rhinitics (P < 0.01). Subjects over 35 years were more likely to report one or more non-allergic triggers, particularly tobacco smoke (P < 0.05). Allergic rhinitics reported more non-allergic symptom triggers than did non-allergic, non-rhinitics. As indexed by self-reported reactivity to non-specific physical and chemical triggers, both non-allergic rhinitics and a subset of allergic rhinitics may constitute susceptible populations for non-specific building-related illness.


CONCLUSIONS
Judging by self-report, a substantial subset of individuals with allergic rhinitis--along with all individuals with nonallergic rhinitis (by definition)--are hyperreactive to non-allergic triggers. There is overlap between these triggers (elicited in the process of obtaining a clinical diagnosis) and environmental characteristics associated with ''problem buildings.'' Since individuals with self-identified rhinitis report an excess of symptoms in most epidemiologic studies of problem buildings (even in the absence of unusual aeroallergen levels), rhintics may be acting as a ''sentinel'' subgroup when indoor air quality is suboptimal. Together, non-allergic rhinitics plus allergic rhinitics with prominent non-allergic triggers, are thought to constitute approximately one-sixth of the US population.
Shusterman
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Department of Medicine, University of Washington, Seattle, WA 98104, USA. dennis3@u.washington.edu
Murphy
M A
MA
D000328:Adult; D000367:Age Factors; D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects*; D016535:Bronchial Hyperreactivity / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D003902:Detergents / Q000009:adverse effects; D004781:Environmental Exposure / Q000009:adverse effects / Q000706:statistics & numerical data; D006795:Household Products / Q000009:adverse effects; D006801:Humans; D006813:Humidity; D008875:Middle Aged; D010476:Perfume / Q000009:adverse effects; D012220:Rhinitis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D012221:Rhinitis, Allergic, Perennial / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D006255:Rhinitis, Allergic, Seasonal / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D012307:Risk Factors; D012621:Seasons; D012737:Sex Factors; D012867:Skin / Q000276:immunology*; D013696:Temperature; D014028:Tobacco Smoke Pollution / Q000009:adverse effects
D000393:Air Pollutants; D003902:Detergents; D010476:Perfume; D014028:Tobacco Smoke Pollution