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      The united allergic airway: Connections between allergic rhinitis, asthma, and chronic sinusitis

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          Abstract

          Background:

          The united allergic airway is a theory that connects allergic rhinitis (AR), chronic rhinosinusitis, and asthma, in which seemingly disparate diseases, instead of being thought of separately, are instead viewed as arising from a common atopic entity.

          Objective:

          This article describes patients with such diseases; explores ideas suggesting a unified pathogenesis; elucidates the various treatment modalities available, emphasizing nasal corticosteroids and antihistamines; and provides an update of the literature.

          Methods:

          A literature review was conducted.

          Conclusion:

          The aggregation of research suggests that AR, asthma, and chronic rhinosinusitis are linked by the united allergic airway, a notion that encompasses commonalities in pathophysiology, epidemiology, and treatment.

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          Most cited references41

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          Quality of life in allergic rhinitis and asthma. A population-based study of young adults.

          B Leynaert, F Neukirch, R Liard … (2000)
          Quality of life has been found to be impaired both in patients with asthma and in patients with allergic rhinitis, but the relative burden of these diseases has not been investigated. We analyzed answers to the SF-36 questionnaire from 850 subjects recruited in two French centers participating in the European Community Respiratory Health Survey, a population-based study of young adults. Both asthma and allergic rhinitis were associated with an impairment in quality of life. However, 78% of asthmatics also had allergic rhinitis. Subjects with allergic rhinitis but not asthma (n = 240) were more likely than subjects with neither asthma nor rhinitis (n = 349) to report problems with social activities, difficulties with daily activities as a result of emotional problems, and poorer mental well-being. Patients with both asthma and allergic rhinitis (n = 76) experienced more physical limitations than patients with allergic rhinitis alone, but no difference was found between these two groups for concepts related to social/mental health. As asthma was not found to further impair the quality of life in subjects with allergic rhinitis for concepts related to mental disability and well-being, and as subjects with asthma often also suffer from allergic rhinitis, further studies on quality of life in asthma should ensure that the impairment in quality of life attributed to asthma could not result from concomitant allergic rhinitis.
          Article 0 comments Cited 81 times – based on 0 reviews     Review now
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            Association between severity of asthma and degree of chronic rhinosinusitis.

            David C Lin, Rakesh K Chandra, Bruce K Tan … (2015)
            There is a clinical association between asthma and chronic rhinosinusitis (CRS). This study was designed to determine whether severity of coexistent asthma affects the clinical presentation of CRS. Cross-sectional analysis was performed of prospectively collected data in 187 patients with CRS who were evaluated in a large, tertiary academic nasal and sinus center. Patients were stratified into three groups based on asthma status using National Institutes of Health criteria: (1) nonasthmatic, (2) intermittent/mild asthma, (3) or moderate/severe asthma. Mean Lund-Mackay scores were 9.7, 11.6, and 15.6, respectively. ANOVA testing with post-hoc Tukey analysis revealed that Lund-MacKay scores were significantly greater in group 3 than either group 1 (p < 0.05) or group 2 (p < 0.01). The prevalence of allergic sensitization was 72.4, 82.8, and 100% in groups 1, 2, and 3, respectively (p = 0.03). The prevalence of nasal polyposis was 31.4% in group 1, 48.3% in group 2, and 94.4% in group 3 (p < 0.0001). No differences were observed regarding demographic factors or the incidence of the triad of aspirin sensitivity, asthma, and nasal polyposis among those with different severities of asthma. Increasing severity of asthma is associated with advancing radiological severity of CRS and a greater prevalence of allergic sensitization and nasal polyposis. This large adult series shows that asthma severity may have a significant correlation with the presentation of CRS. This study adds to the growing support for the unified airway theory.
            Article 0 comments Cited 59 times – based on 0 reviews     Review now
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              Segmental bronchial provocation induces nasal inflammation in allergic rhinitis patients.

              Dirk Kleinjan, W. Fokkens, Gerhard E. Overbeek … (2000)
              Allergic rhinitis and asthma often coexist and share a genetic background. Pathophysiologic connections between the nose and lungs are still not entirely understood. This study was undertaken to compare allergic inflammation and clinical findings in the upper and lower airways after segmental bronchial provocation (SBP) in nonasthmatic allergic rhinitis patients. Eight nonasthmatic, grass pollen-sensitive patients with allergic rhinitis and eight healthy controls were included. Bronchial biopsies and blood samples were taken before (T(0)) and 24 h (T(24)) after SBP. Nasal biopsies were obtained at T(0), 1 h after SBP (T(1)), and T(24). Immunohistochemical staining was performed for eosinophils (BMK13), interleukin (IL)-5, and eotaxin. The number of eosinophils increased in the challenged and unchallenged bronchial mucosa (p < 0.05) and in the blood (p = 0.03) of atopic subjects at T(24). We detected an increase of BMK13-positive and eotaxin-positive cells in the nasal lamina propria and enhanced expression of IL-5 in the nasal epithelium of atopic subjects only at T(24) (p < 0.05). SBP induced nasal and bronchial symptoms as well as reductions in pulmonary and nasal function in the allergic group. No significant changes could be observed in healthy controls. The study shows that SBP in nonasthmatic allergic rhinitis patients results in peripheral blood eosinophilia, and that SBP can induce allergic inflammation in the nose.
              Article 0 comments Cited 55 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Am J Rhinol Allergy
                Journal ID (iso-abbrev): Am J Rhinol Allergy
                Journal ID (pmc): rhinol
                Title: American Journal of Rhinology & Allergy
                Publisher: OceanSide Publications, Inc. (Providence, RIUSA )
                ISSN (Print): 1945-8924
                ISSN (Electronic): 1945-8932
                Publication date (Print): May-Jun 2012
                Volume: 26
                Issue: 3
                Pages: 187-190
                Affiliations
                [1]From the 1Department of Internal Medicine,
                [2] 2Division of Allergy and Immunology, Scripps Green Hospital, La Jolla, California
                Author notes
                Address correspondence and reprint requests to Charles Feng, M.D., 10666 Torrey Pines Road MS:403C, La Jolla, CA 92037 E-mail address: cfeng622@ 123456gmail.com

                CH Feng and MD Miller contributed equally to this work

                Article
                Publisher ID: AJRA353-11
                DOI: 10.2500/ajra.2012.26.3762
                PMC ID: 3906509
                PubMed ID: 22643942
                SO-VID: 378b7efe-2482-47bc-8ef6-85ef506fd09c
                Copyright © Copyright © 2012, OceanSide Publications, Inc., U.S.A.
                License:

                This publication is provided under the terms of the Creative Commons Public License ("CCPL" or "License"), in attribution 3.0 unported, further described at http://creativecommons.org/license/by/3.0/legalcode. The work is protected by copyright and/or other applicable law. Any use of the work other then as authorized under this license or copyright law is prohibited

                History
                Categories
                Subject: Articles

                ScienceOpen disciplines: Immunology
                Keywords: allergic rhinitis,antihistamines,asthma,chronic rhinosinusitis,sinusitis,nasal corticosteroids,united airway
                Data availability:
                ScienceOpen disciplines: Immunology
                Keywords: allergic rhinitis, antihistamines, asthma, chronic rhinosinusitis, sinusitis, nasal corticosteroids, united airway

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