Chest
Volume 122, Issue 5, November 2002, Pages 1560-1565
Journal home page for Chest

Clinical Investigations: Asthma
Sputum Eosinophilia and Maximal Airway Narrowing in Dermatophagoides pteronyssinus Allergic Rhinitis Patients: Only Rhinitis or Rhinitis Plus Mild Asthma?

https://doi.org/10.1378/chest.122.5.1560Get rights and content

Study objective

To study the existence of bronchial disease among rhinitis patients. To evaluate the laboratory test or set of tests (ie, symptoms, exposure, and sensitization to the allergen, and the provocative dose of methacholine [Mth] causing a 20% fall in FEV1 [PD20] and the maximal response plateau [MRP] to Mth) that best identifies a case of mild asthma.

Design

Cross-sectional analysis in 52 Dermatophagoides pteronyssinus-monosensitized patients who were consulting a physician for perennial rhinitis.

Setting

Allergy Department, Hospital Doctor Negrín, Las Palmas, Grand Canary Island, Spain.

Interventions and measurements

Patients filled out a standardized asthma symptom questionnaire, and underwent sputum induction and Mth challenge in which 40% falls in FEV1 were attained. Dose-response curves were expressed in terms of both PD20 values and the level of the MRP. D pteronyssinus allergen exposure was assessed in dust samples from patients’ beds.

Results

No difference between patients who positively responded to the questionnaire and those who did not was observed. Mth-PD20 values were not detected in 13% of the patients reporting bronchial symptoms, and an MRP was not identified in 59% of the subjects who did not respond positively. A higher degree of allergen sensitization (ascertained from skin test results, and total and specific serum IgE levels) and higher degree of sputum eosinophilia were detected in subjects in whom an MRP had not been identified. The presence of sputum eosinophilia provided the best differentiation between those patients who presented with an MRP and those who did not.

Conclusion

The individual perception of bronchial symptoms is highly variable among perennial allergic rhinitis patients. The lack of a maximal airway-narrowing plateau is related to the presence of sputum eosinophilia, which might be useful in the detection of patients susceptible to anti-inflammatory therapy. Prospective studies evaluating whether these patients are more likely to develop symptomatic asthma in the future and if the early anti-inflammatory treatment prevents its development are needed.

Section snippets

Subjects and Study Design

We selected 52 nonsmoking D pteronyssinus-allergic patients who consecutively attended our department reporting nonseasonal rhinitis. D pteronyssinus sensitization was established by means of positive skin-prick test results with a standardized extract (ALK-Abelló; Madrid, Spain) and detection of a specific IgE to this allergen in the context of a compatible clinical history. Subjects who had been sensitized to other perennial or seasonal allergens were excluded. Patients underwent clinical and

First Criterion of Grouping: Response to the Asthma Symptom Questionnaire

The 52 mite rhinitis patients were matched according to their positive (n = 30) or negative (n = 22) responses to the questionnaire (Table 1). Groups did not differ in age, sex, allergen sensitization, Der p 1 exposure, or baseline lung function. Sputum induction was safe in every patient. Adequate samples for analysis were obtained in 93% of the AS+ patients and in 68% of the AS− patients. No difference in sputum composition was detected between groups. The results of the Mth-BPT were positive

Discussion

Allergic asthma and rhinitis are related disorders that frequently are associated and show a parallel development.6 Although less frequently than in patients with asthma, the lower airways of rhinitis patients exhibit eosinophilic infiltration17,19 and increased sensitivity to bronchoconstricting agonists,17,20 suggesting that both diseases are manifestations of the same disorder.6 Some authors3 have documented the benefits of the early detection and onset of inhaled steroid therapy in patients

ACKNOWLEDGMENT

The authors thank Ms. Theresa Hetherington for her review of the English language of this manuscript.

References (33)

  • HC Siersted et al.

    Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study

    BMJ

    (1998)
  • R Sporik et al.

    Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood: a prospective study

    N Engl J Med

    (1990)
  • R Sporik et al.

    Allergen exposure and the development of asthma

    Thorax

    (2001)
  • N Steen et al.

    Development of a symptom based outcome measure for asthma

    BMJ

    (1994)
  • ER Tovey et al.

    The distribution of dust mite allergen in the houses of patients with asthma

    Am Rev Respir Dis

    (1981)
  • S Dreborg et al.

    Dust sampling for determination of allergen content

    Allergy

    (1995)
  • Cited by (8)

    • The complex link between severity of asthma and rhinitis in mite allergic patients

      2013, Respiratory Medicine
      Citation Excerpt :

      However an evaluation, excluding this subset of patients was performed and the result of the survey did not change (data not shown). Subjective assessment of rhinitis and asthma severity is the most questionable point of our study; a need for more sophisticated tools to investigate this relationship in mite allergic patients with respiratory allergy has been emphasized.31 However our study aim was only to evaluate the relationship between asthma and rhinitis severity with those tools that are currently used in the clinical setting and in real life surveys.8,9,11,27

    • Comparison of ΔFVC between patients with allergic rhinitis with airway hypersensitivity and patients with mild asthma

      2007, Annals of Allergy, Asthma and Immunology
      Citation Excerpt :

      For example, the level of maximal airway response, rather than airway hypersensitivity, was shown to be a reliable marker for the development of asthma in patients with allergic rhinitis. 29 Another study 30 reported that among patients consulting physicians for rhinitis symptoms, the absence of a maximal response plateau was the only factor correlated with sputum eosinophilia; this might be useful for identifying patients responsive to anti-inflammatory therapy. Whether the level of ΔFVC has a similar prognostic or clinical value in these situations needs to be determined by future study.

    • The connection between allergic rhinitis and bronchial asthma

      2007, Current Opinion in Pulmonary Medicine
    • Maximal airway plateau responses and eosinophils in cough variant asthma

      2004, Allergy: European Journal of Allergy and Clinical Immunology
    View all citing articles on Scopus

    This study was supported by a research grant from the Government of Canarias (FUNCIS).

    View full text