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United airways disease: therapeutic aspects
  1. Giovanni Passalacqua,
  2. Giorgio Ciprandi,
  3. Giorgio Walter Canonica
  1. Allergy and Respiratory Diseases, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
  1. Dr G W Canonicagcanonica{at}

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During the past few years the global pathogenic view of respiratory allergy has changed. The link between rhinitis and asthma—that is, upper and lower airways—has been underlined by epidemiological and clinical studies. Taken together, these have led to the operative definition of “allergic rhinobronchitis”1 or, as we have proposed, “united airways disease (UAD)”. In recent years more evidence has been provided of the frequent co-existence of rhinitis and asthma, the possible role of upper respiratory infections, and the importance of paranasal sinus infections. These relationships are particularly notable in children. Detailed knowledge of the mechanisms sustaining allergic inflammation in the respiratory tract allows a greater understanding of the functional relationships between the upper and lower sections of the tract. In this respect it is logical to assume that allergy is not a disease confined to a specific target organ, but rather a disorder of the whole respiratory tract which has a broad spectrum of clinical manifestations. The concept of “united airways disease” also has therapeutic implications.

Epidemiological evidence

Early epidemiological studies described the association between allergic rhinitis and asthma. One of the earliest observations on a large sample assessed the effects of specific immunotherapy.2 This association has been …

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