Reviews and Feature Articles: Current Reviews of Allergy and Clinical ImmunologyRhinitis and asthma: Evidence for respiratory system integration☆
Section snippets
Epidemiologic relationships
The epidemiology of rhinitis and asthma and their links offer us the opportunity to reflect on the nature of the relationship between these 2 conditions. The first important observation is that the prevalence of allergic rhinitis appears to be at least triple the prevalence of asthma. The best information on the prevalence of allergic rhinitis in the United States derives from the National Health and Nutritional Examination Survey II data.2 With skin testing to a panel of common aeroallergens,
Clinical observations
The relationships between rhinitis and asthma could be attributed to the above-described model without the need of any other consideration. However, a number of additional clinical and experimental observations that indicate a more complicated relationship have been made. These observations center around the concept that changes in the nasal airways might affect the lower airways.
In 1992, Corren et al74 suggested that nasal provocation with allergen can lead to increased lower airways
Conclusion
The relationship between rhinitis and asthma is complex, and the model I have presented hopefully offers a thinking framework for further examination and exploration. The main concept is that of integration of the 2 conditions as manifestations of one syndrome, the chronic allergic respiratory syndrome. In examining and treating this syndrome, we should be simultaneously considering the parallel relationship between rhinitis and asthma and the interactions between the upper and lower airways,
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Reprint requests: Alkis Togias, MD, Unit Office 7, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore MD 21224.