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Allergic Rhinitis and Onset of Bronchial Hyperresponsiveness

A Population-based Study

¹ Unit 700 Epidemiology, National Institute of Health and Medical Research (INSERM), Paris, France; ² Center for Research in Environmental Epidemiology (CREAL), Institut Municipal d'Investigació Mèdica, Barcelona, Spain; ³ Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; ⁴ Institute of Epidemiology, GSF–National Research Center for Environment and Health, Neuherberg, Germany; ⁵ Respiratory Medicine and Allergology, University of Uppsala, Uppsala, Sweden; and ⁶ Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom

Correspondence and requests for reprints should be addressed to Rafea Shaaban, M.D., INSERM U700, Epidémiologie des Maladies Respiratoires Faculté Xavier Bichat, BP 416, 16 rue Henri Huchard, 75018 Paris, France. E-mail: shaaban{at}bichat.inserm.fr

Rationale: Patients with allergic rhinitis have more frequent bronchial hyperresponsiveness (BHR) in cross-sectional studies.

Objectives: To estimate the changes in BHR in nonasthmatic subjects with and without allergic rhinitis during a 9-year period.

Methods: BHR onset was studied in 3,719 subjects without BHR at baseline, who participated in the follow-up of the European Community Respiratory Health Survey.

Measurements and Main Results: BHR was defined as a 20% decrease in FEV₁ for a maximum dose of 1 mg of methacholine. Allergic rhinitis was defined as having a history of nasal allergy and positive specific IgE (0.35 IU/ml) to pollen, cat, mites, or Cladosporium. The cumulative incidence of BHR was 9.7% in subjects with allergic rhinitis and 7.0% in subjects with atopy but no rhinitis, compared with 5.5% in subjects without allergic rhinitis and atopy (respective odds ratios [OR] and their 95% confidence intervals [95% CI] for BHR onset, 2.44 [1.73–3.45]; and 1.35 [0.86–2.11], after adjustment for potential confounders including sex, smoking, body mass index and FEV₁). Subjects with rhinitis sensitized exclusively to cat or to mites were particularly at increased risk of developing BHR (ORs [95% CI], 7.90 [3.48–17.93] and 2.84 [1.36–5.93], respectively). Conversely, in subjects with BHR at baseline (n = 372), 35.3% of those with allergic rhinitis, compared with 51.8% of those without rhinitis had no more BHR at follow-up (OR [95% CI], 0.51 [0.33–0.78]). BHR "remission" was more frequent in patients with rhinitis treated by nasal steroids than in those not treated (OR [95% CI], 0.33 [0.14–0.75]).

Conclusions: Allergic rhinitis was associated with increased onset of BHR, and less chance for remission except in those treated for rhinitis.

Key Words: allergic rhinitis • bronchial hyperresponsiveness • ECRHS • epidemiology • longitudinal

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Allergic rhinitis is strongly associated with bronchial hyperresponsiveness in cross-sectional studies, even in nonasthmatic subjects. What This Study Adds to the Field Allergic rhinitis was associated with increased onset of bronchial hyperresponsiveness, and less chance for remission except in those treated for rhinitis.

 

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