Published ahead of print on July 5, 2007, doi:10.1164/rccm.200703-427OC Am. J. Respir. Crit. Care Med., Volume 176, Number 7, October 2007, 659-666 A more recent version of this article appeared on October 1, 2007
Submitted on March 15, 2007 Allergic Rhinitis and Onset of Bronchial Hyperresponsiveness: A Population-based StudyRafea Shaaban1*,1 Unit 700 Epidemiology, Faculte de Medicine Xavier Bichat, National Institute of Health and Medical Research (Inserm), Paris, France, 2 Institut Municipal d'Investigacio Medica, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain, 3 Institute of Epidemiology, GSF-National Research Center for Environment and Health, Neuherberg, Germany, 4 Respiratory Medicine and Allergology, University of Uppsala, Uppsala, Sweden, 5 Institut Municipal d'Investigacio Medica, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain, 6 Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom * To whom correspondence should be addressed. E-mail: shaaban{at}bichat.inserm.fr.
Rationale: Patients with allergic rhinitis have more frequent bronchial hyper-responsiveness (BHR) in cross-sectional studies.
Objective: To estimate the changes in BHR in non-asthmatic 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: BHR was defined as a Key words: Allergic rhinitis; Bronchial hyperresponsiveness; ECRHS; Epidemiology; Longitudinal
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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 (>0.35UI/ml) to pollen, cat, mites or cladosporium.
Main Results: The cumulative incidence of BHR was 9.7% in subjects with allergic rhinitis, 7.0% in subjects with atopy but no rhinitis, compared to 5.5% in subjects without allergic rhinitis and atopy (respective odds-ratio (OR) ) for BHR onset 2.44 [1.73-3.45] and 1.35 [0.86-2.11], after adjustment for potential confounders including sex, smoking, BMI and FEV1. Subjects with rhinitis sensitised exclusively to cat or to mites were particularly at increased risk of developing BHR (ORs: 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 to 51.8% of those without rhinitis had no more BHR at follow-up; OR=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= 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.
