Alkis Togias1, Peter J Gergen1, Jack W Hu2, Denise C Babineau3, Robert A Wood4, Robyn T Cohen5, Melanie M Makhija6, Gurjit K Khurana Hershey7, Carolyn M Kercsmar7, Rebecca S Gruchalla8, Andrew H Liu9, Emily Wang10, Haejin Kim10, Carin I Lamm11, Leonard B Bacharier12, Dinesh Pillai13, Steve M Sigelman1, James E Gern14, William W Busse14. 1. Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, Bethesda, Md. 2. Rho Federal Systems Division, Chapel Hill, MC. Electronic address: jack_hu@rhoworld.com. 3. Rho Federal Systems Division, Chapel Hill, MC. 4. Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md. 5. Department of Pediatrics, Boston University School of Medicine, Boston, Mass. 6. Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill. 7. Division of Asthma Research and Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio. 8. University of Texas Southwestern Medical Center, Dallas, Tex. 9. Division of Allergy and Immunology, National Jewish Health, Denver, and the Department of Allergy and Immunology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo. 10. Division of Allergy and Immunology, Henry Ford Health System, Detroit, Mich. 11. Department of Pediatrics, College of Physicians and Surgeons, New York, NY. 12. Division of Allergy, Immunology, and Pulmonary Medicine, St Louis Children's Hospital, St Louis, Mo. 13. Department of Pulmonary Medicine, Children's National Health System, Washington, DC. 14. Division of Allergy and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Abstract
BACKGROUND: Rhinitis and asthma are linked, but substantial knowledge gaps in this relationship exist. OBJECTIVE: We sought to determine the prevalence of rhinitis and its phenotypes in children and adolescents with asthma, assess symptom severity and medication requirements for rhinitis control, and investigate associations between rhinitis and asthma. METHODS: Seven hundred forty-nine children with asthma participating in the Asthma Phenotypes in the Inner-City study received baseline evaluations and were managed for 1 year with algorithm-based treatments for rhinitis and asthma. Rhinitis was diagnosed by using a questionnaire focusing on individual symptoms, and predefined phenotypes were determined by combining symptom patterns with skin tests and measurement of serum specific IgE levels. RESULTS: Analyses were done on 619 children with asthma who completed at least 4 of 6 visits. Rhinitis was present in 93.5%, and phenotypes identified at baseline were confirmed during the observation/management year. Perennial allergic rhinitis with seasonal exacerbations was most common (34.2%) and severe. Nonallergic rhinitis was least common (11.3%) and least severe. The majority of children remained symptomatic despite use of nasal corticosteroids with or without oral antihistamines. Rhinitis was worse in patients with difficult-to-control versus easy-to-control asthma, and its seasonal patterns partially corresponded to those of difficult-to-control asthma. CONCLUSION: Rhinitis is almost ubiquitous in urban children with asthma, and its activity tracks that of lower airway disease. Perennial allergic rhinitis with seasonal exacerbations is the most severe phenotype and most likely to be associated with difficult-to-control asthma. This study offers strong support to the concept that rhinitis and asthma represent the manifestations of 1 disease in 2 parts of the airways.
BACKGROUND:Rhinitis and asthma are linked, but substantial knowledge gaps in this relationship exist. OBJECTIVE: We sought to determine the prevalence of rhinitis and its phenotypes in children and adolescents with asthma, assess symptom severity and medication requirements for rhinitis control, and investigate associations between rhinitis and asthma. METHODS: Seven hundred forty-nine children with asthma participating in the Asthma Phenotypes in the Inner-City study received baseline evaluations and were managed for 1 year with algorithm-based treatments for rhinitis and asthma. Rhinitis was diagnosed by using a questionnaire focusing on individual symptoms, and predefined phenotypes were determined by combining symptom patterns with skin tests and measurement of serum specific IgE levels. RESULTS: Analyses were done on 619 children with asthma who completed at least 4 of 6 visits. Rhinitis was present in 93.5%, and phenotypes identified at baseline were confirmed during the observation/management year. Perennial allergic rhinitis with seasonal exacerbations was most common (34.2%) and severe. Nonallergic rhinitis was least common (11.3%) and least severe. The majority of children remained symptomatic despite use of nasal corticosteroids with or without oral antihistamines. Rhinitis was worse in patients with difficult-to-control versus easy-to-control asthma, and its seasonal patterns partially corresponded to those of difficult-to-control asthma. CONCLUSION:Rhinitis is almost ubiquitous in urban children with asthma, and its activity tracks that of lower airway disease. Perennial allergic rhinitis with seasonal exacerbations is the most severe phenotype and most likely to be associated with difficult-to-control asthma. This study offers strong support to the concept that rhinitis and asthma represent the manifestations of 1 disease in 2 parts of the airways.
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