Airway Hyperresponsiveness in Allergic Rhinitis: A Risk Factor for Asthma

doi:10.1378/chest.91.5.671

Chest

Volume 91, Issue 5, May 1987, Pages 671-674

https://doi.org/10.1378/chest.91.5.671 Get rights and content

In order to study whether the methacholine inhalation challenge could predict which patients with allergic rhinitis were at risk to develop asthma, we prospectively studied a group of ragweed-sensitive patients over a four to five year period. On the initial study, 16 of 40 patients (40 percent) were found to be hyperresponsive to methacholine. On the follow-up study, three of these 16 patients (19 percent) were found to have developed asthma from one and one-half to five years after the initial testing. Each had greater methacholine responsiveness on repeat study. The degree of methacholine hyperresponsiveness, judged by the PD₂₀, could not predict which of the initial responders would develop asthma. Twenty-four (60 percent) of our patients showed normal responses to methacholine on initial study; none developed asthma and 88 percent remained nonresponders on repeat study. Our study shows that allergic rhinitis patients hyperresponsive to methacholine are at greater risk to develop asthma than those with normal bronchial challenges (p<0.05).

Section snippets

METHODS

Fifty-two Allergy Clinic patients with ragweed-sensitive allergic rhinitis without symptoms of asthma were studied initially during the winter seasons of 1979 and 1980. A follow-up study was done in the winter of 1984. Entrance criteria included the following: (1) rhinitis symptoms for at least two consecutive ragweed seasons; (2) a positive immediate (scratch) skin test to ragweed antigen; (3) no previous symptoms of chronic cough, sputum production, shortness of breath, or wheezing; and (4)

RESULTS

Forty patients (25 females, 15 males) with ragweed-sensitive allergic rhinitis were followed for a mean of 54 months (48 to 65 months). Their mean age was 27.4 years (12 to 54 years). Five were smokers; three were hyperresponders, and two nonresponders.

On the initial study, 20 (38 percent) of our original 52 patients were methacholine hyperresponders. The prevalence of methacholine hyperresponsiveness in our study group (those with initial and follow-up studies) was 40 percent (16 of the 40

DISCUSSION

Allergic rhinitis and asthma are closely related disorders that commonly occur together. It has even been suggested, but not proven, that they are two different manifestations of the same disease. They are strongly related by family history, are both associated with blood eosinophilia, and elevated IgE levels, and can both be precipitated by exposure to aeroallergens mediated by immediate hypersensitivity mechanisms. Most patients with allergic asthma have symptoms of rhinitis and some rhinitis

ACKNOWLEDGMENT

Mrs. Nina Dunn provided secretarial assistance and Mr. John Pezzullo was the statistician.

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: Manuscript received August 11; revision accepted October 14

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Chest

Airway Hyperresponsiveness in Allergic Rhinitis: A Risk Factor for Asthma

Section snippets

METHODS

RESULTS

DISCUSSION

ACKNOWLEDGMENT

J Allerg Clin Immunol

J Allergy

J Allerg Clin Immunol

J Allerg Clin Immunol

J Allerg Clin Immunol

J Allerg Clin Immunol

Lancet

Epidemiology and natural history of asthma, allergic rhinitis, and atopic dermatitis (eczema)

Asthma in children

N Engl J Med

Comparative action of acetyl-beta-methyl choline and histamine on the respiratory tract in normals, patients with hay fever, and subjects with bronchial asthma

J Clin Invest

Methacholine aerosol as test for bronchial asthma

Arch Intern Med

Studies with the quantitative-inhalation challenge technique: I. Curve of dose response to acetyl-beta-methylcholine in patients with asthma of known and unknown origin, hay fever subjects, and nonatopic volunteers

J Allergy