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Asthma and allergic rhinitis

Asthma and allergic rhinitis are often co-morbid diseases. Asthma is estimated to affect approximately 4%–11% of the general population while allergic rhinitis is estimated to affect 10%–30% [1,2]. Twenty to forty per cent of patients with allergic rhinitis are reported to have concomitant asthma, while 30%–90% of patients with asthma are reported to have concomitant allergic rhinitis [3,4]. Aspects of the underlying pathology that are common to both diseases are striking. Both conditions are characterized by inflammation of the respiratory mucosa, and are associated with the same allergic and pro-inflammatory mediators such as histamine, leukotrienes and cytokines from allergen-activated mast cells, eosinophils and Th2 lymphocytes [5,6]. Local allergen exposure may result in generalized airway inflammation, suggesting linked inflammatory pathways in the respiratory mucosa. Thus, tissue eosinophilia, a characteristic of allergic inflammation [7], is seen in the upper and lower airways following nasal allergen provocation in non-asthmatic patients with seasonal allergic rhinitis [8]. Conversely, segmental bronchial provocation in non-asthmatic allergic rhinitis patients caused allergic inflammation in the nose, while also in [9].

References

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2. Nathan RA, Meltzer EO, Selner JC, Storms W. Prevalence of allergic rhinitis in the United States. J Allergy Clin Immunol 1997;99:S808-S814

3. Leynaert B, Neukirch F, Demoly P, Bousquet J. Epidemiologic evidence for asthma and rhinitis comorbidity. J Allergy Clin Immunol 2000;106:S201-S205

4. Simons FER. Allergic rhinobronchitis: the asthma-allergic rhiniti link. J Allergy Clin Immunol 1999;104:534-40

5. Vignola AM, Chanez P, Bousquet J. The relationship between asthma and allergic rhinitis: exploring the basis for a common pathophysiology. Clin Exp Allergy Rev 2003;3:63-8

6. Casale TB, Lazarus SC. Immunobiology of asthma and rhinitis: pathogenic factors and therapeutic options. Am J Respir Cri Care Med 1999;160:1778-87

7. Braunstahl GJ, Fokkens W. Nasal involvement in allergic asthma. Allergy 2003;58:1235-43

8. Braunstahl GJ, Overbeek SE, Kleinjan A, Prins JB, Hoogsteden HC, Fokkens WJ. Nasal allergen provocation induces adhesion molecule expression and tissue eosinophilia in upper and lower airways. J Allergy Clin Immunol 2001:107:469-76

9. Braunstahl GJ, Kleinjan A, Overbeek SE, Prins JB, Hoogsteden HC, Fokkens WJ. Segmental bronchial provocation induces nasal inflammation in allergic rhinitis patients. Am J Respir Crit Care Med 2000;161:2051-7