Questionnaire as an alternative of skin prick tests to differentiate allergic from non-allergic rhinitis in epidemiological studies

Asthma is associated with increased severity and duration of rhinitis: A study with the Allergic Rhinitis and its Impact on Asthma classes in the Constances cohort

BACKGROUND

Few population-based studies have described allergic rhinitis (AR) according to the Allergic Rhinitis and its Impact on Asthma (ARIA) classification, and none have assessed the impact of asthma on this classification. Our aims were to 1) describe AR according to four ARIA classes and 2) within each of the four ARIA classes, compare participants with AR alone versus those with AR and asthma.

METHODS

Cross-sectional analyses were performed using data from the 2014 annual follow-up questionnaire of the French adult population-based cohort Constances. Current AR was defined by the report of sneezing, runny, or blocked nose in the last 12 months and the report of nasal allergies. Following ARIA recommendations, rhinitis was classified according to its severity (mild or moderate-severe) and duration (intermittent or persistent). Ever asthma was also defined by a questionnaire.

RESULTS

Among the 4675 participants with AR (57% women, mean age 50.2 ± 12.7 years), 44% were classified as mild/intermittent, 16% mild/persistent, 25% moderate-severe/intermittent, and 15% moderate-severe/persistent. Within each of the four ARIA classes, compared to participants with rhinitis alone, participants with rhinitis and asthma had significantly more severe symptoms, more conjunctivitis, a higher mean eosinophil count and more treatments with intra-nasal corticosteroids and oral antihistamines co-medication.

CONCLUSIONS

This is a paradigm shift study as for the first time this large population-based study in adults showed that asthma status has a profound effect on the ARIA classification. Rhinitis alone and rhinitis with asthma represent two distinct phenotypes. These results reinforce the need to include asthma status in the ARIA classification and guidelines.

Rhinitis phenotypes and multimorbidities in the general population: the CONSTANCES cohort

BACKGROUND

Scarce epidemiological studies have characterised allergic rhinitis (AR) and non-allergic rhinitis (NAR) in adults. In a population-based cohort, our aims were to 1) describe rhinitis, AR and NAR, and 2) explore how asthma and conjunctivitis may lead to the identification of novel rhinitis phenotypes.

METHODS

In this cross-sectional analysis, current rhinitis was defined as present in the last 12 months using a questionnaire from the French CONSTANCES cohort. Participants with current rhinitis reporting nasal allergies were considered as AR, otherwise as NAR. We described AR and NAR phenotypes, and their phenotypes including co-occurrence with ever-asthma and ever-conjunctivitis.

RESULTS

Among the 20 772 participants included in this analysis (mean±sd age 52.6±12.6 years; 55.2% female), crude prevalences of AR and NAR were 28.0% and 10.9%. AR participants more frequently reported persistent rhinitis (31.6% versus 25.1%) and moderate-to-severe rhinitis (40.1% versus 24.2%) than NAR participants. Among AR or NAR participants, those with ever-asthma reported more moderate-to-severe rhinitis. Participants with AR, ever-asthma and ever-conjunctivitis had an earlier age of rhinitis onset, more severe rhinitis and higher eosinophil counts than participants in other groups. Results were replicated in another cohort.

CONCLUSIONS

In this large population-based cohort, 40% reported current rhinitis, with a lower prevalence of moderate-to-severe rhinitis than in clinical practice. For the first time in a general adult population, we showed that AR and NAR alone or in combination with asthma or in combination with asthma and conjunctivitis are different phenotypes. These results provide new insights on how best to manage rhinitis and its multimorbidities.

Knowledge and Attitude Among Patients and Physicians on Allergic Rhinitis (KAPPA): An International Survey

PURPOSE

Our study compared knowledge of, and attitudes towards, allergic rhinitis (AR) among patients and physicians in: Brazil, Japan, Korea, Mexico, Saudi Arabia, Spain, United Arab Emirates, and the United Kingdom.

PATIENTS AND METHODS

Patients with AR were recruited via probability-based sampling. Data were captured via telephone interview, personal interview, or self-administered online survey. Physicians were recruited from an online physician panel and interviewed by self-administered online survey.

RESULTS

In total, 1436 patients and 1637 physicians were surveyed. Most patients (76.9%) reported moderate-to-severe AR, whereas physicians reported more mild (mean cases ranging from 57.0-68.2) than moderate-to-severe AR (mean cases ranging from 31.8-43.0). Overall, most physicians (85.4%) and patients (77.5%) agreed AR could be controlled with treatment. Physicians preferred prescribing oral antihistamines (OAHs) for mild AR (from 45.3% of physicians in Brazil to 73.6% of physicians in Mexico). For moderate and severe AR, more physicians preferred prescribing intranasal corticosteroids (INCSs) and OAHs for moderate and severe AR than other available treatments (from 48.5% of physicians in the UK to 69.5% of physicians in Spain). Patients preferred OAHs to INCSs for treating AR (62.0%). Patients also reported a range of comorbidities: overall, sinus infections were the most common (24.7%), and comorbid asthma was present in 12.9% of patients. Per country, Saudi Arabia had the highest proportion (53.5%) and Mexico had the lowest proportion (8.0%) of patients with comorbid asthma.

CONCLUSION

Patient and physician perceptions of AR mostly differed between and within countries, although there was generally agreement that AR could be controlled with treatment. Differing attitudes towards AR among patients and physicians suggests a need for improved education in and communication between these groups, with subsequent implications for optimizing disease management.

Worldwide prevalence of rhinitis in adults: A review of definitions and temporal evolution

Introduction

Objective

Methods

Results

Conclusions

Assessing the impact of air pollutants on clinical visits for childhood allergic respiratory disease induced by house dust mite in Shanghai, China

Background

The prevalence of allergic respiratory disease (ARD) is increasing worldwide during the last few decades, causing a great disease burden especially for children. Air pollution has been increasingly considered as a potential contributor to this trend, but its role in ARD induced by house dust mite (HDM-ARD) remains unclear, especially in time-series study.

Methods

A positive reporting of respiratory allergy to named allergens was included by serum specific IgE testing. A time series Quasi-Poisson regression with distributed lag non-linear model, combined with generalized linear model was used to examine the effects of air pollutants on ARD, HDM-ARD and ARD induced by non-house dust mite (NHDM-ARD).

Results

A total of 16,249 cases of ARD, including 8,719 HDM-ARD and 8,070 NHDM-ARD from 1 Jan 2013 to 31 Dec 2017 were involved in this study. Air pollutants were significantly associated with clinical visits for childhood ARD and HDM-ARD. Exposure to higher O₃ and interquartile range (IQR) increment in O₃ (40.6 µg/m³) increased the risks of clinical visits for childhood HDM-ARD (RR_lag0-5 for the 95th percentile of O₃: 1.26, 95% confidence interval (CI): 1.03, 1.55; RR_lag0-5 for IQR increment (40.6 µg/m³): 1.09, 95% CI: 1.01, 1.17) and ARD (RR_lag0-5 for the 95th percentile of O₃: 1.19, 95% CI: 1.03, 1.38; RR_lag0-5 for IQR increment (40.6 µg/m³): 1.06, 95% CI: 1.01, 1.12). In addition, higher O₃ was associated with increased RR of boys with ARD (RR_lag0-5 for the 95th percentile: 1.26, 95% CI: 1.05, 1.51; RR_lag0-5 for IQR increment (40.6 µg/m³): 1.09, 95% CI: 1.02, 1.16) and HDM-ARD (RR_lag0-5 for the 95th percentile: 1.36, 95% CI: 1.06, 1.75; RR_lag0-5 for IQR increment (40.6 µg/m³): 1.11, 95% CI: 1.02, 1.22), but not in girls.

Conclusions

Exposure to O₃ appeared to be a trigger of clinical visits for childhood ARD, especially for HDM-ARD and boys. These findings provide novel evidence on the impact of air pollution on HDM-ARD, which may have significant implications for designing effective intervention programs to control and prevent childhood ARD, especially HDM-ARD, in China and other similar developing countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12931-022-01967-1.

The prevalence of non-allergic rhinitis phenotypes in the general population: A cross-sectional study

Background

Non‐allergic rhinitis (NAR) can be subdivided into several phenotypes: rhinorrhea of the elderly, rhinitis medicamentosa, smokers', occupational, hormonal, drug‐induced, gustatory, and idiopathic rhinitis. There are two pathophysiological endotypes of NAR: inflammatory and neurogenic. Phenotypes may serve as an indicator of an underlying endotype and, therefore, help to guide the treatment. The prevalence of each phenotype in the general population is currently unknown.

Methodology/Principal

Cross‐sectional questionnaire‐based study in the general population of the Netherlands.

Results

The prevalence of chronic rhinitis in the general population was 40% (N = 558, of those, 65% had NAR and 28% AR, in 7% allergy status is unknown). Individuals with NAR (N = 363) had significantly more complaints in October–February. Those with AR (N = 159) had significantly more complaints in April–August. The most common NAR phenotypes were idiopathic (39%) and rhinitis medicamentosa (14%), followed by occupational (8%), smokers' (6%), hormonal (4%), gustatory (4%), and rhinorrhea of the elderly (4%). The least prevalent phenotype was drug induced (1%). Nineteen percent of the NAR group could not be classified into any of the phenotypes.

Conclusions

This is the first study to describe the prevalences of NAR phenotypes in the general population. AR and NAR have a distinct seasonality pattern with NAR being more prevalent in autumn/winter and AR in spring/summer. Our data on the prevalence of phenotypes may help clinicians to anticipate the type of patients at their clinic and help guide a tailored treatment approach. The high prevalence of rhinitis medicamentosa is alarming, since this is a potentially preventable phenotype.