Allergic rhinitis (AR) and asthma can be considered as manifestations of the same disease entity. The treatment of AR may improve also asthma symptoms. The aim of the study was to evaluate, how often AR is diagnosed and treated in patients with asthma. A retrospective chart review in the allergy and asthma unit of a secondary paediatric hospital. From 903 eligible 7- to 15-year-old children with doctor-diagnosed asthma, 372 were randomly included in the study. In all, 229 patients (61.6%, 95% CI: 56.5-66.4%) had symptoms presumptive for AR. The diagnosis of AR was recorded in the patient records only for 87 patients (23.4%, 95% CI: 19.4-28.0). There was evidence that children with AR or nasal symptoms had more severe asthma; 35% of the patients with AR, 23% with nasal symptoms without AR diagnosis and 12% without nasal symptoms required inhaled steroids and long-acting beta-agonists for asthma (p = 0.035). AR was both under-diagnosed and under-treated in school-aged children with doctor-diagnosed asthma.
The aim of this study was to evaluate adult patients in general practice suspected of having rhinitis.
A total of 72 patients suspected of having rhinitis underwent a secondary specialist investigation, resulting in 55 final specialist diagnoses of rhinitis. Through interviews of patients and a questionnaire mailed to the primary physician, information on diagnostic strategy, final diagnosis, suggested treatments and patients' knowledge about rhinitis were determined.
One third of the 72 patients examined for possible rhinitis would have benefited from a supplementary specialist examination, where one group was made up of patients with negative allergy tests and chronic symptoms of either non-rhinitis disease or vasomotoric rhinitis and the other group was made up of patients with severe seasonal allergic rhinitis, who would benefit from immunotherapy. The suggested medical treatments followed modern treatment principles. Of the patients with a final diagnosis of rhinitis, only one third were informed about treatment principles with inhalation steroids, while half of the patients knew about the basic principles of antihistamine treatment. Of 53 patients with rhinitis, 6 were prepared to change medical treatment without first contacting their physician.
Patients with chronic or recurrent symptoms should be referred to specialists more often, and patients who might benefit from allergen-specific treatment, such as immunotherapy or allergen prevention, should be evaluated by an allergy specialist. Patients with rhinitis should be given more information on disease mechanisms and treatment principles.
AIM: Several studies have shown a negative correlation between cancer and atopy-related diseases. There are also a few reports of a positive relationship. We wanted to further evaluate these relationships in a prospective study. SUBJECTS AND METHODS: The incidence of malignant diseases among adult patients with atopy-related diseases (asthma, rhinitis, urticaria, eczema etc; n = 13811), who had been skin prick tested in 1976-1999 was compared with the incidence in the general population. Expected cancer incidence from the date of skin prick testing up to 1999 was obtained from cause-, sex-, calendar-year-, and 5-year-age-group specific incidence rates for the county. These rates were calculated from cancer incidence and population counts obtained from the Swedish Cancer Register. The 95% confidence intervals (CIs) for cause-specific standardized incidence ratios (SIRs) were calculated. Skin prick tests were performed with Dermatophagoides pteronyssinus, horse, dog, cat, timothy, mugwort, birch, and Cladosporium. Patients having one or several positive skin prick test reactions (> or = 2+) were regarded as atopics. RESULTS: 119 cases of cancer occurred among 6224 atopic individuals (SIR 1.0) compared with 216 cases (SIR 0.94, CI 0.82-1.08) among 6358 non-atopics. There was a slight excess of Hodgkin's lymphoma cases among atopic men (SIR 4.03, 95% CI 1-10.3), and of non Hodgkin lymphoma cases among atopic women (SIR 4.52, 95% CI 1.23-11.6). However, a large number of comparisons were made which can have caused random findings. CONCLUSIONS: The results showed no associations between atopy or allergic symptoms, and subsequent cancer risk, but supported the theory that type-I allergy is not related to cancer risk.
From 1 July 1990 to 31 December 1991, all patients referred to the Allergy Section of the ENT Department, University Hospital, Lund, Sweden, (n = 678) answered a 134-item questionnaire presented on the screen of a personal computer by pressing Y (for yes) or N (for no) on the keyboard. The objective of this study was to compare the questionnaire responses from patients with allergic rhinitis (AR) with those of patients with perennial nonallergic rhinitis or vasomotor rhinitis (VMR). Nasal blockage was the predominant symptom in the VMR group, whereas the AR patients mainly suffered from eye irritation, sneezing, and, to some extent, rhinorrhea. Concomitant asthma was more prevalent in the AR group than in the VMR group, whose histories were characterized by symptoms associated with airway infections. About 60% of both groups reported problems with such nonspecific airway irritants as cigarette smoke and perfumes. With respect to the diagnostic reliability of the history, in the AR group the order of accuracy (according to the skin prick test results) of reported hypersensitivity to allergens was as follows: cat > timothy > birch > dust mite > mugwort. A history of hypersensitivity to molds as a cause of symptoms was of no diagnostic value. The findings suggest that there are several differences in the medical histories of AR and VMR patients that merit further investigation.
Severe eczema in young children is associated with an increased risk of developing asthma and rhino-conjunctivitis. In the general population, however, most cases of eczema are mild to moderate. In an unselected cohort, we studied the risk of current asthma and the co-existence of allergy-related diseases at 6 years of age among children with and without eczema at 2 years of age.
Questionnaires assessing various environmental exposures and health variables were administered at 2 years of age. An identical health questionnaire was completed at 6 years of age. The clinical investigation of a random subsample ascertained eczema diagnoses, and missing data were handled by multiple imputation analyses.
The estimate for the association between eczema at 2 years and current asthma at 6 years was OR=1.80 (95% CI 1.10-2.96). Four of ten children with eczema at 6 years had the onset of eczema after the age of 2 years, but the co-existence of different allergy-related diseases at 6 years was higher among those with the onset of eczema before 2 years of age.
Although most cases of eczema in the general population were mild to moderate, early eczema was associated with an increased risk of developing childhood asthma. These findings support the hypothesis of an atopic march in the general population.
The Prevention of Allergy among Children in Trondheim study has been identified as ISRCTN28090297 in the international Current Controlled Trials database.
The present paper is designed to report results of a clinico-epidemiological study that had the objective to elucidate the prevalence of allergic rhinitis among 8,311 first- and eighth-grade schoolchildren from the city of Tomsk and rural areas of the Tomsk region. The investigation was undertaken in the framework of the International Study of Asthma and Allergy in Childhood (ISAAC). It has demonstrated that clinical symptoms of allergic rhinitis (AR) in the region of interest occurred in 36.7% of the children including 35.6% and 38.9% of those attending urban and rural schools respectively. Positive skin test response to the selected panel of allergens was documented in 45.41% and 16.09% of the children in these groups. They most frequently reacted to the cat's hair, birch tree pollen, and a mixture of tick allergens and domestic dust. Only urban community-dwelling children proved sensitized to cockroach (15.62%), wormwood (6%), saltbush (8%), and ragweed (10.93%) allergens. It may be hypothesized that epidemiological characteristics of allergic rhinitis are generated not only under the influence of the urban environment but also depend on other endemic ecological factors.
Exhaled nitric oxide is a potential marker of lower airway inflammation. Allergic rhinitis is associated with asthma and bronchial hyperresponsiveness. To determine whether or not nasal and exhaled NO concentrations are increased in allergic rhinitis and to assess the relation between hyperresponsiveness and exhaled NO, 46 rhinitic and 12 control subjects, all nonasthmatic nonsmokers without upper respiratory tract infection, were randomly selected from a large-scale epidemiological survey in Central Norway. All were investigated with flow-volume spirometry, methacholine provocation test, allergy testing and measurement of nasal and exhaled NO concentration in the nonpollen season. Eighteen rhinitic subjects completed an identical follow-up investigation during the following pollen season. Exhaled NO was significantly elevated in allergic rhinitis in the nonpollen season, especially in perennially sensitized subjects, as compared with controls (p=0.01), and increased further in the pollen season (p=0.04), mainly due to a two-fold increase in those with seasonal sensitization. Nasal NO was not significantly different from controls in the nonpollen season and did not increase significantly in the pollen season. Exhaled NO was increased in hyperresponsive subjects, and decreased significantly after methacholine-induced bronchoconstriction, suggesting that NO production occurs in the peripheral airways. In allergic rhinitis, an increase in exhaled nitric oxide on allergen exposure, particularly in hyperresponsive subjects, may be suggestive of airway inflammation and an increased risk for developing asthma.