Comorbidities and allergic rhinitis: Not just a runny nose

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Medical Education Library

Comorbidities and allergic rhinitis: Not just a runny nose

February 2012 · Vol. 61, No. 02 Suppl: S11-S15

By

James A. Hadley, MD

Jennifer M. Derebery, MD

Bradley F. Marple, MD

References

1. Meltzer EO, Gross GN, Katial R, Storms WW. Allergic rhinitis substantially impacts patient quality of life: Findings from the Nasal Allergy Survey Assessing Limitations. J Fam Pract. 2012;61(suppl 1):S5-S10.

2. Brozek JL, Bousquet J, Baena-Cagnani CE. et al; Global Allergy and Asthma European Network; Grading of Recommendations Assessment, Development and Evaluation Working Group. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466-476.

3. Price D. Asthma and allergic rhinitis: linked in treatment and outcomes. Ann Thorac Med. 2010;5(2):63-64.

4. Compalati E, Ridolo E, Passalacqua G, Braido F, Villa E, Canonica GW. The link between allergic rhinitis and asthma: the united airways disease. Expert Rev Clin Immunol. 2010;6(3):413-423.

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8. Craig TJ, Sherkat A, Safaee S. Congestion and sleep impairment in allergic rhinitis. Curr Allergy Asthma Rep. 2010;10(2):113-121.

9. Muliol J, Maurer M, Bousquet J. Sleep and allergic rhinitis. J Investig Allergol Clin Immunol. 2008;18(6):415-419.

10. Storms W, Yawn B, Fromer L. Therapeutic options for reducing sleep impairment in allergic rhinitis, rhinosinusitis, and nasal polyposis. Curr Med Res Opin. 2007;23(9):2135-2146.

11. Bachert C, Vignola AM, Gevaert P, Leynaert B, Van Cauwenberge P, Bousquet J. Allergic rhinitis, rhinosinusitis, and asthma: one airway disease. Immunol Allergy Clin North Am. 2004;24(1):19-43.

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Table of Contents

Introduction

Allergic rhinitis substantially impacts patient quality of life: Findings from the Nasal Allergy Survey Assessing Limitations

Comorbidities and allergic rhinitis: Not just a runny nose

Insights on allergic rhinitis from the patient perspective

Closing thoughts: Implications of the findings from the National Allergy Survey Assessing Limitations for the management of allergic rhinitis in America

Appendix

TAKE-HOME POINTS

Allergic rhinitis (AR) is rarely found in isolation and should be considered in the context of upper and lower airway disease.
People with AR are at greater risk of suffering asthma, rhinosinusitis, and other related upper airway conditions.
Most people with both nasal allergies and asthma report that their asthma gets better when their nasal allergies are under control.
People with AR are more than twice as likely to suffer problems sleeping due to their nasal allergy symptoms.

Introduction

Allergic rhinitis (AR) is a common health problem that affects all ages and is often inadequately treated. Because it is often perceived as just a nuisance, many patients do not seek medical treatment, and others self-medicate with over-the-counter products. However, as discussed by Meltzer et al¹ earlier in this supplement, untreated or inadequately treated AR can substantially impair overall quality of life. Importantly, AR is rarely found in isolation and should be considered in the context of systemic allergic disease. The presence of AR has been associated with numerous comorbid disorders, including asthma,^2-4 chronic otitis media,⁵ rhinosinusitis,^6,7 and oropharyngeal lymphoid hypertrophy, with secondary obstructive sleep apnea and disordered sleep.^8-10 Poorly controlled AR can trigger exacerbations of these comorbidities because they often share pathophysiologic (inflammatory) pathways in common with AR.^11,12 Moreover, if left untreated, AR symptoms themselves can worsen, leading to a spiral of worsening comorbidities.

Although there is significant evidence supporting the link between AR and other comorbidities, most studies have necessarily focused on selected populations and there has been relatively little information on how comorbidities affect the general AR population. The objective of this part of the National Allergy Survey Assessing Limitations (NASAL; www.nasalsurvey.com), a study sponsored by Teva Respiratory, LLC, was to examine the full range of symptoms patients with AR experience and how these symptoms relate to other, potentially more serious conditions. To enable comparison between the prevalence of comorbidities in the AR population (N = 400) and that in the general population, selected results of the general population survey (N = 522) are also included. Full details of the survey methodology have been provided elsewhere in this supplement.

Results of the National Allergy survey Assessing limitations

Worst Month for Nasal Allergies

Most adults with AR experience symptoms that are worse during certain times of year. In line with this, 76% of AR patients questioned reported that their nasal allergy symptoms have been worse or more frequent during a particular season or time of year in the past 12 months. Of these, most reported that the worst months of their allergy symptoms were in the spring, with 26% reporting March, 58% reporting April, and 44% reporting May as the worst month for allergy symptoms (FIGURE 1A). As expected, the most frequently reported symptom was nasal congestion, and 56% of AR patients reported experiencing this congestion every day or most days during the worst month in the past year. Other common symptoms that occurred every day or most days during the worst month were postnasal drip (48%), repeated sneezing (45%), watering or tearing eyes (41%), rhinorrhea (41%), red or itching eyes (38%), and nasal pruritus (31%). Importantly, not all of the symptoms reported were nasal, as 26% of AR patients reported cough, 21% reported headache, 20% reported throat itching, 18% reported facial pain or pressure, and 16% reported ear pain or pressure every day or most days during the worst month in the past year (FIGURE 1B).

FIGURE 1

Patient-rated nasal allergies (A) during months when symptoms are worst and symptoms suffered (B) during the worst allergy months

Patients with nasal allergies were asked: (A) During what particular months of the year are your nasal allergies the worst? (B) Which symptoms did you have during the worst one month period in the past year?
(A) Base: Allergies are worst during certain times of the year, n = 305; (B) Base: All respondents, unweighted, N = 400.

Asthma and Allergy

The survey found a strong relationship between asthma and nasal allergies, with 38% of AR patients reporting that they have been previously diagnosed with asthma. By contrast, only 8% of adults without nasal allergies reported that they have ever been diagnosed with asthma (FIGURE 2A). According to those patients with asthma and nasal allergies, their asthma symptoms are related to their allergy symptoms. The majority of adults with both nasal allergies and asthma (52%) reported that asthma gets better when their nasal allergies are under control; 37% said that their asthma stays about the same when their nasal allergies are under control, and 11% were not sure.