Mucosal and systemic inflammatory changes in allergic rhinitis and asthma: a comparison between upper and lower airways

A remarkable relationship exists between upper and lower airways. Bronchial obstruction is a paramount feature of asthma as well as nasal obstruction of allergic rhinitis (AR). This study aims to evaluate the response to both bronchodilation and decongestion testing and their relationships in a large group of patients with moderate-severe persistent AR alone. Two hundred eleven patients with moderate-severe persistent AR were prospectively and consecutively evaluated. Clinical examination, skin prick test, spirometry, bronchodilation test, rhinomanometry, and decongestion test were performed on all patients. Seventeen subjects (8%) did not respond to any of the tests, 55 subjects (26.1%) were responders only to the decongestion test, 31 (14.7%) only to the bronchodilation test, and 108 subjects (51.2%) responded to both these tests. Longer AR duration was significantly associated with positive response to both tests (p<0.01). In conclusion, this study provides the first evidence that patients with moderate-severe persistent AR may frequently show reversibility to both bronchodilation and decongestion tests.

Background: Global airway disease, with symptoms from both upper and lower airways, is a challenging problem for clinicians. Our goal is to design one single standard test for the awareness of global airway diseases to be used in clinical setting. Material and Methods: During 2019, rhinologists and pulmonologists generated a pool of items based on literature, patient-reported outcome measures and clinical experience. The items were administered to 206 patients with known asthma, CRS, allergic rhinitis, or a combination thereof. The patients also completed the Asthma Control Questionnaire (ACQ-5) and the Sino-Nasal Outcome Test (SNOT-22). Using a mix of clinical knowledge and data-driven methods a global airways questionnaire was developed. Results: Mean ACQ score was highest in patients with all three, whereas the highest SNOT-22 score was observed in patients with CRS and asthma. After the development process, analysis of responses from 206 patients to 44 items on a new global airway’s questionnaire led to identification of 15 items that form the STARR-15 questionnaire with three underlying domains (an allergic rhinitis sub-factor, a CRS sub-factor and an asthma sub-factor). Conclusion: STARR-15 represents the first global airways questionnaire, to be used when examining patients with upper and lower airways symptoms. Future analyses are warranted to evaluate the clinical and psychometric properties of STARR-15.

Background: The Link between allergic rhinitis and asthma is well known. Bronchial hyperreactivity (BHR) may be present in rhinitics. The present study is aimed at evaluating a large group of subjects suffering from allergic rhinitis alone to investigate the presence of spirometric impairment and BHR both during and outside the pollen season. Methods: 360 rhinitics (subdivided in 3 groups: seasonal, SAR, perennial, PAR, and polysensitized, PolysR) were investigated by spirometry and methacholine challenge. Results: There was a significant seasonal difference concerning the number of rhinitics with impaired FEV1 (p&lt;0.01 for SAR, p&lt;0.02 for PAR, and p&lt;0.03 for PolysR) and FEF25-75 (p&lt;0.05 for SAR, p&lt;0.03 for PAR, and p&lt;0.05 for PolysR) as well as with BHR (p&lt;0.05 for SAR and p&lt;0.03 for PAR). Conclusions: This study evidences that an impairment of spirometric parameters and BHR may be observed in patients with allergic rhinitis alone. Thus, careful evaluation of lower airways should be performed in patients with allergic rhinitis alone.