Perennial rhinitis: An independent risk factor for asthma in nonatopic subjects. Results from the European Community Respiratory Health Survey

Background: Although clinical and experimental studies suggest that upper r espiratory tract dysfunction may affect the lower airways, rhinitis is usua lly not studied as a potential risk factor for asthma, This is because both diseases share key elements of pathogenesis and are usually considered as different manifestations of the same underlying "atopic" state. Objective: We sought to assess whether asthma is associated with rhinitis i n the absence of immunologic disorders in a population study. Methods: Data from 34 centers participating in the European Community Respi ratory Health Survey were analyzed. Random samples of 20- to 44-year-old su bjects were invited to complete a detailed questionnaire and undergo total and specific IgE measurements, skin prick tests to 9 allergens, and broncho provocation challenges with methacholine, Results: Subjects with perennial rhinitis (n = 1412) were more likely than: control subjects (n = 5198) to have current asthma, After adjustment for se x, age, smoking habit, family history of asthma, geographic area, and seaso n at the time of examination, asthma was strongly associated with rhinitis among atopic subjects (odds ratio [OR] = 8.1; 95% confidence interval [CI] = 5.4-12.1) but also among nonatopic subjects (OR = 11.6; 95% CI = 6.2-21.9 ), Moreover, the association remained very strong when the analysis was res tricted to nonatopic subjects with IgE levels of 80 kIU/L or less (OR = 13. 3; 95% CI = 6.7-26.5), In nonasthmatic subjects bronchial hyperresponsivene ss was also more frequent in subjects with rhinitis than in those without r hinitis (OR = 1.7; 95% CI = 1.2-2.6 in nonatopic subjects with IgE levels o f less than or equal to 80 kIU/L). Conclusion: The strong association between perennial rhinitis and: asthma i n nonatopic subjects with normal IgE levels is consistent with the hypothes is that rhinitis is an independent risk factor for asthma.