Management of Patients with Allergic Rhinitis and Asthma: Literature Review

Robert A. Nathan, MD


September 22, 2009

In This Article

Abstract and Introduction


Allergic rhinitis (AR) and asthma are disorders of the airway characterized by inflammation of the respiratory mucosa. The presence of one disorder increases the likelihood that the other will also occur. As they are mechanistically intertwined, one can exacerbate the other when both conditions are present. In addition, comorbid AR and asthma have an additive impact on patients' health-related quality of life. The Allergic Rhinitis and its Impact on Asthma (ARIA) recommendations suggest that asthma patients should be evaluated for AR, and all AR patients should undergo tests for asthma. They also suggest that ideally, a combined strategy should be used to treat the upper and lower airway diseases. While treatment for AR includes antihistamines, intranasal glucocorticosteroids, antileukotrienes, and specific immunotherapy, data suggest that these treatment approaches may also improve asthma outcomes. This article reviews current clinical approaches to the diagnosis and management of patients with comorbid AR and asthma.


Allergic rhinitis (AR) and asthma affect the upper and lower respiratory tracts, respectively. Both are characterized by inflammation of the respiratory mucosa and involve similar inflammatory cells and mediators.[1] Allergic rhinitis affects approximately 15% to 40% of individuals,[2–4] although the prevalence is likely underestimated given that many people with AR do not seek medical care.[3] Approximately 23 million children and adults in the US had asthma in 2006,[5,6] and the prevalence is estimated to be 3% to 19% in Western countries.[4–6] Both asthma and AR have a considerable impact on quality of life (QOL), work and school productivity, absenteeism, and individual and societal economic burden.[2–4,7]


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