Rhinitis Common, Difficult to Control in Children With Asthma

Jennifer Garcia

September 18, 2018

Rhinitis is common, and often not well-controlled, among children and adolescents with asthma, according to a new study published online September 18 in the Journal of Allergy and Clinical Immunology.

"This study offers strong support to the concept that rhinitis and asthma represent the manifestations of one disease in two parts of the airways," write Alkis Togias, MD, from the National Institute of Allergy and Infectious Diseases, in Bethesda, Maryland, and colleagues.

As part of the Asthma Phenotypes in the Inner City (APIC) study, researchers enrolled 619 children and adolescents with asthma (6 to 17 years of age) who were prospectively treated using standardized algorithms for the management of asthma and rhinitis. During the study, patients were evaluated every 2 months for 1 year and were assessed for "the prevalence and severity of rhinitis and its relationship to asthma."

Rhinitis was diagnosed on the basis of reponses to a standardized questionnaire regarding symptoms (eg, runny nose, sneezing, itchy eyes) and doctor's diagnosis. Clinical phenotyping for rhinitis was based on a second questionnaire to determine symptom seasonality as well as results of skin testing and aeroallergen-specific serum IgE. The five clinical phenotypes included nonallergic rhinitis (NAR), perennial allergic rhinitis (PAR), perennial allergic rhinitis with seasonal exacerbations (PARSE), indeterminate atopic rhinitis (IAR), and seasonal allergic rhinitis (SAR).

Overall, 93.5% of children with asthma had a concurrent diagnosis of rhinitis. PARSE was the most common and severe phenotypic presentation, and NAR was the least common (34.2% vs 11.2%, respectively).

Further, the researchers found that PARSE was more prevalent among children with difficult-to-control asthma (44.2%) compared with those who had easy-to-control asthma (26.5%). Difficult-to-control asthma was defined as "requiring 500 µg/d of inhaled fluticasone with or without salmeterol in at least 4 out of the 6 post-baseline study visits."

Despite the use of nasal corticosteroids and/or oral antihistamines, most children remained symptomatic for rhinitis, regardless of the time of year. However, symptoms were lowest in all groups during the summer months.

The authors acknowledge study limitations, including the lack of data on other rhinitis therapies, such as nasal antihistamines, lower than optimal medication adherence, or the possibility that patients with severe asthma may have been overrepresented owing to convenience sampling.

"Rhinitis is almost ubiquitous in asthma and its clinical activity tracks that of lower airway disease," write Togias and colleagues.

"Clinicians should always query for rhinitis symptoms in children with asthma and should be aware that these symptoms will frequently remain uncontrolled with conventional treatment," the authors conclude.

Funding for this study was provided by the National Institute of Allergy and Infectious Diseases, National Institutes of Health. Several coauthors report one or more financial relationships (consulting, personal fees, serving as a board member, travel support, and grants) from one or more of the following companies: Aerocrine, GlaxoSmithKline, Genentech/Novartis, Cephalon, Teva, Boehringer Ingelheim, Merck, DBV Technologies, AstraZeneca, WebMD/Medscape, Sanofi, Vectura, Circassia, Roche, 3M, PrEPBiopharm, Circassia, Regeneron, Peptinnovate, Boston Scientific DSMB, ICON Study Oversight Committee, Elsevier, Janssen, Merck Sharp & Dohme, Stallergens, DBV, Aimmune, Astellas, HAL-Allergy, and UpToDate.

J Allergy Clin Immunol. Published online September 18, 2018. Abstract

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