Reference
Carr, Tara F, et al. “Non-Atopic Rhinitis at Age 6 Is Associated With Subsequent Development of Asthma”. Clin. Exp. Allergy, vol. 49, no. 1, Jan. 2019, pp. 35–43.
Abstract
BACKGROUND: It has been postulated that the association between
allergic rhinitis and asthma is attributable to the progressive
clinical expression of respiratory inflammation during
childhood. The role of non-allergic rhinitis in early life in
relation to subsequent asthma has not been extensively explored.
OBJECTIVE: We sought to determine whether rhinitis in early life
was associated with risk of asthma development into adulthood,
and whether this relationship is independent of allergic
sensitization. METHODS: Participants were identified from the
Tucson Children's Respiratory Study, a non-selected birth
cohort. Allergy skin prick testing was performed at age 6 years
using house dust mix, Bermuda, mesquite, olive, mulberry,
careless weed, and Alternaria aeroallergens. Atopy was defined
as $\geq$1 positive tests. Physician-diagnosed active asthma
from age 6 to 32 and physician-diagnosed rhinitis at age 6 were
determined by questionnaire. Participants with asthma or active
wheezing at age 6 were excluded from analyses. Risk estimates
were obtained with Cox regression. RESULTS: There were 521
participants who met inclusion criteria. The hazard ratio for
subsequently acquiring a diagnosis of asthma between the ages of
8 and 32 for those with non-atopic rhinitis was 2.1 (95% CI:
1.2, 3.4, P = 0.005), compared with the non-atopic no rhinitis
group, after adjusting for sex, ethnicity, maternal asthma,
maternal education and smoking, and history of 4+ colds per year
at age 6. Among the atopic participants, both the active and no
rhinitis groups were more likely to develop and have asthma
through age 32. The relation between non-atopic rhinitis and
asthma was independent of total serum IgE levels at age 6.
CONCLUSION AND CLINICAL RELEVANCE: Childhood rhinitis, even in
the absence of atopy, confers significant risk for asthma
development through adulthood. These findings underscore the
importance of non-allergic mechanisms in the development of
asthma.