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Allergy-Asthma Link Nothing to Sneeze At

Treating allergic rhinitis can help people with asthma

Proper diagnosis and treatment of hay fever and other forms of allergic rhinitis is an important factor in controlling asthma. And more doctors need to understand that link to better care for their asthma patients, say allergy and asthma experts.

“We’re trying to get the message out that when a doctor sees a patient with asthma, the doctor needs to ask [the patient] about stuffy nose and blowing and drainage and sneezing,” says Dr. William Storms, an allergist in Colorado Springs, Colo.

“It’s obvious that the presence of allergic rhinitis adds a significant cost factor to the management of asthma, and that [the nose and lungs are] really different ends of the same organ system. And if we don’t appreciate that fact, we’re kind of missing the boat,” adds Dr. Richard Weber, allergy training program director at the National Jewish Medical and Research Center in Denver.

The two doctors discussed the connection between allergic rhinitis and asthma at the recent annual meeting of the American College of Allergy, Asthma and Immunology.

Allergic rhinitis is an inflammation of the mucous membranes of the nose. Symptoms include sneezing, congestion, runny nose, and itchy eyes, throat, nose and ears.

Hay fever is a form of seasonal allergic rhinitis. But allergic rhinitis can be a year-round condition caused by such household allergens as animal dander, dust mites and indoor molds.

Allergic rhinitis affects up to 26 percent of Americans. The bulk of asthma patients have rhinitis, and patients with rhinitis have a much higher prevalence of asthma than people without rhinitis, Storms says.

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Newly released guidelines from the World Health Organization recognize the link between allergic rhinitis and asthma. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines provide updated information for doctors about allergic rhinitis and its impact on asthma and offer revised methods of diagnosis and treatment, Weber says.

Storms says it’s not fully understood why allergic rhinitis aggravates asthma, which afflicts about 20 million Americans. One theory is that because rhinitis makes it difficult to breathe through your nose, the condition hampers the normal functions of the nose.

When you have to breathe through your mouth, air isn’t warmed, filtered or humidified before it reaches your lungs, and all those factors can make asthma worse, Storms says.

Weber says there are many doctors who still discount a link between asthma and allergic rhinitis.

“I would bet there’s probably still a significant number of people who would say ‘Ah, baloney, asthma is asthma and noses is noses,’ ” Weber says.

But he and Storms stress that the lungs and the nose are parts of the same system.

“One way to look at this is that this is one organ, the respiratory tract, and if you irritate one end, the other end gets it too,” Storms says.

He says asthma patients need to be more aware of this issue and tell their doctor about any symptoms that may indicate allergic rhinitis. The condition can be controlled in a number of ways, including drugs such as antihistamines and nasal steroids, avoiding allergens, and, for some patients, allergy shots.

“The feeling is that if you treat the nose aggressively then you may be able to, if not prevent, at least diminish the severity and modulate asthma,” Weber says.

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