Asthma, Allergic Rhinitis Prevalence With Long-Term Opioid Use

This article is part of Pulmonology Advisor‘s coverage of the American Academy of Allergy, Asthma & Immunology, taking place in Orlando, Florida. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI/WAO 2018.

ORLANDO — Patients with opioid dependence or abuse may exhibit a higher prevalence of asthma compared with the general population, according to a study presented at the 2018 Joint Congress of the American Academy of Allergy, Asthma & Immunology and World Allergy Organization (AAAAI/WAO), held March 2-5, 2018, in Orlando, Florida.¹

In addition to their analgesic effects, opioid binding to opioid receptors leads to the release of histamine from mast cells, including those implicated in asthma and allergic rhinitis.^2,3 This effect of opioids is mediated by activation of allergen-reactive type 2 helper T cells, which trigger the activation and recruitment of immunoglobulin E.

For this retrospective study, the charts of inpatients (aged 18-80 years) who consulted the emergency department or ambulatory surgery department of Kings County Hospital in Brooklyn, New York, between 2013 and 2017 were reviewed. Charts included International Classification of Diseases coding for asthma and allergic rhinitis, opioid abuse, or opioid dependence, as well as for chronic conditions including fibromyalgia, chronic pain, joint disorder, and osteoarthritis. Assessment of opioid prescriptions was used to evaluate chronic opioid use.

 Of the patients assessed in this study, 51,977 were found to exhibit opioid abuse or dependence, 18% of whom had asthma. A greater percentage of men vs women were found to exhibit opioid abuse or dependence, both with no asthma (73% vs 27%, respectively) and in combination with asthma (56% vs 44%, respectively; P <.05 for both in a χ² analysis). Of the patients in this cohort who had both a chronic pain condition and asthma or allergic rhinitis, 51% had prescriptions for opioids, 68% of whom were women.

“We showed that the prevalence of asthma in patients with opioid abuse/dependence was higher than the national prevalence of asthma,” concluded the study authors. “The prevalence of opioid abuse/dependence is known to be higher in males, and females are more likely to use prescribed opioid for noncancer pain.”

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References

1. Naik R, Goodrich G, Al-Shaikhly T, and Joks R. Prevalence of long-term opioid use in patients with asthma and allergic rhinitis. Presented at: 2018 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress; March 2-5, 2018; Orlando, FL. Abstract 685.
2. Baldo BA, Pham NH. Histamine-releasing and allergenic properties of opioid analgesic drugs: resolving the two. Anaesth Intensive Care. 2012;40(2):216-235.
3. Farnam K, Chang C, Teuber S, Gershwin ME. Nonallergic drug hypersensitivity reactions. Int Arch Allergy Immunol. 2012;159(4):327-345.