Rhinitis is present in nearly all  urban children with asthma. Perennial allergic rhinitis with seasonal exacerbations (PARSE) is the most severe phenotype and may be linked to difficult-to-control asthma, according to study results published in the Journal of Allergy and Clinical Immunology.

Researchers evaluated 749 children with asthma and managed their treatment for 1 year with algorithm-based treatments for rhinitis and asthma. The children were followed up every 2 months and received extensive testing, including aeroallergen-specific immunoglobulin E.

At baseline, rhinitis was present in 93.5% of study participants, and phenotypes were confirmed during the evaluation and management year. These phenotypes included PARSE, which was the most common and severe, found in 34.2% of the 619 study participants who completed ≥4 of 6 follow-up visits. Nonallergic rhinitis was least common and found in 11.2% of study participants. Nonallergic rhinitis was also the least severe compared with PARSE. The majority of study participants remained symptomatic even with nasal corticosteroids and oral antihistamines. Rhinitis was worse in difficult to control asthma compared with easy to control asthma and seasonal patterns were partially linked to those of difficult to control asthma.

The researchers concluded, “Rhinitis is almost ubiquitous in urban children with asthma, and its activity tracks that of lower airway disease. PARSE is the most severe phenotype and most likely to be associated with difficult to control asthma.”

The study results suggest that rhinitis and asthma may signify the materialization of a single disease in 2 parts of the airways.

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Disclosures: Multiple authors declare affiliations with the pharmaceutical industry. Please see reference for a full list of authors’ disclosures.

Reference

Togias A, Gergen PJ, Hu JW, et al. Rhinitis in children and adolescents with asthma: ubiquitous, difficult to control, and associated with asthma outcomes [published online September 10, 2018]. J Allergy Clin Immunol. doi:10.1016/j.jaci.2018.07.041