Allergic rhinitis and the associated morbidity

Curated by Luigi Ferritto (1), Walter Ferritto (2)

Asthma and Allergic Rhinitis

The pathology most frequently associated with allergic rhinitis is bronchial asthma . The unitary concept of allergic airway inflammation is supported by numerous studies showing similar characteristics

both in the upper and lower airways. In most cases, rhinitis and asthma coexist for a genetic predisposition towards the development of allergy. Rhinitis often precedes the appearance of asthma and is an important risk factor, therefore a combined strategy must be taken into account for the treatment of both. In a subject that shows symptoms of rhinitis, even seasonal, treating only asthma means risking a flare-up.

Many mechanisms have been suggested to justify the interaction between nose and bronchial tubes, such as the alteration of nasal function, bronchial aspiration of nasal contents through the posterior nasal discharge, nasolobchial reflex and increased blood several pro-inflammatory mediators.

Allergic conjunctivitis

The second pathology associated with rhinitis is allergic conjunctivitis . Allergic reactions to the eye generally affect the conjunctiva, which is widely exposed to environmental pollen.

Allergic conjunctivitis can be seasonal or perennial and is almost always associated with rhinitis and asthma, rarely isolated. The perennial form manifests itself already in early childhood, while the seasonal appears between 20 and 40 years. The characteristic symptoms are periocular itching, photophobia, redness, foreign body sensation and tearing.

Sinusitis

When rhinitis is very important and obstructs the nasal passages, it can also cause sinusitis, which affects 12-25% of the European population, characterized by inflammation of the sinuses (frontal, maxillary, ethmoidal).

The paranasal sinuses have ducts that open into the nasal cavities, which, as a result of allergic inflammation, can close again, causing a secretion of the secretions. Breast obstruction is the fundamental element in determining rhinosinusitis, which can be acute or chronic.

Nasal polyps

Another manifestation of chronic inflammation is the development of nasal polyps, a particularly serious complication of bronchial asthma.

Nasal polyps are not necessarily the expression of a true allergic disease, the intolerance that most often occurs in these patients is in fact aspirin.

Otitis media

Otitis media is an inflammatory disease of the middle ear.

The causes can be multifactorial, in particular infectious, but we must not forget that the nose and middle ear are covered by the respiratory mucosa and that there is an anatomical continuity between the two cavities through the Eustachian tube. It is therefore not surprising how often a viral infection of the nose precedes the development of an obstruction of the Eustachian tube and subsequent otitis media. Even allergic inflammation of the nose, which classically occurs during the spring months, can spread to the middle ear and cause ear infections.

Atopic dermatitis

In allergic pathology, another particularly frequent manifestation concerns atopic dermatitis, a chronic inflammation of the skin with various clinical manifestations. Many cases of atopic dermatitis occur in childhood, although the disease can become evident at any age. Children with allergic dermatitis are at greater risk of developing a respiratory allergy, asthma and / or rhinitis in later years. Some European pediatric studies are evaluating whether dermatitis therapy, as the first manifestation of allergy, is able to block progression against asthma and rhinitis.

Food allergy

A percentage of patients with allergic rhinitis to seasonal pollens may develop mild symptoms of food allergy, generally in the form of an oral allergic syndrome. The subject with rhinitis on grasses, for example, may show pharyngeal itching during the spring following the intake of strawberries, or other fruit or vegetables. Subjects sensitive to grasses or ambrosia experience symptoms after taking bananas or melons; this is the phenomenon of cross-reactivity, given that the chemical structure of food is similar to that of some respiratory pollens.

Sleep disorders

Allergic rhinitis can also cause severe obstruction of the nasal passages, causing sleep disorders and nasal breathing. These disorders can cause daytime sleepiness and - if present in the first months of life - the development of craniofacial abnormalities.

Nasal obstruction can cause a variety of sleep disorders, such as apnea, hypopneas, and snoring. The child with these disorders frequently has awakenings, with sleepiness during the day, irritability and difficulty in concentration.