The Misconception
It is a widely held misconception that allergies are limited to sneezing, itching and congestion. But the scope and the burden of allergies extend far and further. Asthma, a common and dreaded lung disease, is also a manifestation of a not-so-mundane allergy!
The Connection
Hay fever or allergic rhinitis (affecting the upper airway) and asthma (affecting lower airway) are two of the most common chronic diseases of mankind. It is estimated that about 20% of the population has hay fever while up to 7% has asthma. Data also shows that 40% of patients with hay fever eventually develop asthma and 80% of patients with asthma already have hay fever. In fact several surveys suggest the rate of hay fever in asthmatics to be as high as 100%. These numbers suggest a significant association of the two conditions, which has led to the concept of “One Airway Disease”.
It has been seen that when the nose of patients with allergic rhinitis is challenged with allergy-producing substances (allergens), lungs quickly show changes of asthma even in patients with no previous history of asthma. The most likely reason for this intricate connection is the common underlying mechanism for both disease processes. In fact, both of the conditions are characterized by allergic inflammation through a specific process in response to exposure to inhalant allergens like pollens.
It is now felt that hay fever and asthma are two points in the same allergic continuum!
What this Connection Implies?
The clinical implication of this connection in rendering patient care is enormous. Without proper control of nose/sinus allergy, it is almost impossible to obtain effective asthma control with inhalers alone. It is helpful for both patient and the treating physician to understand the connection and address both conditions simultaneously for optimal management. It is interesting to recognize that allergy shots (immunotherapy) for allergic rhinitis in children can reduce the likelihood of developing asthma.
As we learn more about this very important link between rhinitis and asthma, this may lead to better treatment for both conditions. It is still not clear why all patients with rhinitis do not develop asthma. Hopefully this will be answered in the near future. But for now, it is of paramount importance to remember that evaluation of rhinitis is not complete without an assessment of the lower airways, and that each patient with asthma should be screened for underlying rhinitis. Hannibal Regional Medical Group will be holding free asthma screenings on May 19 from 1-5pm on the first floor of the Hannibal Regional Medical Group building. For more information on allergies and asthma, or any Hannibal Regional Medical Group.
By: Mohammad Aktaruzzaman, M.D.
Hannibal Regional Medical Group