Asma

There are several links between asthma and allergic rhinitis in the same patient, although these conditions are frequently underdiagnosed with suboptimal clinical outcomes. The two conditions coexist and share clinical, pathogenic, and pathophysiological mechanisms.

The aim of this article was to review the major links between the mechanisms of allergic rhinitis and asthma, as well as their treatment according to existing guidelines, focusing on treatment of allergic rhinitis in patients with comorbid asthma.

The authors concluded there are some unmet needs for patients with asthma and allergic rhinitis. Not all allergic rhinitis patients are screened for asthma. This screening should be conducted with a multidisciplinary approach to characterize the journey of patients with respiratory allergies to subsequently refer adequately to Allergy/Asthma centers. There may be advantages in treatment with allergen immunotherapy and/or biosimilars, which might represent encouraging advances in the management of both conditions.

Allergic conjunctivitis is a reaction of the conjunctiva of the eye due to IgE hypersensitivity. It is commonly associated with other allergic conditions, such as eczema, food allergy, but especially allergic rhinitis and asthma. Still, the relation between allergic conjunctivitis and allergic rhinitis and asthma needs to be understood.

This study aimed to classify allergic conjunctivitis in a patient population and evaluate the relationship between allergic conjunctivitis and asthma, using the Consensus Document for Allergic Conjunctivitis (DECA).

A total of 2914 participants of all ages who participated in the “Alergológica 2015” study were included. They were then divided into two age groups ≤14 and >14 years old. Of these, 965 participants were diagnosed with allergic conjunctivitis, classified by severe (1,8%), moderate (46,4%) or mild (51,8%), and as intermittent (51,6%) or persistent (48,4%). Allergic conjunctivitis was mainly associated with allergic rhinitis (88,4%), asthma (38,2%), food allergy (8,3%), and atopic dermatitis (3,5%). The duration and severity of allergic conjunctivitis were significantly related to allergic rhinitis for both age groups and asthma in adults.

In conclusion, the new DECA classification showed a direct relationship between allergic conjunctivitis, allergic rhinitis, and asthma, which suggests that it should be considered in the hypothesis of the one airway concept.

People with chronic diseases behave according to their perception of the disease, which may impact treatment results. The prevalence of allergic rhinitis is high, around 400 million people worldwide. However, it is poorly self-recognized by patients, as well as it is poorly controlled. The PETRA study’s objective was to evaluate the management of allergic rhinitis by patients and their general practitioners and to describe the relationship between disease perception, patient behavior, and treatment outcomes.

The PETRA study was a cross-sectional study that included 2001 participants between May and October 2017. The study’s main objective was to precisely identify and describe factors associated with a poor perception of the disease in people with allergic rhinitis. 201 French general practitioners selected 1929 patients for analysis (mean age: 39 years; intermittent/persistent symptoms: 46.2/52.3%). 71,7% of the participants had uncontrolled allergic rhinitis (ARCT score < 20), 53,6% had a good perception of their illness (BIPQ score < 5), and 14,1% of the patients had also been diagnosed with asthma.

A poor perception of allergic rhinitis was related to ear, nose, and throat complications, nasal pruritus, uncontrolled allergic rhinitis, and asthma. Also, there was a strong negative correlation between the BIPQ and ARCT scores: the poorer the patient’s perception, the less the disease was controlled.

In conclusion, the PETRA cohort included a high proportion of patients with moderate to severe allergic rhinitis symptoms and a low disease control level. It was shown that many patients were not satisfied with their treatment and did not perceive their disease very well. Although no causal relationship could be drawn from this study, results suggest that improving the perception of allergic rhinitis could be beneficial and lead to better control of symptoms.