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Shaaban, R., Zureik, M., Soussan, D., Anto, J. M., Heinrich, J., Janson, C., Kunzli, N., Sunyer, J., Wjst, M., Burney, P. G., Neukirch, F., Leynaert, B

Allergic Rhinitis and Onset of Bronchial Hyperresponsiveness: A Population-based Study

Am.J.Respir.Crit Care Med., 2007, 176, 7, 659, 666, IF: 9.074, PMID: 17615387

RATIONALE: Patients with allergic rhinitis have more frequent bronchial hyper-responsiveness (BHR) in cross-sectional studies. OBJECTIVE: To estimate the changes in BHR in non-asthmatic subjects with and without allergic rhinitis during a 9-year period. METHODS: BHR onset was studied in 3,719 subjects without BHR at baseline, who participated in the follow-up of the European Community Respiratory Health Survey. MEASUREMENTS: BHR was defined as a >/=20% decrease in FEV1 for a maximum dose of 1 mg of methacholine. Allergic rhinitis was defined as having a history of nasal allergy and positive specific IgE (>0.35UI/ml) to pollen, cat, mites or cladosporium. MAIN RESULTS: The cumulative incidence of BHR was 9.7% in subjects with allergic rhinitis, 7.0% in subjects with atopy but no rhinitis, compared to 5.5% in subjects without allergic rhinitis and atopy (respective odds-ratio (OR) ) for BHR onset 2.44 [1.73-3.45] and 1.35 [0.86-2.11], after adjustment for potential confounders including sex, smoking, BMI and FEV1. Subjects with rhinitis sensitised exclusively to cat or to mites were particularly at increased risk of developing BHR (ORs: 7.90 [3.48-17.93] and 2.84 [1.36-5.93] respectively). Conversely, in subjects with BHR at baseline (N=372), 35.3% of those with allergic rhinitis, compared to 51.8% of those without rhinitis had no more BHR at follow-up; OR=0.51 [0.33-0.78]. BHR \"remission\" was more frequent in patients with rhinitis treated by nasal steroids than in those not treated (OR= 0.33 [0.14-0.75]). CONCLUSIONS: Allergic rhinitis was associated with increased onset of BHR, and less chance for remission except in those treated for rhinitis


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