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Free Content Allergic rhinitis and asthma connection: Treatment implications

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Abstract:

Treatment of patients with allergic rhinitis and asthma involves securing accurate diagnoses, avoidance measures, pharmacotherapy, and in some patients allergen immunotherapy, with consideration of immunomodulator therapy. At least 20% of patients with asthma have evidence of gastroesophageal reflux (GERD) and others have laryngeal pharyngeal reflux (LPR) also referred to as supraesophageal reflux (SERD) or “atypical reflux.” The scientific foundation of subcutaneous allergen immunotherapy (SCIT) includes generation of T-reg cells, which generate IL-10 and TGF-beta and suppress TH2 and TH1 lymphocyte responses. SCIT alone or even to a greater degree with omalizumab has been shown to reduce the extent of “facilitated allergen presentation” of allergen-IgE complexes binding to B lymphocytes, with the implication of reducing the extent of allergen presentation by B lymphocytes to T lymphocytes. In viewing the concept of the unified airway and the multiple approaches required for optimal patient care, asthma should be considered as a syndrome, which includes the concomitant conditions of allergic rhinitis and GERD (SERD or LPR) with the possibility of intermittent or chronic rhinosinusitis.

Keywords: Allergic; T reg; asthma; avoidance; gastroesophageal; immunotherapy; omalizumab; reflux; rhinitis; rhinosinusitis

Document Type: Research Article

DOI: http://dx.doi.org/10.2500/aap.2008.29.3168

Affiliations: Division of Allergy–Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. p-greenberger@northwestern.edu

Publication date: November 1, 2008

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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