Corren J, Manning BE, Thompson SF, Hennessy S, Strom BL. J Allergy Clin Immunol. 2004;113:415–419
Purpose of the Study.
To examine the effect of treatment of allergic rhinitis on hospitalization and emergency department visits in patients with concomitant allergic rhinitis and asthma.
Three hundred sixty-one subjects and 1444 control patients with allergic rhinitis and asthma who were at least 6 years of age.
A case-control analysis of patients with asthma and concomitant allergic rhinitis was performed between 1996 and 1997 in a large managed care organization in northeastern United States. Diagnosis, procedure, laboratory, health care utilization, and pharmacy records were analyzed to determine if treatment of allergic rhinitis affected the frequency of asthma exacerbations. Patients fulfilled the requirements for diagnosis of asthma and allergic rhinitis within a 12-month period. Patients were defined as asthmatic if they had ≥2 claims with diagnostic codes for asthma; had claims with 1 asthma diagnosis code and 1 asthma-related prescription; or filled 2 asthma-related prescriptions. Patients with allergic rhinitis had ≥2 claims with allergic rhinitis diagnosis codes; ≥2 prescriptions for second-generation antihistamine; ≥2 prescriptions for nasal corticosteroids; 1 prescription for a second-generation antihistamine and 1 prescription for a nasal corticosteroid; or a claim with 1 allergic rhinitis diagnosis code and at least 1 prescription for a second-generation antihistamine and a nasal corticosteroid.
Treatment of allergic rhinitis was associated with a lower frequency of emergency department visits and hospitalization resulting from asthma. Patients receiving monotherapy with a nasal corticosteroid had significantly lower risk of emergency department visits (odds ratio [OR]: 0.75) and hospitalization (OR: 0.56). A similar trend was seen with treatment with a second-generation antihistamine alone. Treatment with a combination of nasal corticosteroids and second-generation antihistamines was associated with additional lower risk of emergency department visits (OR: 0.37) and hospitalization (OR: 0.22).
Treatment of allergic rhinitis lowers the risk of asthma-related health care utilization in patients with concomitant allergic rhinitis and asthma.
This was a useful study in that it supports the National Heart, Lung, and Blood Institute guidelines for long-term successful management of patients with asthma and concomitant allergic rhinitis. This is the first large case-control study to definitively show a positive relationship between treatment of allergic rhinitis and lowered risk for asthma health care utilization. Findings support the idea of “one airway,” and physicians should remain cognizant of the benefits of treating the upper airway in patients with lower-airway disease.