ORLANDO, FLA—Treating allergic rhinitis (AR) may help reduce upper respiratory tract infections (URIs). Researchers who presented their work at the 2001 Annual Meeting of the American College of Allergy, Asthma, and Immunology found that following treatment of AR with prescription drugs, the incidence and cost of medications prescribed for URIs dropped dramatically.

Also discussed at the meeting was the value of nasal lavage in alleviating chronic rhinitis symptoms, as well as the connection between AR and asthma. Additionally, researchers reported that fewer organisms than previously believed may cause allergic fungal sinusitis.

AR TREATMENT PREVENTS URIs

Treating AR may help reduce the risk of URI, as well as the cost of its treatment. Corren et al investigated the connection between patients’ use of prescription medications for AR and the rate at which such patients subsequently visited emergency departments and physicians’ offices to receive treatment for URIs.

This retrospective cohort study relied upon data gathered from the claims records of a large commercial health care plan between 1997 and 1998. The prescription of antihistamines or intranasal corticosteroids was assessed monthly. Definition of URI included viral URI, otitis media, tonsillitis, laryngitis, pharyngitis, and sinusitis; the incidence of each was also noted on a monthly basis.

The researchers controlled for age, sex, race, socioeconomic status, seasonal trends, and history of allergy, URI, and allergy treatment. They found that in the months following treatment of AR, URI incidence decreased by 31%, and that, on average, treatment of AR also reduced average antibiotic costs for URI by 49%.

NASAL LAVAGE REDUCES CHRONIC RHINITIS SYMPTOMS

For patients with chronic rhinitis, saline nasal lavage using either a lavage system or a nasal spray may alleviate symptoms when other treatments fail. Research conducted by Desrosiers et al compared the two methods, using 56 adult subjects in a randomized, single-blinded, prospective trial.

Patients were given twice-a-day saline therapy for eight weeks through a nasal wash system or with a nasal spray device. A four-week observation period followed. Results were assessed using a visual analogue scale, quality of life was estimated according to a sino-nasal outcome test, and nasal patency was evaluated through anterior rhinomanometry.

Patients reported that both techniques provided greater relief from such symptoms as nasal congestion, pain, and postnasal drip than did previous treatments. This was corroborated through objective measurements. Furthermore, the moderate improvement persisted through the end of the four-week observation period. However, the researchers noted that results obtained through lavage were superior to those produced with a nasal spray, leading them to conclude that nasal lavage could be a viable treatment for patients with chronic rhinitis.

HOW MANY AR PATIENTS SUFFER FROM ASTHMA, TOO?

Patients diagnosed with AR may or may not exhibit a symptom complex associated with asthma. But because an association between AR and asthma is known to exist, Anolick et al designed a cross-sectional, random sampling strategy to determine how often asthma symptoms may be found in patients diagnosed with AR alone; they then compared the severity of asthma symptoms in these patients to that found in patients given a diagnosis of both asthma and AR.

Adult patients and parents of children selected for the study completed questionnaires about symptoms and quality of life. Included in the study were 5,726 adults and 1,731 children with a diagnosis only of AR, as well as 4,781 adults and 2,848 children with comorbid disease.

The researchers noted that 11% of the adult patients diagnosed only with AR had symptom scores that were a statistically significant 10 points below, and therefore worse than, the average score for comorbid patients; 13% had functioning scores that were that far below the mean for comorbid patients. Similarly, more than 10% of the pediatric patients diagnosed only with AR scored at or below the mean of comorbid patients on scales that measured daytime symptoms, nighttime symptoms, and functional limitations. The researchers concluded that 20% of all patients diagnosed only with AR have asthma symptoms that are as bad as, or worse than, those described by patients diagnosed with both conditions.

CAUSES OF ALLERGIC FUNGAL SINUSITIS

Are allergic fungal sinusitis (AFS) and allergic bronchopulmonary mycosis (ABPM) really caused by different organisms? Although popular belief has declared this to be true, research performed by McCann et al indicates otherwise. Through histologic examination, they sought to find immunoglobulin E (IgE) specific to Aspergillus fumigatus, the known culprit in ABPM, or five recombinant A fumigatus allergens in the allergic mucin (AM) of four groups of AFS sufferers. The first group was composed of 18 patients with definite AFS. A second group comprised 10 probable AFS patients. The third and fourth groups included six patients with chronic sinusitis and five A fumigatus–allergic patients, respectively.

Of the definite-AFS patients, 97% showed A fumigatus–specific IgE, and 67% of them were also positive for at least one recombinant allergen. A fumigatus–specific IgE was seen in 40% of the probable AFS patients, while 20% of them also had IgE specific to at least one recombinant allergen. Only one of the patients with chronic sinusitis had A fumigatus–specific IgE, and none reacted to recombinant allergens. In the A fumigatus–allergic group, 80% of patients had IgE specific to that organism, and one patient had IgE specific to one recombinant allergen. The researchers concluded that a limited number of organisms are responsible for both ABPM and AFS, and that histologic examination should be performed along with AM culture and allergy-related AFS testing.

—Owen McCarthy