Comorbidities and allergic rhinitis: Not just a runny nose

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Medical Education Library

Comorbidities and allergic rhinitis: Not just a runny nose

February 2012 · Vol. 61, No. 02 Suppl: S11-S15

References

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FIGURE 3

Incidence of other comorbidities associated with allergic rhinitis in the allergy vs general population

Respondents were asked: During the past 4 weeks, have you had heartburn, reflux or gastroesophageal reflux disease (GERD), migraines, sleep disturbances, sleep apnea, sinusitis, skin rashes, earaches, chronic tonsillitis, conjunctivitis or red eye, or none of these?

Base: All respondents, N = 522; *Pearson chi-square, P ≤ 0.05.

As demonstrated in this study, rhinosinusitis is another common complication of AR, which can lead to inflammation of the sinus mucosa and obstruction of the sinus drainage pathway or ostium.^6,17 Moreover, rhinosinusitis may be implicated in the genesis of nasal polyps, which are common when rhinosinusitis complicates AR. Although the reasons for nasal surgery were not collected in this survey, it is interesting to note the relatively high proportion of patients with AR who have had nasal surgery (15%), which may have included surgery to remove nasal polyps.

Common pathologic pathways can also explain the higher prevalence of other comorbidities seen in the survey of AR patients compared with the general population. Allergic rhinitis involves inflammation of the mucous membranes of the nose, eyes, eustachian tubes, middle ear, paranasal sinuses, and pharynx. Allergen exposure in the nasopharynx with release of histamine and other mediators can cause eustachian tube obstruction, possibly leading to middle ear effusions.¹⁸ Similarly, chronic allergic inflammation of the upper airway causes oropharyngeal lymphoid hypertrophy with prominence of adenoidal and tonsillar tissue. This is important, as retrospective analysis of medical claims data has shown that claims for rhinosinusitis, tonsillitis, otitis media, migraines, and asthma all increase during the allergy season with significant increases in the cost of treatment.¹⁹ Finally, the survey also confirmed the significant impact of AR on sleep quality. Several studies have found that AR patients, and particularly those with nasal congestion, often have significant sleep disturbances leading to fatigue, daytime somnolence, and impaired daytime functioning as reflected in lower levels of productivity at work or school.^8,10 As discussed in more detail by Meltzer et al¹ earlier in this supplement, sleep problems and the associated daytime fatigue are common problems reported by many AR patients. There may be a link between AR patients being tired and feelings of depression and anxiety. Therefore, although there is no direct pathologic link between AR and mental health, they certainly should be considered as serious potential consequences of uncontrolled AR.

In summary, the NASAL survey found that patients with AR are at a higher risk of other comorbidities compared with the general US population. Moreover, it showed that these comorbidities were exacerbated during the spring months when the symptoms of AR are worst. It therefore follows that timely diagnosis and treatment should be a priority for patients and physicians, not only to control AR symptoms but also to improve the management of associated diseases.