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Allergic Rhinitis, Asthma, and Obstructive Sleep Apnea: The Link

  • Jeffrey R. Stokes
  • Thomas B. Casale
Part of the Allergy Frontiers book series (ALLERGY, volume 3)

Abstract

Airway diseases such as asthma, allergic rhinitis and obstructive sleep apnea are quite common and frequently co-exist. The reasons for this relationship have not been clearly demonstrated. However, several mechanisms for the “unified airway” have been postulated involving common inflammatory and neurologic pathways. Specific associations between allergic rhinitis and asthma, allergic rhinitis and obstructive sleep apnea, and asthma and obstructive sleep apnea are reviewed in detail. Epidemiologic, pathologic, and physiologic links among the diseases as well as differences are discussed. When these diseases are present together it may be more difficult to treat one without appropriately managing the others.

Keywords

Obstructive Sleep Apnea Continuous Positive Airway Pressure Allergic Rhinitis Allergic Rhinitis Obstructive Sleep Apnea Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Bousquet J, van Cauwenberge P, Khaltaev N, World Health Organization. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001;108:S147–S336.PubMedCrossRefGoogle Scholar
  2. 2.
    The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee, Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet 1998;351:1225–1232.CrossRefGoogle Scholar
  3. 3.
    Global strategy for asthma management and prevention, Global Initiative for Asthma (GINA) 2006. Available from: http://www.ginasthma.org
  4. 4.
    Masoli M, Fabian D, Holt S, Beasley R, Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA dissemination committee report. Allergy 2004;59:469–478.PubMedCrossRefGoogle Scholar
  5. 5.
    Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217–1239.PubMedCrossRefGoogle Scholar
  6. 6.
    Hosselet JJ, Ayuappa I, Norman RG, Krieger AC, Rapoport DM. Classification of Sleep-disordered Breathing. Am J Respir Crit Care Med, 2001;163:398–405.PubMedGoogle Scholar
  7. 7.
    Netzer NC, Hoegel JJ, Loube D, Netzer CM, Hay B, Alvarex-Sala R, Strohl KP. Sleep in primary care international study group. Prevalence of symptoms and risk of sleep apnea in primary care. Chest 2003;124:1406–1414.PubMedCrossRefGoogle Scholar
  8. 8.
    Hudgel DW. Mechanisms of obstructive sleep apnea. Chest 1992;101:541–549.PubMedCrossRefGoogle Scholar
  9. 9.
    Sassani A, Findley LJ, Kryger M, Goldlust E, George C, Davidson TM. Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. Sleep 2004;27:453–458.PubMedGoogle Scholar
  10. 10.
    McNicholas WT, Bonsignore MR. Management Committee of EU COST ACTION B26. Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J 2007;29:156–178.PubMedCrossRefGoogle Scholar
  11. 11.
    Janson C, De Backer W, Gislason T, Plaschke P, Björnsson E, Hetta J, Kristbjarnarson H, Vermeire P, Boman G. Increased prevalence of sleep disturbances and daytime sleepiness in subjects with bronchial asthma: a population study of young adults in three European countries. Eur Respir J 1996;9:2132–2138.PubMedCrossRefGoogle Scholar
  12. 12.
    Demoly P, Bousquet. The relationship between asthma and allergic rhinitis. Lancet 2006;368: 711–713.PubMedCrossRefGoogle Scholar
  13. 13.
    Gaugris S, Sazonov-Kocevar V, Thomas M. Burden of concomitant allergic rhinitis in adults with asthma. J Asthma 2006;43:1–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Greiner AN. Allergic rhinitis: Impact of the disease and considerations for management. Med Clin North Am 2006;90:17–38.PubMedCrossRefGoogle Scholar
  15. 15.
    Dold S, Wjst M, von Mutius E, Reitmeir P, Stiepel E. Genetic risk for asthma, allergic rhinitis, and atopic dermatitis. Arch Dis Child 1992;67:1018–1022.PubMedCrossRefGoogle Scholar
  16. 16.
    Settipane RJ, Hagy G, Settipane GA. Long-term risk factors for developing asthma and allergic rhinitis: A 23-year follow-up study of college students. Allergy Proc 1994;15:21–25.PubMedCrossRefGoogle Scholar
  17. 17.
    Guerra S, Sherrill DL, Martinez FD, Barbee RA. Rhinitis as an independent risk factor for adult-onset asthma. J Allergy Clin Immunol 2002;109:419–425.PubMedCrossRefGoogle Scholar
  18. 18.
    Togias A. Mechanisms of nose-lung interaction. Allergy 1999;54:S94–S105.CrossRefGoogle Scholar
  19. 19.
    Braunstahl GJ. The unified immune system: respiratory tract-nasaobronchial interaction mechanisms in allergic airway disease. J Allergy Clin Immunol 2005;115:142–148.PubMedCrossRefGoogle Scholar
  20. 20.
    Simons FER. Allergic rhinobronchitis: the asthma-allergic rhinitis link. J Allergy Clin Immunol 1999;104:534–540.PubMedCrossRefGoogle Scholar
  21. 21.
    Kay AB. Allergy and allergic diseases. N Engl J Med 2001;344:30–37.PubMedCrossRefGoogle Scholar
  22. 22.
    Gaga M, Lambrou P, Papageorgiou N, Koulouris NG, Kosmas E, Fragakis S, Sofios C, Rasidakis A, Jordanoglou J. Eosinophils are a feature of upper and lower airway pathology in non-atopic asthma, irrespective of the presence of rhinitis. Clin Exp Allergy 1998;30:663–669.CrossRefGoogle Scholar
  23. 23.
    Madonini E, Briatico-Vangosa G, Pappacoda A, Maccagni G, Cardani A, Saporiti F. Seasonal increase of bronchial reactivity in allergic rhinitis. J Allergy Clin Immunol 1987;79:358–363.PubMedCrossRefGoogle Scholar
  24. 24.
    Braunstahl GJ, Overbeek SE, KleinJan A, Prins JB, Hoogsteden HC, Fokkens WJ. Nasal allergen provocation induces adhesion molecule expression and tissue eosinophilia in upper and lower airways. J Allergy Clin Immunol 2001;107:469–476.PubMedCrossRefGoogle Scholar
  25. 25.
    Braunstahl G-J, Kleinjan A, Overbeek SE, et al. Segmental bronchial provocation induces nasal inflammation in allergic rhinitis patients. Am J Respir Crit Care Med 2000;161(6):2051–2057.PubMedGoogle Scholar
  26. 26.
    Demoly P, Bousquet J. The relationship between asthma and allergic rhinitis. Lancet 2006;368:711–713.PubMedCrossRefGoogle Scholar
  27. 27.
    Corren J, Manning BE, Thompson SF, Hennessy S, Strom BL. Rhinitis therapy and prevention of hospital care for asthma: a case-control study. J Allergy Clin Immunol 2004;113:415–419.PubMedCrossRefGoogle Scholar
  28. 28.
    Grant JA, Nicodemus CF, Findlay SR, Glovsky M, Grossman J, Kaiser H, Meltzer EO, Mitchell DQ, Pearlman D, Selner J, Settipane G, Silvers W. Cetirizine in patients with seasonal rhinitis and concomitant asthma: prospective, randomized, placebo-controlled trial. J Allergy Clin Immunol 1995;95:923–932.PubMedCrossRefGoogle Scholar
  29. 29.
    Corren J, Harris AG, Aaronson D, Beaucher W, Berkowitz R, Bronsky E, Chen R, Chervinsky P, Cohen R, Fourre J, Grossman J, Meltzer E, Pedinoff A, Stricker W, Wanderer A. Efficacy and safety of loratadine plus pseudoephedrine in patients with seasonal allergic rhinitis and mild asthma. J Allergy Clin Immunol 1997;100:781–788.PubMedCrossRefGoogle Scholar
  30. 30.
    Philip G, Malmstrom K, Hampel Jr FC, Weinstein SF, LaForces CF, Ratner PH, Malice MP, Reiss TF. Montelukast Spring Rhinitis Study Group. Montelukast for treating seasonal allergic rhinitis: a randomized, double-blind, placebo-controlled trial performed in the spring. Clin Exp Allergy 2002;32:1020–1028.PubMedCrossRefGoogle Scholar
  31. 31.
    Donnelly AL, Glass M, Minkwitz MC, Casale TB. The leukotriene D4-receptor antagonist, ICI 204,219, relieves symptoms of acute seasonal allergic rhinitis. Am J Resp Crit Care Med 1995;151:1734–1739.PubMedGoogle Scholar
  32. 32.
    Meltzer EO, Malmstrom K, Lu S, Prenner BM, Wei LX, Weinstein SF, Wolfe JD, Reiss TF. Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: a randomized, placebo-controlled clinical trial. J Allergy Clin Immunol 2000;105:917–922.PubMedCrossRefGoogle Scholar
  33. 33.
    Corren J, Adinoff AD, Buchmeier AD, Irvin CG. Nasal beclomethasone prevents the seasonal increase in bronchial responsiveness in patients with allergic rhinitis and asthma. J Allergy Clin Immunol 1992;90:250–256.PubMedCrossRefGoogle Scholar
  34. 34.
    Welsh PW, Striker WE, Chu CP, Naessens JM, Reese ME, Reed CE, Marcoux JP. Efficacy of beclomethasone nasal solution, flunisolide, and cromolyn in relieving symptoms of ragweed allergy. Mayo Clin Proc 1987;62:125–134.PubMedGoogle Scholar
  35. 35.
    Watson WT, Becker AB, Simons FE. Treatment of allergic rhinitis with intranasal corticosteroids in patients with mild asthma: effect on lower airway responsiveness. J Allergy Clin Immunol 1993;91:97–101.PubMedCrossRefGoogle Scholar
  36. 36.
    Taramarcaz P, Gibson PG. Intranasal corticosteroids for asthma control in people with coexisting asthma and rhinitis. Cochrane Database of Systemic Reviews 2003, Issue 3. Art. No.: CD003570. DOI:10.1002/14651858.CD003570.Google Scholar
  37. 37.
    Vignola AM, Humbert M, Bousquet J, Boulet L-P, Hedgecock S, Blogg M, Fox H, Surrey K. Efficacy and tolerability of anti-immunoglobulin E therapy with omalizumab in patients with concomitant allergic asthma and persistent allergic rhinitis: SOLAR. Allergy 2004;59:709–717.PubMedCrossRefGoogle Scholar
  38. 38.
    Ng DK, Chan CH, Wang GY, Chow P, Kwok K. A review of the roles of allergic rhinitis in childhood obstructive sleep apnea syndrome. Allergy Asthma Proc 2006;27:240–242.PubMedCrossRefGoogle Scholar
  39. 39.
    Shepard JW Jr, Burger CD. Nasal and oral flow–volume loops in normal subjects and patients with obstructive sleep apnea. Am Rev Respir Dis 1990;142:1288–1293.PubMedGoogle Scholar
  40. 40.
    Scharf MB, Cohen AP. Diagnostic and treatment implications of nasal obstruction in snoring and obstructive sleep apnea. Ann Allergy Asthma Immunol 1998;81:279–290.PubMedGoogle Scholar
  41. 41.
    Young T, Finn L, Palta M. Chronic nasal congestion at night is a risk factor for snoring in a population-based cohort study. Arch Intern Med 2001;161:1519.Google Scholar
  42. 42.
    Staevska MT, Mandajieva MA, Dimitrov VD. Rhinitis and sleep apnea. Curr Allergy Asthma Rep 2004;4:193–199.PubMedCrossRefGoogle Scholar
  43. 43.
    McLean HA, Urton AM, Driver HS, Tan AKW, Day AG, Munt PW, Fitzpatrick. Effect of treating severe nasal obstruction on the severity of obstructive sleep apnoea. Eur Respir J 2005;25:521–527.PubMedCrossRefGoogle Scholar
  44. 44.
    Young T, Finn L, Kim H. Nasal Obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group. J Allergy Clin Immunol 1997;99:S757–S762.PubMedCrossRefGoogle Scholar
  45. 45.
    McNicholas WT, Tarlo S, Cole P, Zamel N, Rutherford R, Griffin D, Phillipson EA. Obstructive apneas during sleep in patients with seasonal allergic rhinitis. Am Rev Respir Dis 1982;126:625–628.PubMedGoogle Scholar
  46. 46.
    Canova CR, Downs SH, Knoblauch A, Andersson M, Tamm M, Leuppi JD. Increased prevalence of perennial allergic rhinitis in patients with obstructive sleep apnea. Resp 2004;71:138–143.Google Scholar
  47. 47.
    Kramer MF, De La Chaux R, Dreher A, Pfrongner E, Rasp G. Allergic rhinitis does not constitute a risk factor for obstructive sleep apnea syndrome. Acta Otolaryngol 2001;121:494–499.PubMedCrossRefGoogle Scholar
  48. 48.
    Craig TJ, McCann JL, Gurevich F, Davies MJ. The correlation between allergic rhinitis and sleep disturbance. J Allergy Clin Immunol 2004;114:S139–S145.PubMedCrossRefGoogle Scholar
  49. 49.
    Chau K, Ng K, Kwok K, Cheung M. Survey of children with obstructive sleep apnea syndrome in Hong Kong of China. Chin Med J 2004;117:657–660.PubMedGoogle Scholar
  50. 50.
    Anuntaseree W, Rookkapan K, Kuasirikul S, Thongsuksai P. Snoring and obstructive sleep apnea in Thai school-age children: prevalence and predisposing factors. Pediatr Pulmonol 2001;32:222–227.PubMedCrossRefGoogle Scholar
  51. 51.
    Chng SY, Goh DYT, Wang XS, Tan TN, Ong NBH. Snoring and atopic disease: a strong association. Pediatr Pulmonol 2004;38:210–216.PubMedCrossRefGoogle Scholar
  52. 52.
    McColley SA, Carroll JL, Curtis S, Loughlin GM, Sampson HA. High prevalence of allergic sensitization in children with habitual snoring and obstructive sleep apnea. Chest 1997;111:170–173.PubMedCrossRefGoogle Scholar
  53. 53.
    Ramirez PL, Umre U, Schneider A. Association between obstructive sleep apnea syndrome and atopy in children. J Allergy Clin Immunol 2006;117:s297 (abstract).CrossRefGoogle Scholar
  54. 54.
    Yumoto E, Kozawa T, Yanagihara N. Influence of tonsillar hypertrophy to physical growth and diseases of the nose and ear in school-age children. Nippon Jibiinkoka Gakkai Kaiho 1991;94:534–540.PubMedGoogle Scholar
  55. 55.
    Mansfield LE, Diaz G, Posey CR, Flores-Neder J. Sleep disordered breathing and daytime quality of life in children with allergic rhinitis during treatment with intranasal budesonide. Ann Allergy Asthma Immunol 2004;92:240–244.PubMedCrossRefGoogle Scholar
  56. 56.
    Brouillette RT, Manouklan JJ, Ducharme FM, et al. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr 2001;138:838–844.PubMedCrossRefGoogle Scholar
  57. 57.
    Chau KW, Ng KK, Kwok KL, et al. Survey of children with obstructive sleep apnea syndrome in Hong Kong of China. Chin Med J (Engl) 2004;117:657–660.Google Scholar
  58. 58.
    Al-Ghamdi SA, Manoukian JJ, Morielli A, et al. Do systemic corticosteroids effectively treat obstructive sleep apnea secondary to adenotonsillar hypertrophy? Laryngoscope 1997;107:1382–1387.CrossRefGoogle Scholar
  59. 59.
    Berlucchi M, Salsi D, Valetti L, Parrinello G, Nicolai P. The role of mometasone furoate aqueous nasal spray in the treatment of adenoidal hypertrophy in the pediatric age group: preliminary results of a prospective randomized study. Pediatrics 2007;119:e1392–e1397.PubMedCrossRefGoogle Scholar
  60. 60.
    Ekici A, Ekici M, Kurtipek E, Keles H, Kara T, Tunckol M, Kocyigit P. Association of asthma-related symptoms with snoring and apnea and effect on health-related quality of life. Chest 2005;128:3358–3363.PubMedCrossRefGoogle Scholar
  61. 61.
    Larsson LG, Lindberg A, Franklin KA, Lundback B. Symptoms related to obstructive sleep apnoea are common in subjects with asthma, chronic bronchitis and rhinitis in a general population. Respir Med 2001;95:423–429.PubMedCrossRefGoogle Scholar
  62. 62.
    Kalra M, Biagini J, Bernstein D, Stanforth S, Burkle J, Cohen A, LeMasters G. Effect of asthma on the risk of obstructive sleep apnea syndrome in atopic women. Ann Allergy Asthma Immunol 2006;97:231–235.PubMedGoogle Scholar
  63. 63.
    ten Brinke A, Sterk PJ, Masclee AAM, Spinhoven P, Schmidt JT, Zwinderman AH, Rabe KF, Bel EH. Risk factors of frequent exacerbations in difficult-to treat asthma. Eur Respir J 2005;26:812–818.PubMedCrossRefGoogle Scholar
  64. 64.
    Yigla M, Tov N, Solomonov A, Rubin AH, Harley D. Difficult-to-control asthma and obstructive sleep apnea. J Asthma 2003;40:865–871.PubMedCrossRefGoogle Scholar
  65. 65.
    Kasasbeh A, Kasasbeh E, Krishnaswamy G. Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex: a hypothetical review. Sleep Med Rev 2007;11:47–58.PubMedCrossRefGoogle Scholar
  66. 66.
    Devouassoux G, Lévy P, Rossini E, Pin I, Fior-Gozlan M, Henry M, Seigneurin D, Pépin JL. Sleep apnea is associated with bronchial inflammation and continuous positive airway pressure-induced airway hyperresponsiveness. J Allergy Clin Immunol 2007;119:597–603.PubMedCrossRefGoogle Scholar
  67. 67.
    Basner RC. Continuous positive pressure for obstructive sleep apnea. N Engl J Med 2007;356:1751–1758.PubMedCrossRefGoogle Scholar
  68. 68.
    Guilleminault C, Quera-Salva MA, Powell N, Riley R, Romaker A, Partinen M, Baldwin R, Nino-Murcia G. Nocturnal asthma: snoring, small pharynx and nasal CPAP. Eur Respir J 1988;10:902–907.Google Scholar
  69. 69.
    Chan CS, Woolcock AJ, Sullivan CE. Nocturnal asthma: role of snoring and obstructive sleep apnea. Am Rev Respir Dis 1988;137:1502–1504.PubMedGoogle Scholar
  70. 70.
    Ciftci TU, Ciftci B, Guven SF, Kokturk O, Turktas H. Effect of nasal continuous positive airway pressure in uncontrolled nocturnal asthmatic patients with obstructive sleep apnea syndrome. Resp Med 2005;99:529–534.CrossRefGoogle Scholar
  71. 71.
    Lafond C, Series F, Lemiere C. Impact of CPAP on asthmatic patients with obstructive sleep apnoea. Eur Respir J 2007;29:307–311.PubMedCrossRefGoogle Scholar
  72. 72.
    Martin RJ, Pak J. Nasal CPAP in non-apneic nocturnal asthma. Chest 1991;100:1024–1027.PubMedCrossRefGoogle Scholar
  73. 73.
    Moller C, Dreborg S, Ferdousi HA, Halken S, Host A, Jacobsen L, Koivikko A, Koller DY, Niggemann B, Norberg LA, Urbanek R, Valovirta E, Wahn U. Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (the PAT-study). J Allergy Clin Immunol 2002 Feb;109(2):251–256.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Jeffrey R. Stokes
    • 1
  • Thomas B. Casale
    • 2
  1. 1.Associate Professor Department of Medicine, Program Director Allergy/ImmunologyCreighton University, Division of Allergy/ImmunologyOmahaUSA
  2. 2.Professor, Department of Medicine, Chief, Allergy/ImmunologyCreighton University, Division of Allergy/Immunology Suite 5850OmahaUSA

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