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Asthma and rhinitis by storage mites

Allergic rhinitis (AR) is a global health problem (1) and is a risk factor for asthma (1), with up to 78% of asthmatics having rhinitis (2). Thus, several organisms recommend patients with AR to be evaluated for asthma (3). However, the impact of asthma on AR is much less studied. We aimed to determine the impact of the presence of concurrent asthma on immediate nasal changes in patients consecutively assessed with a history of persistent AR for at least 2 years and sensitization to house dust mite (HDM; n = 286) assisting to an outpatient clinic. Skin prick test performed with a common battery of airborne allergens, including mites such as HDM, moulds, dander and pollens (Leti, Spain) and the storage mite Thyreophagus entomophagus (4), showed that 40 of the 286 patients (14%) sensitized to HDM had concomitant T. entomophagus sensitization. Three groups were compiled, all of them with AR and HDM sensitization: group 1 consisted in patients with AR plus HDM + T. entomophagus sensitization (n = 10; four women/six men; mean age 32 years); group 2, same features as group 1 but with added asthma (n = 13; five women/eight men; mean age 31 years); and group 3, as the control group, patients with AR and HDM sensitization but negative SPT to T. entomophagus (n = 20; 11 women/nine men; mean age 34 years). The study was approved by the ethical committee of the hospital. Informed consent was obtained from each patient. Nasal provocation test (NPT; 8:30 a.m.), avoiding nasal cycle influence and hyper-responsiveness, was performed with increasing doses of T. entomophagus sprayed in one single nostril. Clinical significance was assessed every 15 min by score of symptoms and acoustic rhinometry (5) (Rhinoscan, Interacoustics A/S, Denmark), which evaluates nasal geometry, including obstruction, by analysing reflections of a sound pulse introduced via the nostrils, to determine basal minimal cross-sectional area (MCA; cm) (5). Forced spirometry was also simultaneously performed to obtain FEV1. Doses of topical (bronchial and nasal) steroids were minimized for 2 weeks before the provocation. Basal MCA (0.48 cm) in the group 1 significantly dropped 42% after specific NPT. Basal MCA (0.47 cm) in the group 2 significantly decreased 21% after specific NPT. No changes in MCA or in clinical score were found in group 3. Differences between groups 1 and 2 were also significantly different (P < 0.05; Mann–Whitney). Clinical score (positive >3 points) showing nasal symptoms – rhinorrhoea, congestion, sneezing and pruritus – was 5.9 after NPT in group 1, 4.2 in group 2 and 1.9 in group 3. No differences/changes were found in basal FEV1 or throughout the NPT between groups. It has shown how strong nasal changes after specific NPT in patients with AR are softened by the presence of concurrent allergic asthma. Although it is known that patients with asthma have milder perception of symptoms of AR, it has been exposed in this report that patients with concomitant entities could have milder objective nasal response. Further and larger studies are needed.