6 岁时的非过敏性鼻炎与随后哮喘的发展有关。
Non-atopic rhinitis at age 6 is associated with subsequent development of asthma.
机构信息
Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona.
出版信息
Clin Exp Allergy. 2019 Jan;49(1):35-43. doi: 10.1111/cea.13276. Epub 2018 Oct 9.
BACKGROUND
It has been postulated that the association between allergic rhinitis and asthma is attributable to the progressive clinical expression of respiratory inflammation during childhood. The role of non-allergic rhinitis in early life in relation to subsequent asthma has not been extensively explored.
OBJECTIVE
We sought to determine whether rhinitis in early life was associated with risk of asthma development into adulthood, and whether this relationship is independent of allergic sensitization.
METHODS
Participants were identified from the Tucson Children's Respiratory Study, a non-selected birth cohort. Allergy skin prick testing was performed at age 6 years using house dust mix, Bermuda, mesquite, olive, mulberry, careless weed, and Alternaria aeroallergens. Atopy was defined as ≥1 positive tests. Physician-diagnosed active asthma from age 6 to 32 and physician-diagnosed rhinitis at age 6 were determined by questionnaire. Participants with asthma or active wheezing at age 6 were excluded from analyses. Risk estimates were obtained with Cox regression.
RESULTS
There were 521 participants who met inclusion criteria. The hazard ratio for subsequently acquiring a diagnosis of asthma between the ages of 8 and 32 for those with non-atopic rhinitis was 2.1 (95% CI: 1.2, 3.4, P = 0.005), compared with the non-atopic no rhinitis group, after adjusting for sex, ethnicity, maternal asthma, maternal education and smoking, and history of 4+ colds per year at age 6. Among the atopic participants, both the active and no rhinitis groups were more likely to develop and have asthma through age 32. The relation between non-atopic rhinitis and asthma was independent of total serum IgE levels at age 6.
CONCLUSION AND CLINICAL RELEVANCE
Childhood rhinitis, even in the absence of atopy, confers significant risk for asthma development through adulthood. These findings underscore the importance of non-allergic mechanisms in the development of asthma.
背景
有人假设，过敏性鼻炎和哮喘之间的关联归因于儿童时期呼吸道炎症的逐渐临床表达。非过敏性鼻炎在生命早期与随后的哮喘之间的关系尚未得到广泛探讨。
目的
我们旨在确定生命早期的鼻炎是否与成年后哮喘发展的风险相关，以及这种关系是否独立于过敏致敏。
方法
参与者是从图森儿童呼吸系统研究中确定的，这是一个非选择性的出生队列。在 6 岁时使用屋尘混合物、百慕大、牧豆树、橄榄、桑树、粗心杂草和交链孢霉过敏原进行过敏皮肤点刺试验。过敏定义为≥1 项阳性测试。通过问卷确定 6 至 32 岁时的医生诊断为活动性哮喘和 6 岁时的医生诊断为鼻炎。在分析中排除了在 6 岁时患有哮喘或活动性喘息的参与者。使用 Cox 回归获得风险估计。
结果
符合纳入标准的有 521 名参与者。在调整性别、种族、母亲哮喘、母亲教育和吸烟以及 6 岁时每年患 4+次感冒的历史后，与非过敏性无鼻炎组相比，对于非过敏性鼻炎患者，在 8 至 32 岁之间随后诊断出哮喘的风险比为 2.1（95%CI：1.2，3.4，P=0.005）。在过敏性参与者中，无论是活跃组还是无鼻炎组，都更有可能在 32 岁之前发展并患有哮喘。非过敏性鼻炎与哮喘之间的关系独立于 6 岁时的总血清 IgE 水平。
结论和临床相关性
儿童期鼻炎，即使没有过敏，也会显著增加成年后患哮喘的风险。这些发现强调了非过敏性机制在哮喘发展中的重要性。
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