Allergic rhinitis and asthma are the “same airway, same disease”. Epidemiological surveys have confirmed that the incidence of asthma is 4-20 times higher in patients with allergic rhinitis than in normal people, while the incidence of asthma in the normal population is about 2-5%, the incidence of asthma in patients with allergic rhinitis can be as high as 20-40%, and it is even believed that 60% of allergic rhinitis may develop into asthma or be accompanied by lower respiratory symptoms. The relationship between allergic rhinitis and asthma is determined by the anatomical and physiological continuity of the nasal cavity and bronchi. As a result, some scholars have proposed the concepts of “combined respiratory tract”, “allergic rhinobronchitis” and “total airway inflammation syndrome”, which suggest that upper and lower respiratory tract diseases need combined diagnosis and It is believed that upper and lower respiratory tract diseases need joint diagnosis and joint treatment. Some scholars have even proposed the concept of allergic syndrome, which should be treated from a systemic perspective. At present, the World Allergy Organization and the Allergy & Clinical Immunology International Journal and the World Health Organization have proposed the concept of allergy syndrome.
The journal Allergy & Clinical Immunology International and the International Archives of Allergy and
Immunology journals have officially proposed to adopt the diagnostic terminology of allergic rhinitis-asthma syndrome. Allergic inflammation of the nasal mucosa and bronchial inflammation of asthma are usually caused by the same allergens, their pathogenesis is mostly related to type I allergic reactions, and the pathology is allergic inflammation characterized by an increase in respiratory eosinophils.
Allergic rhinitis-asthma patients’ susceptibility to allergens, or atopy, is a major factor in the development of asthma, and the main indicator of atopy in asthmatic patients is increased levels of total and specific IgE in the body. The development of allergic inflammation of the upper or lower respiratory tract in the allergic rhinitis-asthma sign is related to the type and concentration of atopic allergens to which the allergic patient is exposed. Seasonal allergens, such as grass or tree pollen can cause intermittent symptoms, i.e. intermittent/seasonal allergic rhinoconjunctivitis and/or asthma. In contrast, allergens that are present year-round, such as house dust mites, molds and animal fur are more likely to cause persistent symptoms of asthma and/or rhinitis. To some extent, allergen sensitization is related to the particle size of the allergen because pollen, which is usually about 5 microns in diameter, is very easily filtered by the upper respiratory tract barrier, so pollen allergy can lead to upper respiratory symptoms mainly when the patient develops nasal congestion and breathes through the mouth instead, which can lead to lower respiratory symptoms because the filtering function of the upper respiratory tract is bypassed. Because house dust mites, mold spores and pet allergens are small (about 1 micron in diameter), they can easily enter the lower respiratory tract and trigger asthma. In our allergic reactions unit, patients with allergic rhinitis and/or asthma are usually treated by careful history, signs and symptoms to determine if there is a mutual combination of symptoms and to develop a comprehensive treatment plan. If asthma is only controlled and rhinitis is neglected, recurrent attacks of rhinitis will make it difficult to get complete control of asthma. For patients with rhinitis with mainly stuffy and runny nose symptoms, we usually also do pulmonary function tests to determine whether there is a concomitant asthma or potential asthma and decide whether asthma treatment is needed at the same time, and for those rhinitis patients who have no symptoms, we should also warn them about the occurrence of asthma. Another mandatory test is the immunological test – blood allergen primary screening (specific IgE), immune function, total IgE test and allergen prick test, which is also the etiological test for allergic rhinitis and asthma, which enables patients to understand where their cause lies and how to avoid recurrent attacks in their lives. Some patients with dust mite allergy and pollen allergy also require specific immunotherapy (desensitization). Patient education is an important part of the management of chronic diseases such as allergic rhinitis and asthma in the Department of Allergology. Through patient education, patients will monitor changes in their conditions, follow up with the hospital in a timely manner, adjust their medication under the guidance of the doctor, avoid side effects of medication, and prevent asthma attacks.