Hi Susan, thanks for the D2D.
Many of my paediatric patients suffer from both asthma and allergic rhinitis. Asthma is a hyper-reactive inflammatory narrowing and obstruction of the lower airways of the lung, which causes recurrent wheezing, difficulty breathing, chest tightness and cough.
Allergic rhinitis represents a hyper-sensitive inflammatory reaction of the lining of the nose (the upper airway), leading to nasal itching, sneezing, runny nose and nasal congestion. We find that allergic rhinitis typically precedes the onset of asthma and often worsens the control of asthma.
Studies show that children with allergic rhinitis are 3 times more likely to go on to develop asthma, compared to those who don't. Three-quarters of asthma patients also have allergic rhinitis!
So asthma and allergic rhinitis share a very close relationship: “One airway, one disease”. What this means is that the symptoms of allergic rhinitis such as a persistent drip of infected secretions or mucus from the nose (the upper airway) can lead to irritation of the bronchi (lower airway) of the lungs.
A chronically runny nose due to nasal allergies may trigger an acute attack of asthma, as the nasal secretions flow into the hyper-reactive lower airways of the lung and cause them to constrict, affecting breathing and airflow.
Essentially, if we want to treat asthma effectively and keep it under control, we need to treat any co-existing allergic rhinitis to prevent flare-ups. We practise evidence-based medicine by following the international ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines to treat asthma and allergic rhinitis.
This means treatment with nasal steroid sprays, saline nasal washes and antihistamine medication. Montelukast (Singulair) is a useful medication to treat both asthma and allergic rhinitis, as it stabilises mast cells, a key type of immune cell involved in driving the hyper-reactive response which occurs in asthma and allergic rhinitis.
Both asthma and allergic rhinitis often share the same triggers, such as house dust mite, cigarette smoke, grass pollen and mould spores. Allergy testing may help to identify the triggers so that they may be avoided. There are now newer medications available on the market which aim to desensitize the immune system against grass and house dust mite, to hopefully achieve a longterm cure for allergic rhinitis.
