Allergic rhinitis and asthma connection: treatment implications

Treatment of patients with allergic rhinitis and asthma involves securing accurate diagnoses, avoidance measures, pharmacotherapy, and in some patients allergen immunotherapy, with consideration of immunomodulator therapy. At least 20% of patients with asthma have evidence of gastroesophageal reflux (GERD) and others have laryngeal pharyngeal reflux (LPR) also referred to as supraesophageal reflux (SERD) or "atypical reflux." The scientific foundation of subcutaneous allergen immunotherapy (SCIT) includes generation of T-reg cells, which generate IL-10 and TGF-beta and suppress T(H2) and T(H1) lymphocyte responses. SCIT alone or even to a greater degree with omalizumab has been shown to reduce the extent of "facilitated allergen presentation" of allergen-IgE complexes binding to B lymphocytes, with the implication of reducing the extent of allergen presentation by B lymphocytes to T lymphocytes. In viewing the concept of the unified airway and the multiple approaches required for optimal patient care, asthma should be considered as a syndrome, which includes the concomitant conditions of allergic rhinitis and GERD (SERD or LPR) with the possibility of intermittent or chronic rhinosinusitis.