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Rhinitis and asthma in children: comorbitity or united airway disease?
Athina Papadopoulou, Dionysia Tsoukala, Konstantinos Tsoumakas1
1Asthma and Allergy Unit, Pediatric Department, KAT General Hospital, 2 Nikis Str, Kifissia GR14561, Greece. athinapap@yahoo.com.
Insights
Childhood rhinitis and asthma share common factors, often coexisting in preschoolers. In older children, these conditions may represent a single united airway syndrome, influenced by age and environment.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- United Airway Disease
Background:
- Rhinitis and asthma in children are often linked under the united airway disease theory.
- Potential mechanisms include postnasal dripping, naso-bronchial reflex, and systemic immune responses.
- The exact nature of the association (co-morbid, precipitating, triggering, or epiphenomenon) remains unclear.
Purpose of the Study:
- To evaluate the association between childhood rhinitis and asthma symptoms.
- To review recent knowledge on the physiology and phenotype of these conditions.
Main Methods:
- A systematic review of articles published in the last 10 years concerning the rhinitis-asthma relationship in children.
- Analysis of current physiological and phenotypic data.
Main Results:
- While sharing common etiology, epidemiology, and immunology, upper and lower airways exhibit distinct cytology, immunity, and heredity.
- Allergy is a significant factor in the rhinitis-asthma association.
- Age-environment interactions suggest coexistence in preschoolers and a unified syndrome in older children.
Conclusions:
- Rhinitis and asthma in children may represent a spectrum of united airway disease.
- Allergy plays a key role, but age and environmental factors modulate the presentation.
- Further research is needed to fully elucidate the pathophysiology and clinical implications.
Abstract:
The association of rhinitis with asthma symptoms in children is thought to be part of the united airway disease's theory which proposed three possible explanatory pathophysiological mechanisms: postnasal dripping, naso-bronchial reflex and systemic immune response. However, it is not clear if the relation is a co-morbid, precipitating or triggering condition or an epiphenomenon as an integrated part of the disease. In an attempt to evaluate the association, a review of all articles that were published in the last 10 years which referred to the relation of childhood rhinitis with asthma were analysed, whereas the recent knowledge on physiology and phenotype was reported as background. Even though both diseases share common etiology, epidemiology and immunology, there are important differences between the upper and lower airway system related both to inner organ cytology, immunity and heredity. Allergy seems to be the major causable factor for rhinitis and asthma association; however, ageenvironment interactions enhance the inspection that in preschoolers the diseases coexist, whereas in older children, they represent the manifestation of one united syndrome.
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