Nasal Allergies and Sinus Conditions
The survey also documents that a strong relationship exists between nasal allergies and sinus conditions, with 66% of AR patients reporting that they also suffer with rhinosinusitis or sinus conditions. By contrast, only 20% of adults without nasal allergies suffer from rhinosinusitis or sinus problems (FIGURE 2B). Moreover, although rhinosinusitis or sinus problems occur in about 3 times as many adults with nasal allergies as without nasal allergies, the proportion of individuals who have ever had nasal or sinus surgery is 7 times higher in adults with nasal allergies as in those without (15% vs 2%).
Other Comorbidities and Impact on Sleep
Compared with the general population, 3 times as many adults with nasal allergies reported that they had been extremely or moderately bothered by difficulty getting to sleep in the past week (24% vs 8%); twice as many reported being at least moderately bothered by waking up during the night as a result of their nasal symptoms in the past week (31% vs 13%) for any health-related reason; and more than twice as many adults with nasal allergies were extremely or moderately troubled by lack of a good night’s sleep as a result of the nasal symptoms (26% vs 11%) (FIGURE 2C).
Finally, when questioned about other problems suffered in the past 4 weeks, the proportion of adults with nasal allergies who have had rhinosinusitis, sleep disturbances, earaches, skin rashes, heartburn, gastroesophageal reflux disease, migraines, sleep apnea, conjunctivitis, and chronic tonsillitis were all noticeably higher in patients with AR than in people without nasal allergies. Indeed, a large number of adults without AR (66%) did not have any comorbidities, while only 29% of adults with AR did not report any (FIGURE 3).
FIGURE 2
Incidence of specific comorbidities associated with allergic rhinitis in the allergy vs general population: (A) asthma,* (B) rhinosinusitis,* and (C) sleep problems*
Respondents were asked: (A) Have you ever been diagnosed with asthma? (B) Do you suffer from sinusitis or sinus problems? (C) How troubled have you been by each of these symptoms (difficulty getting to sleep, waking up during the night, lack of a good night’s sleep) during the last week as a result of your health? Were you not troubled, hardly troubled at all, somewhat troubled, moderately troubled, or extremely troubled?
Base: All respondents, N = 522; *Pearson chi-square, P ≤ 0.05.
Discussion
The results of this survey clearly demonstrate that compared with the general United States (US) population, people who have AR are at greater risk of suffering associated comorbidities such as asthma, rhinosinusitis, and other conditions noted previously. Although this is not novel information, most clinical trials have studied these associations only in selected populations, and the current study involving a more representative sample of US allergy sufferers confirms the high prevalence of comorbidities in the “real world.”
Many physicians and patients often dismiss AR as “just a runny nose,” but the results of the present survey clearly show that, especially during the worst spring months, patients with AR suffer a diverse range of symptoms. Although nasal congestion and postnasal drip are the most common symptoms, it is important to note that up to 20% of AR patients reported nonnasal symptoms, such as headache, facial pain or pressure, and ear pain or pressure, every day or most days during the worst month in the past year. Again, this information is not really new: the Allergies in America survey in 2006 found results on symptom frequency that were very similar to the findings of this survey.13 However, it is important information that needs to reach physicians and patients alike because effective management of AR would likely alleviate many nonnasal symptoms.14
This tendency to ignore or deprioritize AR in the face of other symptoms is very common in people who suffer the various comorbidities associated with AR; a person with asthma and AR is more likely to worry about their symptoms of wheezing than about their rhinorrhea. However, it is increasingly understood that these disorders are deeply connected at the pathologic level. For example, despite differences in the anatomic location of AR and asthma, they share a common inflammatory pattern in which many upper airways cells and mediators are the same as those involved in lower airway disease.4,12 Supporting the concept of a “unified airway disease,” bronchial hyperresponsiveness and subclinical changes in the lower airways can be detected even in patients with AR who do not have asthma.15 As demonstrated in this survey, the presence of AR symptoms is associated with a worsening in asthma control and patient quality of life. The presence and type of asthma is influenced by sensitization, and the duration and severity of AR.4 However, much evidence suggests that effective AR management can lead to a better asthma control. Indeed, AR often precedes the onset of asthma and studies have shown that treatment with specific immunotherapy can prevent or delay asthma onset.16