FCAAIA Notes: For all intents and purposes, one can usually consider allergic rhinitis and asthma as the same disease affecting different ends of the same airway. I frequently refer to the combination as “allergic airway disease”.  The conditions have the same underlying pathophysiology, immunology, triggers, and tenets of treatment.  We know that the vast majority of young people with asthma have allergies.  We have also long recognized the “atopic march” or “allergic march”, in which patients progress from atopic dermatitis, to allergic rhinitis, to asthma.  Depending on the study you want to read, patients with allergic rhinitis have up to a 20-60% chance of having or developing asthma.

This study reaffirms previous data that allergy shots greatly decrease the risk of disease progression. Patients with allergic rhinitis who received allergy shots were about 50% less likely to develop asthma than those who did not get shots.  I understand that many patients with allergic rhinitis but not asthma do not wish to make the commitment necessary for shots to be effective. But, this study confirms their long term effect and certainly shoes that anybody even starting to have progression of disease should think about starting allergy shots.

(Source September 26, 2015. Adapted from The Journal of Allergy and Clinical Immunology September 11, 2015).


Allergic rhinitis (AR) is a main risk factor for the development of asthma. Two randomized open-label trials indicated that allergy immunotherapy (AIT) prevents the onset of asthma in patients with AR. However, these trials have methodological limitations, and it is unclear to what extent this experimental efficacy translates into clinical effectiveness.


We sought to investigate the effectiveness of AIT to prevent asthma in patients with AR.


Using routine health care data from German National Health Insurance beneficiaries, we identified a consecutive cohort of 118,754 patients with AR but without asthma who had not received AIT in 2005. These patients were stratified into one group starting AIT in 2006 and one group receiving no AIT in 2006. Both groups were observed regarding the risk of incident asthma in 2007 to 2012. Risk ratios (RRs) were calculated with generalized linear models by using a Poisson link function with robust error variance and adjustment for age, sex, health care use because of AR, and use of antihistamines.


In a total of 2431 (2.0%) patients, AIT was started in 2006. Asthma was newly diagnosed from 2007-2012 in 1646 (1.4%) patients. The risk of incident asthma was significantly lower in patients exposed to AIT (RR, 0.60; 95% CI, 0.42-0.84) compared with patients receiving no AIT in 2006. Sensitivity analyses suggested significant preventive effects of subcutaneous immunotherapy (RR, 0.54; 95% CI, 0.38-0.84) and AIT including native (nonallergoid) allergens (RR, 0.22; 95% CI, 0.02-0.68). AIT for 3 or more years tended to have stronger preventive effects than AIT for less than 3 years.


AIT effectively prevents asthma in patients with AR in a real-world setting. Confounding by indication cannot be excluded but would lead to an underestimation of the true preventive effects of AIT.

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