Treatment of allergic rhinitis reduces acute asthma exacerbation risk among asthmatic children aged 2–18 years

Background/purpose: Asthma and allergic rhinitis (AR) frequently coexist in the same individuals in childhood and adolescence. We evaluated whether AR had an impact on acute exacerbation (AE) and whether intranasal corticosteroid (INCS) and second-generation antihistamines (SGH) for AR modified the association of AR with AE in asthmatics aged 2–6 years and 7–18 years. Methods: Using the National Health Research Institutes (NHRI) Database 2005 of Taiwan, we investigated patients who had been diagnosed with asthma in the years 2000 through 2012 and who had then been followed-up with for at least one year. The risk factors of AE were evaluated using multiple Cox proportional hazards regression analysis. Results: The incidence of AE was higher in the preschool group than the older group (adj. HR: 1.68, 95% CI: 1.44–1.95). The AR with INCS and/or SGH group was found to have a lower risk of AE than the non-AR group (adj. HR: 0.32, 0.44 and 0.30), but the AR without treatment group did not have a significant difference with the non-AR group. After propensity score matching, the use of INCS and/or SGH was associated with a significant reduction in the occurrence of AE among AR patients aged 2–6 years old (adj. HR: 0.38, 0.57 and 0.45) and 7–18 years old (adj. HR: 0.50, 0.52 and 0.35). Conclusion: The preschool patients had a higher incidence of AE than the older patients in general. Adequate treatment with INCS and/or SGH in asthma with AR patients is important for reducing the incidence of AE of asthma. Keywords: Allergic rhinitis, Asthma, Asthma acute exacerbations, Intranasal corticosteroid, Preschool children