Editorial

Abstract

T he current issue of the American Journal of Rhinology and Allergy highlights two major themes that frequently confront the allergist/rhinologist: chronic rhinosinusitis with nasal polyps (CRSwNPs) and allergic rhinitis (AR). Also addressed in this issue is the rare clinical occurrence of hereditary angioedema (HAE), which deserves attention because of newly developed therapies to prevent potentially life-threatening consequences. In a series of excellent articles, the basic challenges confronting the allergist/rhinologist regarding definition, diagnosis, and treatments of these disorders are rigorously evaluated. ALLERGIC RHINITISThe ideal definition of AR would help clinicians and researchers to distinguish it from nonallergic rhinitis (NAR) and mixed rhinitis (AR ϩ NAR). Bernstein 1 points out this may be difficult because of overlapping symptoms. A careful history followed by skin (or in vitro) testing to assess allergic status is recommended. Although Bernstein suggests that therapeutic response may aid diagnosis, more research is needed to determine if this assumption is correct. Providing insight into therapeutic response is the article by Gawlik et al. 2 , in which the mechanism of action of intranasal azelastine therapy is evaluated in NAR. These authors report that an untreated NAR control group showed greater substance P release in nasal lavage fluids after challenge with hypertonic saline than did an azelastine pretreated group. A different approach to defining AR is taken by Larenas-Linnemann et al. 3 who studied patients diagnosed with AR by Mexican allergists. They categorized patients according to U.S. coding practices as seasonal AR and perennial AR and compared it with the European Allergic Rhinitis and Its Impact on Asthma classifications of intermittent versus persistent and mild versus moderate-severe. They observed that the physicians tended to "overdiagnose" perennial AR and intermittent-persistent compared with the patient's assessment.Comorbidities, risk factors, and physiological triggers of AR are explored by several authors. Haavisto et al., 4 using acoustic rhinometry, measured nasal patency changes induced by physical exercise in AR and asthma and found lower area before and after exercise in the allergic group. All three groups (allergic, asthmatic, and controls) experienced improved (ϳ15%) nasal volume/area after exercise. Increased body mass index in AR patients was found by Ciprandi et al. 5 to be associated with increased markers of inflammation compared with normal weight controls and may increase risk for early bronchial impairment. In Western countries, the incidence of concomitant AR and asthma is common, with some estimates as high as 50%. 1 Hong et al. 6 studied the comorbidity of AR and asthma in two southern Chinese cities via a hospital-based cross-sectional survey. The prevalence of concomitant bronchial asthma was only 5.33%.