Clinical Heterogeneity in Adult Rhinitis: Symptom-Sensitization Concordance and Asthma Burden.

OBJECTIVES

To classify adults by concordance between rhinitis symptoms and measured systemic allergen-specific immunoglobulin E (sIgE) sensitization and to examine associated asthma and sinonasal burden patterns.

METHODS

We analyzed NHANES 2005-2006 adults aged 20 years or older with positive examination weights. Rhinitis symptoms were defined as hay fever or nasal symptoms in the past 12 months. Measured systemic sensitization was defined as at least 1 of 19 serum sIgE results > = 0.35 kU/L. Survey-weighted logistic regression estimated adjusted odds ratios (ORs) from outcome-specific complete cases.

RESULTS

Among 4773 eligible adults, 4487 had complete phenotype data. A total of 4220 adults had complete data for the final model, which included 546 asthma cases. Weighted phenotype prevalence was 38.7% concordant negative, 24.6% isolated systemic sensitization, 17.7% isolated rhinitis symptoms, and 19.0% concordant positive. Compared with concordant negative adults, concordant positive adults had the highest odds of asthma (OR, 6.21; 95% CI, 4.73-8.16). Isolated systemic sensitization (OR, 2.57; 95% CI, 2.08-3.19) and isolated rhinitis symptoms (OR, 2.67; 95% CI, 2.10-3.40) were also associated with asthma. Isolated rhinitis symptoms were associated with sinus infection (OR, 3.16; 95% CI, 2.46-4.06) and modestly with sleep impairment.

CONCLUSION

Rhinitis symptoms and measured systemic sensitization were related but noninterchangeable. Their concordance and discordance described clinically recognizable adult rhinitis phenotypes with distinct asthma and sinonasal burden patterns.

LEVEL OF EVIDENCE: 3.