The Influence Of Active Smoking On Patients With Allergic Rhinitis

Part One:Retrospective study:The impact of active smoking on nasal symptoms and allied diseases in patients with allergic rhinitisObjective:This study was designed to generally investigate the prevalence of active smoking in patients with allergic rhinitis (AR), and determine whether there is any influence of active smoking on nasal symptoms and allied diseases among those patients.Methods:We retrospectively evaluated273adult patients with allergic rhinitis in our outpatient database from2009-2010. Categories of current smokers (33), ex-smokers (7), and never smokers (233) were used to investigate the impact of active smoking on basic information, symptom scores (visual analog scale, VAS) and system history among AR patients.Results:The prevalence of active smoking in adults with allergic rhinitis is about14.7%(40/273), most of which were male (38/40). The average age of AR patients were34.68years, old, ex-smokeres (46.43) and current smokers (38.94) were significantly higher than never smokers (33.73). On VAS, smokers did not show significant difference in nasal symptoms compared with nonsmokers, whereas in male patients, both ex-smokers (64.14±20.73) and current smokers (53.42±35.52) showed more severe nasal itching symptom than never smokers (39.10±27.44). There is no statistically significant difference among the three groups in nasal obstruction, nasal discharge and sneeze scores. In ocular symptoms, ex-smokers (25.71±22.96) and current smokers (19.58±30.44) have higher eye redness and eye swelling scores compared with nonsmokers (8.64±18.80). Ex-smokers have more eye pain scores (21.43±24.43) comparing with nonsmokers (1.09±2.83), and also current smokers (5.53±14.66). In addition, ex-smokers have more chest symptoms versus nonsmokers, and higher scores in cough, wheeze and squeezing feeling versus current smokers furthermore. Logistic regression was used to assess the predictability of the smoking status for subsequent development of allied systematic disease. It was revealed that both ex-smokers and current smokers were significant related to the risk incidence of gastrointestinal symptoms and lower respiratory disease, with the odds ratio (OR) being12.69(95%CI, 2.57-62.74),14.20(95%CI,2.97-67.95),2.71(95%CI,1.70-4.32) and1.85(95%CI,1.17-2.92) respectively. Ex-smokers was significant related to the incidence of chronic dermatitis and asthma, with the OR being8.92(95%CI,1.54-51.74) and5.81(95%CI,1.04-32.51). The above incidences were not significantly change when adjusted for age, sex, education and family history. Current smokers was significant related to the incidence of drug hypersensitivity when adjusted for family history, with the OR being1.68(95%CI,1.05-2.67). There was no other significant difference between ex-smokers and current smokers on risk incidence of symtemic disease.Conclusions:Active smoking in adults with allergic rhinitis is common. Compared with nonsmokers with allergic rhinitis, smokers have more severe nasal symptom, ocular symptoms and respiratory symptoms. In addition, smokers have higher incidence of drug hypersensitivity, gastrointestinal symptoms, chronic dermatitis and respiratory disease. However, being allergic does not seem to act as a deterrent towards starting active smoking or continuing to smoke. Part Two:Investigate the effect of active cigarette smoking on allergic rhinitis and potential mechanismObjective:Despite previous epidemiologic studies have shown that active smoking is a potent risk factor for allergic rhinitis and allied diseases. There is a clear need for experimental studies to address the mechanism. We directly tested cigarette smoke could interact with allergen in human beings to alter immune responses and promote changes associated with allergic airway disease.Methods:32patients with allergic rhinitis (18current smokers,7ex-smokers and10never smokers) visiting during april2011to july2011in outpatient were included in this study.8control health never smokers were also included. AR patients were persistent or intermittent type and confirmed by positive skin tests. Current smokers with allergic rhinitis were defined as those with allergic rhinitis who had smoked5pack-years or more and smoking at least5cigarettes a day; ex-smokers were those with allergic rhinitis who had smoked5pack-years or more but had quitted more than2months but less than5years. The concentration of IL-4、IL-13, IFN-y and IL-17in nasal discharge and serum was assessed using enzyme-linked immuno sorbent assay (ELISA). Comparison was made between cytokines concentration in healthy and rhinitis patients, among never smokers, current smokers and ex-smokers with allergic rhinitis, respectively. Included AR patients also filled out history review and VAS form.Results:The average age of onset in smokers was38.12±13.11, whereas the onset age was significantly posterior to the average starting smoking age (28.72±9.58). Cigarette smoke (vs never smokers with allergic rhinitis) promoted the induction of a Th2-cytokine nasal milieu (increased IL-4and IL-13and decreased IFN-y production) and Th17-cytokine nasal milieu (increased IL-17production), characteristic of an active allergic response. Trend of changes in nasal discharge is generally consistent with in serum. However, serum cytokines did not show significant differences except for IL-17. Furthermore, only IL-13in nasal discharge and serum have a light correlation, r=0.544, P=0.000.Conclusion:Active smoking reduced the integrity and barrier function of the respiratory epithelium and thus facilitates allergen penetration. Those who were exposed to smoke become more easily sensitized to respiratory allergens and had AR therefore. Furthermore, continue smoking could exacerbate nasal allergic Th2and Th17responses to those who had AR already. Compared with serum, nasal discharge has a more representive significance in nasal milieu. IL-4、IL-5、IL-13and IFN-y could be considered as markers as for predicting subsequently AR development. Allergic patients suffering from airway disease tend to quit smoking in order to improve airway function, but nevertheless possibly there was still an immune imbalance in quit smoking patients. Smoking cessation may not improve the immune imbalance and symptom in a short term.