Reply
2
Reply To the Editor: The observations of Ciprandi and Cirillo 1 on the presence of subclinical airway obstruction in patients without asthma with al- lergic rhinitis are appreciated. Airflow obstruction in patients with allergic rhinitis was first reported more than 30 years ago. 2,3 How- ever, relatively small numbers of subjects were included in these earlier studies. Ciprandi and Cirillo 1 report on 4782 subjects with allergic rhinitis without asthma symptoms and with a normal FEV 1 . Twenty-three percent of these patients had a forced expira- tory flow between 25% and 75% of vital capacity (FEF 25-75 ) < _65% predicted. They indicate that an FEV 1 < _85% predicted was 90.7% sensitive and 87.6% specific for the identification of individuals with FEF 25-75 < _65% predicted. It would be important to know whether those with an FEF 25-75 < _65% predicted have reversible airflow obstruction as shown by an improvement in FEV 1 in response to a bronchodilator. Previ- ous publications partially address this question. Fairshter et al 3 re- port that the rhinitis group demonstrated a significant increase in maximal expiratory flow at 50% of vital capacity, FEV 1 , and forced vital capacity in response to isoproterenol inhalation. Sve- nonius et al 4 also demonstrated a significant increase in maximal expiratory flow at 25% of vital capacity (V9 max 25) in their allergic rhinitis group in response to an inhaled ß-adrenergic agonist (al- buterol). Because this information is presented as group results, we do not know whether increased flow rates in response to bron- chodilators in the allergic rhinitis group were the result of greater responses among individuals with FEF 25-75 < _65% predicted than among those with a higher FEF 25-75 . This raises the question of whether the subset of patients with allergic rhinitis who have air- way hyperreactivity 5-7 and reversible airflow obstruction in fact have asymptomatic asthma or whether there are critical physio- logic factors that protect these individuals from developing the asthmatic phenotype despite allergy and baseline airway dysfunction. Michael R. Simon, MD a Vernon M. Chinchilli, PhD b Brenda R. Phillips, MS b Christine A. Sorkness, PharmD c Robert F. Lemanske, Jr, MD c Stanley J. Szefler, MD d Lynn Taussig, MD e Leonard B. Bacharier, MD f Wayne Morgan, MD g a The Division of Allergy and Clinical Immunology, William Beaumont Hospital, Royal Oak, and the Departments of Internal Medicine and Pediatrics, Wayne State Univer- sity School of Medicine, Detroit, Mich; b the Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, Pa; c the Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Mad- ison, Wis; d the Department of Pediatrics, National Jewish Health, Denver, Colo; e the Division of Natural Sciences and Mathematics, University of Denver, Denver, Colo; f the Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Wash- ington University School of Medicine and St Louis Children’s Hospital, St Louis, Mo; and g Respiratory Sciences Center, University of Arizona College of Medicine, Tucson, Ariz. E-mail: [email protected]. Disclosure of potential conflict of interest: V. M. Chinchilli receives research support from the National Institutes of Health. L. B. Bacharier receives honoraria from Astra- Zeneca and serves on advisory boards for Genentech, GlaxoSmithKline, Merck, Schering-Plough, and Aerocrine. W. Morgan has consultant arrangements with Gen- entech, Novartis, and the Cystic Fibrosis Foundation; is a speaker for Phadia AB; and receives research support from the NIH-NHLBI CARE Network and the Cystic Fibro- sis Foundation. S. J. Szefler has consultant arrangements with GlaxoSmithKline, Genentech, Merck, Boehringer-Ingelheim, Novartis, and Schering-Plough and re- ceives research support from the NIH/NHLBI Childhood Asthma Management Pro- gram, the NIH/NHLBI Childhood Asthma Research and Education, the NIH/NHLBI Asthma Clinical Research Network, the NIH/NIAID Inner City Asthma Consortium, GlaxoSmithKline, the NJH/NHLBI Asthma Net, and the NEEHS/EPA Childhood En- vironmental Health Center grant. C. A. Sorkness is on advisory boards for GlaxoS- mithKline, Schering Plough, and AstraZeneca and receives research support from Schering Plough and Compleware/Sandoz. R. F. Lemanske is a speaker for Merck, AstraZeneca, Doembacher Children’s Hospital, Washington University, Medicus Group, Parke Nicolet Institute, ACAAI, LA Allergy Society, Michigan Allergy/ Asthma Society, Medical College of Wisconsin, Fund for Medical Research and Ed- ucation (Detroit), Children’s Hospital of Minnesota, Toronto Allergy Society, AAAAI, Beaumont Hospital (Detroit), University of Illinois, Canadian Society of Al- lergy and Clinical Immunology, New York Presbyterian, Med Media Education Group, Onpointe Medical Communication, Medical University of South Carolina, Health Matters Communication, Bishop McCann, Donohue, Purohit, Miller, Inc, Center for Health Care Education, University of California-San Francisco, American Thoracic Society, University of Iowa, Indiana University, American Lung Association of Upper Midwest, Vanderbilt University, and Rochester Children’s Hospital; has con- sultant arrangements with AstraZeneca, Map Pharmaceuticals, Gray Consulting, Smith Research, Inc, Merck Childhood Asthma Network, Novartis, Quintiles/Inno- vax, RC Horowitz & Co, Inc, International Meetings and Science, Scienomics, Scien- tific Therapeutics, and Cognimed, Inc, is an author for Up-to-Date; and is a textbook editor for Elsevier, Inc. The rest of the authors have declared that they have no con- flicts of interest. REFERENCES 1. Ciprandi G, Cirillo I. Forced expiratory flow between 25% and 75% of vital capacity may be a marker of bronchial impairment in allergic rhinitis. J Allergy Clin Immu- nol 2011;127:549. 2. Lidington RE, Cotton DJ, Graham BL, Dosman JA. Peripheral airways obstruction in patients with rhinitis. Ann Allergy 1979;42:28-33. 3. Fairshter RD, Novey HS, Marchioli LE, Wilson AF. Large airway constriction in allergic rhinitis: response to inhalation of helium-oxygen. J Allergy Clin Immunol 1979;63:39-46. 4. Svenonius E, Arborelius M Jr, Kautto R, Lilja B. Lung function studies in children with allergic rhinitis. Allergy 1982;37:87-92. 5. Cirillo I, Klersy C, Marseglia GL, Vizzaccaro A, Pallestrini E, Tosca M, et al. Role of FEF25%-75% as a predictor of bronchial hyperreactivity in allergic patients. Ann Allergy Asthma Immunol 2006;96:692-700. 6. Cruz AA, Popov T, Pawanker R, Annesi-Messano I, Fokkens W, Kemp J, et al, ARIA Initiative Scientific Committee. Common characteristics of upper and lower airways in rhinitis and asthma: ARIA update in collaboration with GA(2)LEN. Allergy 2007;62(suppl 84):1-41. 7. DiLorenzo G, Pacor ML, Mansueto P, Esposito Pellitteri M, Lo Bianco C, Ditta V, et al. Determinants of bronchial hyperresponsiveness in subjects with rhinitis. Int J Immunopathol Pharmacol 2005;18:715-22. doi:10.1016/j.jaci.2010.10.052 Reply We thank the authors of the published article on forced expiratory flow between 25% and 75% of vital capacity (FEF 25-75 ) and bronchodilation response in children with asthma 1 for their response. 2 The data concerning the response to the bronchodilation test are not available in our study because the Italian Navy Medical Corps states as rules for asthma diagnosis, in case of normal FEV 1 values, that methacholine bronchial challenge must be performed to assess the possible presence and the degree of bronchial hyperreactivity. In this regard, our data showed that 36.7% of patients with impaired FEF 25-75 values (such as < _65% of predicted) had severe bronchial hyperreactivity, whereas only 7.3% of patients with normal FEF 25-75 values had severe bronchial hyperreactivity. Giorgio Ciprandi, MD a Ignazio Cirillo, MD b J ALLERGY CLIN IMMUNOL FEBRUARY 2011 550 CORRESPONDENCE
Transcript of Reply
J ALLERGY CLIN IMMUNOL
FEBRUARY 2011
550 CORRESPONDENCE
Reply
To the Editor:The observations of Ciprandi and Cirillo1 on the presence of
subclinical airway obstruction in patients without asthma with al-lergic rhinitis are appreciated. Airflow obstruction in patients withallergic rhinitis was first reported more than 30 years ago.2,3 How-ever, relatively small numbers of subjects were included in theseearlier studies. Ciprandi and Cirillo1 report on 4782 subjects withallergic rhinitis without asthma symptoms and with a normalFEV1. Twenty-three percent of these patients had a forced expira-tory flow between 25% and 75% of vital capacity (FEF25-75)<_65% predicted. They indicate that an FEV1 <_85% predictedwas 90.7% sensitive and 87.6% specific for the identification ofindividuals with FEF25-75 <_65% predicted.
It would be important to know whether those with an FEF25-75<_65% predicted have reversible airflow obstruction as shown byan improvement in FEV1 in response to a bronchodilator. Previ-ous publications partially address this question. Fairshter et al3 re-port that the rhinitis group demonstrated a significant increase inmaximal expiratory flow at 50% of vital capacity, FEV1, andforced vital capacity in response to isoproterenol inhalation. Sve-nonius et al4 also demonstrated a significant increase in maximalexpiratory flow at 25% of vital capacity (V9max25) in their allergicrhinitis group in response to an inhaled ß-adrenergic agonist (al-buterol). Because this information is presented as group results,we do not know whether increased flow rates in response to bron-chodilators in the allergic rhinitis group were the result of greaterresponses among individuals with FEF25-75 <_65% predicted thanamong those with a higher FEF25-75. This raises the question ofwhether the subset of patients with allergic rhinitis who have air-way hyperreactivity5-7 and reversible airflow obstruction in facthave asymptomatic asthma or whether there are critical physio-logic factors that protect these individuals from developing theasthmatic phenotype despite allergy and baseline airwaydysfunction.
Michael R. Simon, MDa
Vernon M. Chinchilli, PhDb
Brenda R. Phillips, MSb
Christine A. Sorkness, PharmDc
Robert F. Lemanske, Jr, MDc
Stanley J. Szefler, MDd
Lynn Taussig, MDe
Leonard B. Bacharier, MDf
Wayne Morgan, MDg
aThe Division of Allergy and Clinical Immunology, William Beaumont Hospital, Royal
Oak, and the Departments of Internal Medicine and Pediatrics, Wayne State Univer-
sity School of Medicine, Detroit, Mich; bthe Department of Public Health Sciences,
Penn State Hershey College of Medicine, Hershey, Pa; cthe Departments of Pediatrics
and Medicine, University of Wisconsin School of Medicine and Public Health, Mad-
ison, Wis; dthe Department of Pediatrics, National Jewish Health, Denver, Colo; ethe
Division of Natural Sciences and Mathematics, University of Denver, Denver, Colo;fthe Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Wash-
ington University School of Medicine and St Louis Children’s Hospital, St Louis,
Mo; and gRespiratory Sciences Center, University of Arizona College of Medicine,
Tucson, Ariz. E-mail: [email protected].
Disclosure of potential conflict of interest: V. M. Chinchilli receives research support
from the National Institutes of Health. L. B. Bacharier receives honoraria from Astra-
Zeneca and serves on advisory boards for Genentech, GlaxoSmithKline, Merck,
Schering-Plough, and Aerocrine. W. Morgan has consultant arrangements with Gen-
entech, Novartis, and the Cystic Fibrosis Foundation; is a speaker for Phadia AB; and
receives research support from the NIH-NHLBI CARE Network and the Cystic Fibro-
sis Foundation. S. J. Szefler has consultant arrangements with GlaxoSmithKline,
Genentech, Merck, Boehringer-Ingelheim, Novartis, and Schering-Plough and re-
ceives research support from the NIH/NHLBI Childhood Asthma Management Pro-
gram, the NIH/NHLBI Childhood Asthma Research and Education, the NIH/NHLBI
Asthma Clinical Research Network, the NIH/NIAID Inner City Asthma Consortium,
GlaxoSmithKline, the NJH/NHLBI Asthma Net, and the NEEHS/EPAChildhood En-
vironmental Health Center grant. C. A. Sorkness is on advisory boards for GlaxoS-
mithKline, Schering Plough, and AstraZeneca and receives research support from
Schering Plough and Compleware/Sandoz. R. F. Lemanske is a speaker for Merck,
AstraZeneca, Doembacher Children’s Hospital, Washington University, Medicus
Group, Parke Nicolet Institute, ACAAI, LA Allergy Society, Michigan Allergy/
Asthma Society, Medical College of Wisconsin, Fund for Medical Research and Ed-
ucation (Detroit), Children’s Hospital of Minnesota, Toronto Allergy Society,
AAAAI, Beaumont Hospital (Detroit), University of Illinois, Canadian Society of Al-
lergy and Clinical Immunology, New York Presbyterian, Med Media Education
Group, Onpointe Medical Communication, Medical University of South Carolina,
Health Matters Communication, Bishop McCann, Donohue, Purohit, Miller, Inc,
Center for Health Care Education, University of California-San Francisco, American
Thoracic Society, University of Iowa, Indiana University, American Lung Association
of Upper Midwest, Vanderbilt University, and Rochester Children’s Hospital; has con-
sultant arrangements with AstraZeneca, Map Pharmaceuticals, Gray Consulting,
Smith Research, Inc, Merck Childhood Asthma Network, Novartis, Quintiles/Inno-
vax, RC Horowitz & Co, Inc, International Meetings and Science, Scienomics, Scien-
tific Therapeutics, and Cognimed, Inc, is an author for Up-to-Date; and is a textbook
editor for Elsevier, Inc. The rest of the authors have declared that they have no con-
flicts of interest.
REFERENCES
1. Ciprandi G, Cirillo I. Forced expiratory flow between 25% and 75% of vital capacity
may be a marker of bronchial impairment in allergic rhinitis. J Allergy Clin Immu-
nol 2011;127:549.
2. Lidington RE, Cotton DJ, Graham BL, Dosman JA. Peripheral airways obstruction
in patients with rhinitis. Ann Allergy 1979;42:28-33.
3. Fairshter RD, Novey HS, Marchioli LE, Wilson AF. Large airway constriction in
allergic rhinitis: response to inhalation of helium-oxygen. J Allergy Clin Immunol
1979;63:39-46.
4. Svenonius E, Arborelius M Jr, Kautto R, Lilja B. Lung function studies in children
with allergic rhinitis. Allergy 1982;37:87-92.
5. Cirillo I, Klersy C, Marseglia GL, Vizzaccaro A, Pallestrini E, Tosca M, et al. Role
of FEF25%-75% as a predictor of bronchial hyperreactivity in allergic patients. Ann
Allergy Asthma Immunol 2006;96:692-700.
6. Cruz AA, Popov T, Pawanker R, Annesi-Messano I, Fokkens W, Kemp J, et al,
ARIA Initiative Scientific Committee. Common characteristics of upper and lower
airways in rhinitis and asthma: ARIA update in collaboration with GA(2)LEN.
Allergy 2007;62(suppl 84):1-41.
7. DiLorenzo G, Pacor ML, Mansueto P, Esposito Pellitteri M, Lo Bianco C, Ditta V,
et al. Determinants of bronchial hyperresponsiveness in subjects with rhinitis. Int J
Immunopathol Pharmacol 2005;18:715-22.
doi:10.1016/j.jaci.2010.10.052
Reply
We thank the authors of the published article on forcedexpiratory flow between 25% and 75% of vital capacity(FEF25-75) and bronchodilation response in children withasthma1 for their response.2 The data concerning the responseto the bronchodilation test are not available in our studybecause the Italian Navy Medical Corps states as rules forasthma diagnosis, in case of normal FEV1 values, thatmethacholine bronchial challenge must be performed toassess the possible presence and the degree of bronchialhyperreactivity. In this regard, our data showed that 36.7%of patients with impaired FEF25-75 values (such as <_65% ofpredicted) had severe bronchial hyperreactivity, whereasonly 7.3% of patients with normal FEF25-75 values had severebronchial hyperreactivity.
Giorgio Ciprandi, MDa
Ignazio Cirillo, MDb
J ALLERGY CLIN IMMUNOL
VOLUME 127, NUMBER 2
CORRESPONDENCE 551
From athe Department of Internal Medicine, Genoa University, Genoa, Italy and bthe
Navy Medical Service, La Spezia, Italy. E-mail: [email protected].
Disclosure of potential conflict of interest: The authors have declared that they have no
conflict of interest.
REFERENCES
1. Simon MR, Chinchilli VM, Phillips BR, Sorkness CA, Lemanske RF, Szefler SJ,
et al. Forced expiratory flow between 25% and 75% of vital capacity and FEV1/
forced vital capacity ratio in relation to clinical and physiological parameters in
asthmatic children with normal FEV1 values. J Allergy Clin Immunol 2010;126:
527-34.
2. Simon MR, Chinchilli VM, Phillips BR, Sorkness CA, Lemanske RF, Szefler SJ,
et al. Reply. J Allergy Clin Immunol 2011;127:550.
doi:10.1016/j.jaci.2010.10.051
Retraction notice
Retraction notice to ‘‘Children with asthma and no URTI, more commonly have rhinovirus in their exhaled breath, than inmucous’’
[J Allergy Clin Immunol 2009;123:S171]
Tovey ER, Ng DSY, Stelzer-Braid S, Rawlinson WD, Oliver BG
Woolcock Institute of Medical Research
This article has been retracted at the request of the authors.
Reason: This abstract has been retracted at the request of the authors. The authors have identified inconsistencies within the datathat may have affected the results of the study.
