The prevalence of asthma and rhinitis is on the increase and these conditions are frequently associated, thus leading to the concept that these two conditions are different aspects of the same disease: "one airway, one disease" [2]. Most of patients with allergic (80%) and non-allergic asthma (75%) have concomitant rhinitis, while, approximately 34% of patients with allergic rhinitis and 25% of patients with non-allergic have concomitant asthma [2,3]. Although upper and lower airway diseases commonly occur together, clinicians have yet to determine the exact nature of the association between these two chronic conditions and to test the hypothesis that treating rhinitis reduces health care utilization for co-morbid asthma [4].In the present study, we used FeNO and nasal cytology to investigate upper and lower airway inflammation and the clinical benefits of nasal treatment in children with asthma.
Methods and Study Population
Study populationA total of 84 patients, 4-17 years of age, 53 males and 31 females, coming from the allergology outpatient "Filippo del Ponte", were clinically examined from 1 November 2013 to 31 July 2014. All participants were interviewed about respiratory symptoms thanks to ACT (Asthma Control Test) or C-ACT (Childhood-Asthma Control Test) and SNOT (Sino-Nasal Outcome Test); lung function and airway inflammation were measured using HyPAIR FeNO and nasal cytology in children free of treatment (systemic antihistamine and/or nasal steroids) for at least 10 days' time.Furthermore the allergic sensitization to common aeroallergens (birch, core, olive tree, grasses, ragweed, parietaria, dog, cat, house dust mite: DPP and DPF 1 , mould: alternaria) and foods (cow lactalbumin, cow casein, egg white and yolk, peanuts) was evaluated by skin prick-test and used to classify patients in two groups: allergic (72, 47 males and 25 females) and non-allergic (12, 6 males and 6 females). Histamine hydrochloride, 10 mg/mL, and phenolated glycerol-saline served as positive and negative controls. The reaction was regarded as positive if the mean wheal diameter was at least 3 mm greater than negative control [5].