The Impact of Allergic Rhinitis on Asthma Outcomes in Urban Adolescents

Allergic rhinitis (AR) is a known comorbidity in asthmatic adolescents that may exacerbate symptoms. School-based programs have demonstrated that preventive asthma therapy administered under school nurse supervision reduces morbidity. However a subgroup of adolescents continue to have difficult to control asthma despite monitored preventive treatment. Using the unified airway paradigm, we hypothesized that this cohort of adolescents would have significant burden of AR, and AR would be associated with worse asthma outcomes. We included adolescents aged 12-16 years from the Rochester City School District who participated in the School Based Asthma Care for Teens trial between 2016 - 2017. History of AR and asthma outcomes were assessed via clinical history and spirometry. Bivariate and multivariate regression models adjusting for age, gender, race, ethnicity, insurance, and smoke exposure estimated the association between AR and asthma morbidity. We used baseline data from 387 adolescents with persistent asthma (mean age 13, 55% Black, 32% Hispanic, 85% Medicaid). 77% of adolescents reported a history of AR. Adolescents with AR were more likely to be seen in the ED for asthma compared to adolescents without AR (aOR 2.64; 95%CI 1.29-5.44). Adolescents with AR were more likely to use rescue medication and miss school due to asthma compared to those without AR. FENO was elevated in adolescents with AR vs. those without AR. Importantly, only 52% of adolescents with AR reported taking allergy medication. Allergic rhinitis is prevalent in high-risk adolescents with persistent asthma and is associated with significant asthma morbidity and under - treatment.