Background: A close relation between asthma and allergic rhinitis has been reported by several epidemiological and clinical studies. However, the nature of this relation remains unclear. We used the follow-up data from the European Community Respiratory Health Survey to investigate the onset of asthma in patients with allergic and non-allergic rhinitis during an 8·8-year period. Methods: We did a longitudinal population-based study, which included 29 centres (14 countries) mostly in western Europe. Frequency of asthma was studied in 6461 participants, aged 20-44 years, without asthma at baseline. Incident asthma was defined as reporting ever having had asthma confirmed by a physician between the two surveys. Atopy was defined as a positive skin-prick test to mites, cat, Alternaria, Cladosporium, grass, birch, Parietaria, olive, or ragweed. Participants were classified into four groups at baseline: controls (no atopy, no rhinitis; n=3163), atopy only (atopy, no rhinitis; n=704), non-allergic rhinitis (rhinitis, no atopy; n=1377), and allergic rhinitis (atopy+rhinitis; n=1217). Cox proportional hazards models were used to study asthma onset in the four groups. Findings: The 8·8-year cumulative incidence of asthma was 2·2% (140 events), and was different in the four groups (1·1% (36), 1·9% (13), 3·1% (42), and 4·0% (49), respectively; p1), log total IgE, family history of asthma, and smoking, the adjusted relative risk for asthma was 1·63 (95% CI 0·82-3·24) for atopy only, 2·71 (1·64-4·46) for non-allergic rhinitis, and 3·53 (2·11-5·91) for allergic rhinitis. Only allergic rhinitis with sensitisation to mite was associated with increased risk of asthma independently of other allergens (2·79 [1·57-4·96]). Interpretation: Rhinitis, even in the absence of atopy, is a powerful predictor of adult-onset asthma. Funding: UCB Institute of Allergy and Agence Nationale de la Recherche.
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