Changing prevalence of allergic rhinitis and asthma

Objective: This review will enable the reader to discuss prevalence, risk factors, and prognosis of allergic rhinitis and asthma. Data sources: MEDLINE (PubMed) search using the terms allergic rhinitis, asthma, prevalence, risk factors. Study selection: Human studies published in the English language since 1978, especially studies of relatively large populations in the United States, Great Britain, Australia, and New Zealand, with cross referencing to earlier relevant studies. Results: Current prevalence of allergic rhinitis at 16 years of age in cohorts of British children born in 1958 and 1970 increased from 12% in the earlier cohort to 23% and in the later cohort. Local surveys of allergic rhinitis at approximately 18 years of age in the United States in 1962 to 1965 disclosed prevalence of 15% to 28%, while the national survey of 1976 to 1980 disclosed a prevalence of 26%. Thus, it is uncertain whether prevalence of allergic rhinitis has changed in the United States based on these limited data. Data from several sources indicate worldwide increases in prevalence of asthma. Annual Health Interview surveys indicate increases in prevalence of asthma in the United States from 3.1% in 1980 to 5.4% in 1994, but prevalence among impoverished inner city children has been much higher. Combined prevalence of diagnosed and undiagnosed asthma among inner city children has been 26% and 27% at 9 to 12 years of age in Detroit and San Diego. Positive family history and allergy are important risk factors for allergic rhinitis and asthma. Prognosis is guarded; allergic rhinitis resolves in only 10% to 20% of children within 10 years, and at least 25% of young adults who have had asthma during early childhood are symptomatic as adults. Conclusion: Increases in prevalence remain unexplained, but avoidance of recognized allergens should reduce the prevalence of allergic rhinitis and asthma.