ORIGINAL PAPER Allergic rhinitis and asthma comorbidity: ARIA classification of rhinitis does not correlate with the prevalence of asthma L. Antonicelli à , C. Micucci à , S. Voltolini w , V. Feliziani z , G. E. Senna ‰ , P. Di Blasi z , G. Visona ` z , R. De Marco k and F. Bonifazi à à Allergy Unit, Department of Internal Medicine, Immuno-Allergic and Respiratory Diseases, Ospedali Riuniti di Ancona, Ancona, Italy, w Allergy and Clinical Immunology Service, San Martino Hospital, Genova, Italy, z Allergy Service, Unit of Medicine, Lanciano Hospital, Chieti, Italy, ‰ Allergy Service, Verona Major Hospital, Verona, Italy, z Medical Department, GlaxoSmithKline, Verona, Italy, k Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy Clinical and Experimental Allergy Correspondence: L. Antonicelli, Department of Internal Medicine, Immuno-Allergic and Respiratory Diseases, Ospedali Riuniti di Ancona, Via Conca-Torrette, 60200 Ancona, Italy. E-mail: l.antonicelli@ ao-umbertoprimo.marche.it Summary Background Allergic rhinitis and asthma comorbidity is supported by both the similar underlying pathogenesis and immunologic mechanisms. The aim of this study was to verify whether the characteristics of rhinitis classified according to the new Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines correlate with the prevalence of asthma. Methods From 1 March to 30 June 2002, a multi-centre cross-sectional study was conducted by 154 allergists chosen from throughout Italy. Duration, severity of rhinitis (according to the ARIA classification) and the type of allergic sensitizations were compared with the prevalence of asthma. Results One thousand three hundred and twenty-one consecutive rhinitis-allergic patients aged 18 years or older were enrolled for the study. The majority of patients, 1060 (80.24%), were on medication at the time of their specialist visit. Mild intermittent rhinitis was diagnosed in 7.7% of patients, moderate/severe intermittent in 17.1%, mild persistent in 11.6%, and moderate/severe persistent in 63.6%. The prevalence of asthma was 48% in patients with mild intermittent rhinitis, 49.6% in moderate–severe intermittent rhinitis, 36.6% in mild persistent rhinitis and 47.5% in moderate severe persistent patients. No correlation between the ARIA categories of rhinitis and the prevalence of asthma was found. A multivariate analysis, after adjustment for age, sex, type of sensitization, level of severity and duration of rhinitis classified according to the ARIA guidelines, demonstrated that age, over 41 years [risk ratio (RR) 1.260, 95% confidence interval (CI) 1.072–1.482] and especially over 51 years (RR 1.460, 95% CI 1.237–1.723), sensitization to indoor allergens (mite and cat), (RR 1.203, 95% CI 1.060–1.366), and polysensitization (RR 1.178, 95% CI 1.004–1.383) are significant risk factors for asthma. Conclusion In allergic rhinitis (AR) patients referred to a specialist, the features of AR as defined by the ARIA classification are not able to predict the presence of asthma, therefore all such patients should be assessed for asthma. Keywords allergic asthma, allergic rhinitis, ARIA, Italy Submitted 7 October 2006; revised 1 March 2007; accepted 16 March 2007 Introduction The link between rhinitis and asthma is supported by anatomical and epidemiological evidence; moreover the involvement of the same causative agents (allergens, anti- inflammatory drugs, etc.) and the demonstration of ‘bidir- ectional’ allergic inflammation between the upper and lower airways have been shown [1–6]. As a direct result of this evidence it has been proposed that rhinitis and asthma are manifestations of a single chronic inflammatory syndrome, in which the mildest and earliest forms primar- ily affect the upper airway [1–6]. The severity of rhinitis may therefore correlate with the increased prevalence of asthma. Some studies confirm this and demonstrate that the severity of rhinitis is a risk factor for asthma irrespective of the presence of allergy [7]. Moreover, a significant relation- ship between the severity of rhinitis and the prevalence of Clinical and Experimental Allergy, 37, 954–960  c 2007 The Authors Journal compilation  c 2007 Blackwell Publishing Ltd