RUNNING HEAD: SECONDHAND-SMOKE AND ALLERGY RHINITIS 1

Secondhand-Smoke and Allergy Rhinitis: The Suspected Relationship Between the Two

Essence U. Smith
University of North Florida
November 15, 2017
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For many years, cigarette smoking was advertised as the cool thing to do, which is one

of the reasons that cigarettes became so popular around the United States. Since then, research

has shown that there is a relation between cigarettes and many negative health repercussions.

Second-hand smoke is a global public health issue with about 40% of children worldwide being

exposed (Oberg et al., 2011). In the United States in particular, this number was 40.6%

(NHANES., 2011). According to these studies, approximately 40% of children in the United

States (3-11) are at risk to any disease outcomes related to second-hand smoke. A common

condition related to second-smoke is allergy rhinitis.

Allergy rhinitis can directly affect the quality of life for any individual. Constant

sneezing, itchy, and watery eyes is an unpleasant reality for those dealing with allergy rhinitis.

Allergy rhinitis is a multibillionaire industry. People are paying to minimize their symptoms

allergy related symptoms. The annual cost to cover expenses related to allergies in the United

States alone has been shown to be roughly $3.4 billion dollars at one point in time (Meltzer et al.,

2011). This is definitely not a cheap disease. Also, this is usually a lifetime expense. The

symptoms associated with rhinitis have a reported annual incidence of 30% in the United States

pediatric population (Hoppin et al., 2005-2006). Some of the symptoms include sneezing,

congestion, watery eyes, fatigue, and many more. Due to the fact that allergy rhinitis is such a

costly disease, identifying the risk factors for the disease is ideal for all involved.

Tobacco smoke has been linked to respiratory diseases in the past. Allergy rhinitis is

essentially the inflammation of the nasal mucosa. It is biologically plausible to want to

investigate whether tobacco smoke increases the likelihood of one developing an allergy since

smoking is known to cause sensitization to existing indoor allergens (Lannero et al., 2008). If
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smoking around children were eliminated, then essentially there would be a drastic decrease in

the incidence of symptoms associated with rhinitis. There is very little insight on whether this is

something that only effects those that are exposed sporadically versus exposure for long periods

of time. This study is important because many people across the United States are plagued by

their allergies on a regular basis.

Establishing a relationship between smoke inhalation and allergy rhinitis is key. Sinusitis

is defined as the inflammation of one or more paranasal sinuses (Hur et al., 2013). Symptoms

and triggers of sinusitis and allergy rhinitis are very similar, so there is relevancy in discussing

both. Both fall under the umbrella of inflammation of the nasal cavity. Kevin Hur and his

associates were able to find a statistically significant association between sinusitis and

secondhand smoke in 68.4% of the articles that they reviewed regarding sinusitis (Hur et al.

2013). All of the studies included in Hurs initial review did not include the severity of the

symptoms the individuals were experiencing (Hur et al. 2013). All of the data on secondhand

smoke exposure regarding prevalence was conducted through questionnaires. This is true in both

studies that Hur and his associates conducted. The exposure is solely based on the subjects

ability to recall incidences where they were exposed to smoke. There is no way to account for

any validity for what the subject is reporting. This is something that must be taken into

consideration when attempting to establish an association. With that being said, this in no way

refutes that there is an association between smoke inhalation and allergy rhinitis. This study

concluded that the correlation between secondhand smoke exposure and sinusitis was supported

based on their findings. It was also noted that the studies include were of either level 3 or 4 of

evidence based on published guidelines by the Oxford Centre for Evidence-based Medicine-

Levels of Evidence. Therefore, researchers concluded that higher-quality studies from a

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prospective approach should be conducted to provide more understanding between the

relationship between secondhand smoke and sinusitis.

Although allergy rhinitis and sinusitis are very similar, there still must be a direct link

between allergy rhinitis and secondhand smoke exposure. Kevin Hur et al. realized this and went

on to also publish a study on this link specifically just a month later. Hur and his associates were

successful in finding an association between secondhand smoke exposure and allergy rhinitis.

The researches combined 40 articles for this study. Of the articles studying children, 37.5% of

them showed a statistically significant association between allergy rhinitis and secondhand

smoke exposure. This study was mainly geared towards finding out if there was a significant

difference between the proportion of adults and children studies of this sort. According to Hur

and his associates, this is the first systematic review in English examining this correlation.

Because this is the first of its kind, it can be assumed that more research is necessary before

anything is considered to be of fact. The researchers concluded that there is a definite association

between allergy rhinitis and secondhand smoke exposure, but they suggest that more studies be

performed to delineate the relationship between allergy rhinitis and allergy rhinitis (Hur et al.,

2013).

Jurgita Saulyte and her associates recognized the need for more information regarding

active and passing smoking and their association to the risk of allergic rhinitis, allergic

dermatitis, and food allergy among adults and children/adolescents (Saulyte et al., 2016). Passive

smoking is another term for secondhand smoke exposure. Active smoking is referring to the

individual that is actually smoking. Unlike the studies previously mentioned, this study included

a meta-analysis approach. Saulyte and associates found that there was a significant association in

the modest increase in the risk of allergy rhinitis from passive smoking for the overall
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population. They were not able to conclude the same regarding active smoking. This is especially

interesting because some might wonder what exactly separates the two from one another

regarding inhalation. More studies need to be done to determine what exactly is protecting active

smokers from allergy rhinitis.

Saulyte and associates also included that children and youth are more vulnerable to

allergic reactions in general regarding passive smoking (Saulyte et al., 2016). They summed it up

to the immaturity of the developing respiratory, nervous, and immune systems in children

(Saulyte et al., 2016). All of the literature mentioned have supported the hypothesis that a

decrease in smoking would result in a decrease in allergy rhinitis. The overwhelming consensus

of every study that has been previously mentioned regarding both sinusitis and allergy rhinitis

has been that there must be more research conducted. This is something that not only effects

people in the United States, but people all over the world (Jain, 2016). As stated above, allergy

rhinitis is a multibillionaire industry. Another thing to take into consideration is that secondhand

smoke exposure has been inversely with poverty income ratio (Jain, 2016). Essentially, this

means that many of those that are at a higher risk of being susceptible to developing allergy

rhinitis are also of low income. If these medications that are meant to combat allergy rhinitis are

not covered by insurance, then many of these individuals will not be able to afford treatment.

That leaves an entire demographic left vulnerable and exposed. These individuals are completely

defenseless outside of the antibodies they have naturally produced. Public health initiatives are

necessary to address the gaps in response to such issues. There needs to be initiatives to decrease

smoking like adding a tax on tobacco products for instance. In conclusion, more research needs

to be conducted so that public health officials will have solid support when pushing to implement

initiatives.
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References

1. Carlsen, K., & Carlsen, K. L. (2008). CME Article: Respiratory effects of tobacco

smoking on infants and young children. Paediatric Respiratory Reviews, 911-20.

Retrieved from doi: 10.1016/j.prrv.2007.11.007

2. D P Strachan, D G Cook. (1, February 1998). Health effects of passive smoking .5.

Parental smoking and allergic sensitization in children. Retrieved from

http://thorax.bmj.com/content/53/2/117

3. Josef Shargorodsky MD, MPH,Esther Garcia-Esquinas MD, MPH, PhD,Ana Navas-

Acien MD, PhD,Sandra Y. Lin MD,. (17, April 2015) Allergic sensitization, rhinitis, and

tobacco smoke exposure in U.S. children and adolescents. Retrieved from

http://onlinelibrary.wiley.com/doi/10.1002/alr.21444/full

4. Hur K1, Liang J, Lin SY., (2014, Jan 4). The role of secondhand smoke in sinusitis: a

systematic review. Retrieved from http://dx.doi.org/10.1002/alr.21232