Clin Exp Otorhinolaryngol.  2025 Feb;18(1):30-39. 10.21053/ceo.2024.00202.

Assessing the Complex Impact of Smoking Habits on Allergic Rhinitis: A National Cross-Sectional Study

• Shin JM
• Jeong Y
• Kim J
• Lee J
• Kim TH

• KMID: 2565231
• DOI: http://doi.org/10.21053/ceo.2024.00202

Abstract

Objectives
. Allergic rhinitis (AR) significantly impacts quality of life and incurs socioeconomic costs. The influence of smoking habits, including the use of conventional cigarettes (CCs) and electronic cigarettes (ECs), on the prevalence and management of AR remains a subject of debate. This study aims to explore the association between smoking status (CC and EC use) and the prevalence and management of AR among Koreans by analyzing data from the Korea National Health and Nutrition Examination Survey (KNHANES) VII (2018) and VIII (2019–2021).
Methods
. This cross-sectional study involved 22,290 participants aged 19 years and older from the KNHANES. Participants self-reported their smoking status, and urinary cotinine levels were measured to assess nicotine exposure. We employed statistical analyses, including logistic regression, to examine the relationships between smoking status, cotinine levels, and the prevalence and management of AR.
Results
. In univariable logistic regression analysis, EC users exhibited a 35.8% increased risk of AR compared to non-smokers, whereas CC users experienced a 27.7% reduced risk. Multivariable logistic regression analysis showed a 20.3% lower risk of AR among CC users; however, no significant association was observed for EC users. Higher cotinine levels (>500 ng/mL) were associated with a lower prevalence of AR. Specifically, heavy CC users with high cotinine levels demonstrated a 35% reduced risk of AR. Nonetheless, after adjusting for confounders, this association was no longer significant, indicating that other variables might influence this relationship.
Conclusion
. Smoking status is associated with the prevalence of AR in Koreans. Notably, heavy use of CCs is negatively correlated with the prevalence of AR.

Keyword

Electronic Cigarettes; Allergic Rhinitis; Cotinine; Urine

Figure

• 

  Fig. 1. A flowchart of survey participants. Among a total of 30,551 participants from Korea National Health and Nutrition Examination Survey (KNHANES) 2018–2021, those aged under 19 years and with missing values for the variables (age, body mass index, sex, alcohol consumption, area of residence, income, education level, diabetes mellitus, hypertension, allergic rhinitis, asthma, atopic dermatitis, and urine cotinine level) were excluded. After applying these criteria, 22,290 participants were deemed eligible for inclusion in the study.

Reference

1. Small P, Keith PK, Kim H. Allergic rhinitis. Allergy Asthma Clin Immunol. 2018; Sep. 14(Suppl 2):51.

2. Dykewicz MS, Hamilos DL. Rhinitis and sinusitis. J Allergy Clin Immunol. 2010; Feb. 125(2 Suppl 2):S103–15.

3. Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, et al. International consensus statement on allergy and rhinology: allergic rhinitis - 2023. Int Forum Allergy Rhinol. 2023; Apr. 13(4):293–859.

4. Mlinaric A, Popovic Grle S, Nadalin S, Skurla B, Munivrana H, Milosevic M. Passive smoking and respiratory allergies in adolescents. Eur Rev Med Pharmacol Sci. 2011; Aug. 15(8):973–7.

5. Gomez RM, Croce VH, Zernotti ME, Muino JC. Active smoking effect in allergic rhinitis. World Allergy Organ J. 2021; Jan. 14(2):100504.

6. Wang H, Yu M, Ochani M, Amella CA, Tanovic M, Susarla S, et al. Nicotinic acetylcholine receptor alpha7 subunit is an essential regulator of inflammation. Nature. 2003; Jan. 421(6921):384–8.

7. Razani-Boroujerdi S, Singh SP, Knall C, Hahn FF, Pena-Philippides JC, Kalra R, et al. Chronic nicotine inhibits inflammation and promotes influenza infection. Cell Immunol. 2004; Jul. 230(1):1–9.

8. Mishra NC, Rir-Sima-Ah J, Langley RJ, Singh SP, Pena-Philippides JC, Koga T, et al. Nicotine primarily suppresses lung Th2 but not goblet cell and muscle cell responses to allergens. J Immunol. 2008; Jun. 180(11):7655–63.

9. Ruszkiewicz JA, Zhang Z, Goncalves FM, Tizabi Y, Zelikoff JT, Aschner M. Neurotoxicity of e-cigarettes. Food Chem Toxicol. 2020; Apr. 138:111245.

10. Pisinger C, Dossing M. A systematic review of health effects of electronic cigarettes. Prev Med. 2014; Dec. 69:248–60.

11. Hisinger-Molkanen H, Piirila P, Haahtela T, Sovijarvi A, Pallasaho P. Smoking, environmental tobacco smoke and occupational irritants increase the risk of chronic rhinitis. World Allergy Organ J. 2018; Mar. 11(1):6.

12. Marques P, Piqueras L, Sanz MJ. An updated overview of e-cigarette impact on human health. Respir Res. 2021; May. 22(1):151.

13. Skaaby T, Taylor AE, Jacobsen RK, Paternoster L, Thuesen BH, Ahluwalia TS, et al. Investigating the causal effect of smoking on hay fever and asthma: a Mendelian randomization meta-analysis in the CARTA consortium. Sci Rep. 2017; May. 7(1):2224.

14. Wise SK, Lin SY, Toskala E. International consensus statement on allergy and rhinology: allergic rhinitis-executive summary. Int Forum Allergy Rhinol. 2018; Feb. 8(2):85–107.

15. Thomson NC, Chaudhuri R, Heaney LG, Bucknall C, Niven RM, Brightling CE, et al. Clinical outcomes and inflammatory biomarkers in current smokers and exsmokers with severe asthma. J Allergy Clin Immunol. 2013; Apr. 131(4):1008–16.

16. Feeney S, Rossetti V, Terrien J. E-Cigarettes-a review of the evidenceharm versus harm reduction. Tob Use Insights. 2022; Mar. 15:1179173X221087524.

17. Rha MS, Cho HJ, Yoon JH, Kim CH. Association between the use of electronic cigarettes and the prevalence of chronic rhinosinusitis and allergic rhinitis: a nationwide cross-sectional study. Rhinology. 2022; Feb. 60(1):20–8.

18. Tan X, Vrana K, Ding ZM. Cotinine: pharmacologically active metabolite of nicotine and neural mechanisms for its actions. Front Behav Neurosci. 2021; Oct. 15:758252.

19. Moran VE. Cotinine: beyond that expected, more than a biomarker of tobacco consumption. Front Pharmacol. 2012; Oct. 3:173.

20. Marsot A, Simon N. Nicotine and cotinine levels with electronic cigarette: a review. Int J Toxicol. 2016; Mar-Apr. 35(2):179–85.

21. Hong SN, Won JY, Nam EC, Kim TS, Ryu YJ, Kwon JW, et al. Clinical manifestations of allergic rhinitis by age and gender: a 12-year single-center study. Ann Otol Rhinol Laryngol. 2020; Sep. 129(9):910–7.

22. Savoure M, Bousquet J, Zins M, Goldberg M, Jacquemin B, Nadif R. Age of onset of rhinitis as a determinant of different rhinitis phenotypes. Eur Respir J. 2020; 56(suppl 64):433.