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Wise et al.

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take several years to manifest. In fact, Lin et al. 595 found that allergic adults were more likely to have been exposed to secondhand smoke 20 years prior when compared to non allergic adults. Five prospective cohort studies examined the effect of tobacco on the development of AR, all of which failed to find a correlation between active or passive tobacco smoke and the development of AR. 596-600 Keil et al. 596 found that while passive smoke was not significantly related to AR, it was strongly associated with allergic sensitization and asthma symptoms in children with a genetic predisposition (at least 1 or more atopic parents). Additionally, Wright et al. 597 found that while there was no significant association between secondhand smoke exposure and AR, 63% of asthmatics born to heavy smokers developed rhinitis in the first 6 months, vs 43% of asthmatics whose mothers did not smoke. Finally, Bendtsen et al. 598 found that actively smoking more than 15 cigarettes per day actually decreased a patient’s risk of developing AR. This inverse correlation has been identified in several other studies. 124,601-603 Eriksson et al. 124 found that while smoking was associated with a high prevalence of chronic rhinitis in both men and women, it was correlated with a low prevalence of AR in men. Additionally, they found a significantly lower prevalence of sensitization to common airborne allergens in current and exsmokers compared to nonsmokers. In contrast, the significant positive association between tobacco and the development of non-allergic/chronic rhinitis has been repeatedly identified. 124,128,604 Therefore, when discussing the effects of tobacco on rhinitis, differentiating between allergic and non-allergic/chronic is paramount. Finally, tobacco does not appear to influence the efficacy of AR treatment. Katotomichelakis et al. 605 evaluated 163 patients (both smokers and nonsmokers) receiving sublingual immunotherapy (SLIT) for AR and found that, regardless of tobacco status, total symptom scores and QOL questionnaires equally improved. Overall, while most studies evaluating AR and tobacco are case-control or cross-sectional in nature, multiple prospective cohort studies and 2 systematic reviews predominantly found no correlation between active or passive tobacco smoke and AR. Additionally, some studies suggest that tobacco may have a protective effect against the development of AR. Further investigation is needed to identify if specific patient populations (eg, asthmatics or those with atopic parents) or temporal variations (eg, exposure for 20+ years) may alter our understanding of this relationship. • Aggregate Grade of Evidence: C (Level 2a: 1 study; Level 2b: 5 studies; Level 3a: 1 study; Table VI.E). In 1829, John Bostock described 29 cases in the UK, including himself, of individuals who suffered from catarrhus aestivus or “summer cold,” which he noted occurred in patients of middle to high SES. 606 During the 1870s, Blackley found no hay fever among farmers and people living in deprived areas of cities. 606 The positive association between hay fever and high social class was later reported in the British 1958 and 1970 cohorts, 607,608 as well as a Swedish survey of conscripts born from 1952 to 1977. 609 However, during the study period,

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VI.F. Socioeconomic factors

Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.