Hye Ran Jeon; Youn Seon Choi; Seon Mee Kim; So Jung Yoon; Jin Wook Kim; Man Kim; Ji Young Lee; Jung Hwan Yoon

doi:10.4168/aard.2017.5.6.344

Journal List > Allergy Asthma Respir Dis > v.5(6) > 1059288

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Jeon, Choi, Kim, Yoon, Kim, Kim, Lee, and Yoon: Association between electronic cigarette smoking and allergic rhinitis – The Korea National Health and Nutrition Examination Survey (2015)

Original Article

Allergy Asthma Respir Dis 2017;5(6):344-350.

Published online: 5 November 2017

DOI: https://doi.org/10.4168/aard.2017.5.6.344

Association between electronic cigarette smoking and allergic rhinitis – The Korea National Health and Nutrition Examination Survey (2015)

Hye Ran Jeon, Youn Seon Choi, Seon Mee Kim, So Jung Yoon, Jin Wook Kim, Man Kim, Ji Young Lee, Jung Hwan Yoon

Department of Family Medicine, Korea University Guro hospital, Seoul, Korea

Correspondence to: Youn Seon Choi https://orcid.org/0000-0003-2406-5848 Department of Family Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea

Received 19 June 201731 August 2017 Accepted 8 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Allergic rhinitis (AR) is one of the common chronic diseases. Although it is not a life-threatening disease, its persistent symptoms may cause fatigue, mood change, discomfort at work, and academic disability as well as the decrease of quality of life. The prevalence of AR has been increasing steadily due to the Westernized lifestyle and environmental change. In previous studies, it has been found that AR has a clear relationship with smoking. However, there is no relationship study between AR and electronic cigarettes smoking (ECS).

Methods

The study was conducted on >19 -year-old adults who participated in the 2015 Korea National Health and Nutrition Examination Survey. Sex, age, residence status, tobacco smoking, alcohol drinking, stress level, economic status, and diagnosis of AR were analyzed by using univariate and multivariate logistic regression analyses.

Results

AR tended to be associated with ECS in the Korean adult population in univariate analysis, but ECS was not statistically significant in multivariate analysis. By multivariate analysis, AR was significantly related with younger age, male sex, alcohol consumption, and stress. Moreover, the prevalence of AR was linearly decreased as age increased from 19 to 69 years.

Conclusion

A diagnosis of AR was not significantly associated with ECS. Instead, AR showed an increased prevalence in adults at younger age, of male sex, and with alcohol consumption and high stress. To derive statistically significant results of relationship between AR and ECS, more well-designed studies focusing on the temporal causal are needed.

Keywords: Allergic rhinitis, Electronic cigarette, Smoking, Korea National Health and Nutrition Examination Survey, Adults

REFERENCES

1. Liang M, Xu R, Xu G. Recent advances in allergic rhinitis. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015; 29:202–6.

2. Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Ca-sale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010; 126:466–76.

3. Myong JP, Kim H, Lee K, Chang S. Time trends of allergic rhinitis and effects of residence on allergic rhinitis in Korea from 1998 through 2007-2009. Asian Nurs Res (Korean Soc Nurs Sci). 2012; 6:102–6.

4. Lee HS, Park E. Development and evaluation of allergic rhinitis-specific quality of life (ARSQOL) scale for adults. J Korean Acad Nurs. 2016; 46:675–86.

5. Ram G, Lee J, Ott M, Brown-Whitehorn TF, Cianferoni A, Shuker M, et al. Seasonal exacerbation of esophageal eosinophilia in children with eosinophilic esophagitis and allergic rhinitis. Ann Allergy Asthma Immunol. 2015; 115:224–8.e1.

6. Kang HN, Yun HS, Choi YJ, Oh JW, Min UY, Heo YS, et al. Evaluation of the association between pollen count and the outbreak of allergic disease. Allergy Asthma Respir Dis. 2016; 4:415–22.

7. Kim SY, Yoon SJ, Jo MW, Kim EJ, Kim HJ, Oh IH. Economic burden of allergic rhinitis in Korea. Am J Rhinol Allergy. 2010; 24:e110–3.

8. Torres-Borrego J, Molina-Terán AB, Montes-Mendoza C. Prevalence and associated factors of allergic rhinitis and atopic dermatitis in children. Allergol Immunopathol (Madr). 2008; 36:90–100.

9. Ahn SH, Lee HY, Song YE, Park SY, Lim DH, Kim JH, et al. The social and environmental risk factors of allergic rhinitis in children. Pediatr Allergy Respir Dis. 2012; 22:100–9.

10. Lee HS, Hong SC, Kim JH, Kim JW, Lee KH, Lee J. A cross-sectional epidemiological study on trends in the prevalence of allergic diseases among children and adolescents in the Jeju area in 2008 and 2013. J Korean Acad Community Health Nurs. 2015; 26:160–8.

11. Chung E, Park J, Lee SY, Choi YJ, Hong SJ, Park KS. Risk factors, lung function and bronchial hyperresponsiveness in current dust mite-induced allergic rhinitis. Allergy Asthma Respir Dis. 2016; 4:49–54.

12. Hwang IC, Lee YJ, Ahn HY, Lee SM. Association between allergic rhinitis and metabolic conditions: a nationwide survey in Korea. Allergy Asthma Clin Immunol. 2016; 12:5.

13. Fowles J, Dybing E. Application of toxicological risk assessment principles to the chemical constituents of cigarette smoke. Tob Control. 2003; 12:424–30.

14. Accordini S, Janson C, Svanes C, Jarvis D. The role of smoking in allergy and asthma: lessons from the ECRHS. Curr Allergy Asthma Rep. 2012; 12:185–91.

15. Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2016; 9:CD010216.

16. Rahman MA, Hann N, Wilson A, Mnatzaganian G, Worrall-Carter L. E-cigarettes and smoking cessation: evidence from a systematic review and metaanalysis. PLoS One. 2015; 10:e0122544.

17. Kim SK, Han JH, Lee TK, Nam SJ, Jin SJ. Electronic cigarettes. J Korean Soc Tob Sci. 2015; 37:34–48.

18. Polosa R, Caponnetto P, Morjaria JB, Papale G, Campagna D, Russo C. Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC Public Health. 2011; 11:786.

19. Hecht SS, Carmella SG, Kotandeniya D, Pillsbury ME, Chen M, Ransom BW, et al. Evaluation of toxicant and carcinogen metabolites in the urine of e-cigarette users versus cigarette smokers. Nicotine Tob Res. 2015; 17:704–9.

20. Aug A, Altraja S, Kilk K, Porosk R, Soomets U, Altraja A. E-cigarette affects the metabolome of primary normal human bronchial epithelial cells. PLoS One. 2015; 10:e0142053.

21. Callahan-Lyon P. Electronic cigarettes: human health effects. Tob Control. 2014; 23(Suppl 2):ii36–40.

22. Bousquet J, Bachert C, Alexander LC, Leone FT. Hypothesis: may e-ciga-rette smoking boost the allergic epidemic? Clin Transl Allergy. 2016; 6:40.

23. Cho JH, Paik SY. Association between electronic cigarette use and asthma among high school students in South Korea. PLoS One. 2016; 11:e0151022.

24. Chapman DG, Ather JL, Casey DT, Daphtary N, Qian X, Keim AC, et al. E-cigarette flavors and nicotine independently alter airway inflammation in a murine model of allergic airways disease. Am J Respir Cri Care Med. 2017; 195:A3065.

25. Lim HB, Kim SH. Inhallation of e-cigarette cartridge solution aggravates allergen-induced airway inflammation and hyper-responsiveness in mice. Toxicol Res. 2014; 30:13–8.

26. Kim UT, Park JA, Kim SK, Jung JY, Yu EH, Lee SJ. Association between electronic cigarette smoking and atopic dermatitis: the Korea youth risk behavior web-based survey 2014. Korean J Fam Pract. 2016; 6:553–9.

27. Farfel A, Tirosh A, Derazne E, Garty BZ, Afek A. Association between socioeconomic status and the prevalence of asthma. Ann Allergy Asthma Immunol. 2010; 104:490–5.

28. Brooks C, Pearce N, Douwes J. The hygiene hypothesis in allergy and asthma: an update. Curr Opin Allergy Clin Immunol. 2013; 13:70–7.

29. Benson M, Strannegård IL, Wennergren G, Strannegård O. Low levels of interferon-gamma in nasal fluid accompany raised levels of T-helper 2 cytokines in children with ongoing allergic rhinitis. Pediatr Allergy Immunol. 2000; 11:20–8.

30. Uphoff E, Cabieses B, Pinart M, Valdés M, Antó JM, Wright J. A systematic review of socioeconomic position in relation to asthma and allergic diseases. Eur Respir J. 2015; 46:364–74.

Table 1.

Variables for survey

Variable	Question	Example	Definition
Experience rate of diagnosis of allergic rhinitis	Have you ever been diagnosed with allergic rhinitis from doctor?	① Yes ② No	Number of people who replied ‘① Yes’
Experience rate of diagnosis of atopic dermatitis	Have you ever been diagnosed with atopic dermatitis from doctor?	① Yes ② No	Number of people who replied ‘① Yes’
Lifetime electronic cigarette use rate	Have you ever smoked an electronic cigarette?	① Yes ② No	Number of people who replied ‘① Yes’
Lifetime tobacco cigarette use rate	What is the total amount of cigarettes smoked during your lifetime?	① Less than 5 packs (100 PY) ② More than 5 packs (100 PY) ③ Never smoked	Number of people who replied ‘② More than 5 packs’
Lifetime alcohol drinking rate	Have you ever had a drink?	① Never drank ② Ever drank	Number of people who replied ‘② Ever drank’
Economic status	What is your economic status?	① Top ② Upper middle ③ Middle-low ④ Bottom
Stress level	How much stress do you usually feel?	① Very much ② A lot ③ A little ④ Rarely
Housing type	What is the current home type of housing?	① Single-family house ② Apartment ③ Town house ④ Multi-family house ⑤ Others

PY, pack-years.

Table 2.

Demographic and clinical characteristics of study subjects according to electronic cigarette smoking

Characteristic	Electronic cigarette			t/χ²	P-value
Characteristic	Ever-smoker (n=419)	Nonsmoker (n=4,986)	All subjects (n=5,405)	t/χ²	P-value
Age (yr)	37.57±13.92	52.70±16.45	51.52±16.76	-18.276	<0.001
Sex				328.539	<0.001
Male	359 (85.7)	1,993 (40.0)	2,352 (43.5)
Female	60 (14.3)	2,993 (60.0)	3,053 (56.5)
Ever-smoker				620.621	<0.001
Yes	406 (96.9)	1,740 (34.9)	2,146 (39.7)
No	13 (3.1)	3,246 (65.1)	3,259 (60.3)
Alcohol consumption				50.912	<0.001
Yes	413 (98.6)	4,316 (91.3)	4,729 (87.5)
No	6 (1.4)	670 (99.1)	676 (12.5)
Stress level				55.600	<0.001
High	36 (8.6)	243 (4.9)	279 (5.2)
Moderate	140 (33.4)	1,049 (21.0)	1,189 (22.0)
Low	202 (48.2)	2,821 (56.6)	3,023 (55.9)
None	41 (9.8)	871 (17.5)	912 (16.9)
Economic status				25.984	<0.001
Low	47 (11.3)	980 (19.8)	1,027 (19.1)
Low to moderate	93 (22.4)	1,221 (24.6)	1,314 (24.5)
Moderate to high	147 (35.3)	1,330 (26.8)	1,477 (27.5)
High	129 (31.0)	1,427 (28.8)	1,556 (28.9)
Residential status				2.765	0.598
Detached house	144 (34.4)	1,862 (37.4)	2,006 (37.1)
Apartment	221 (52.7)	2,477 (49.7)	2,698 (49.9)
Row house	30 (7.2)	360 (7.2)	390 (7.2)
Multiplex house	20 (4.8)	211 (4.2)	231 (4.3)
Others	4 (0.9)	76 (1.5)	80 (1.5)
Atopic dermatitis				10.694	0.001
No	361 (94.7)	4,546 (97.6)	4,907 (97.3)
Yes	20 (5.3)	114 (2.4)	134 (2.7)
Allergic rhinitis				6.846	0.009
No	310 (81.4)	4,018 (86.2)	4,328 (85.9)
Yes	71 (18.6)	642 (17.8)	713 (14.1)

Values are presented as mean±standard deviation or number (%).

Table 3.

Univariate comparison between allergic rhinitis group and nonallergic rhinitis group

Characteristic	Allergic rhinitis		t/χ²	P-value
Characteristic	No (n=4,328)	Yes (n=713)	t/χ²	P-value
Age (yr)	52.73±16.51	43.56±16.10	13.796	<0.001
Sex			2.683	0.101
Male	1,898 (43.9)	274 (38.4)
Female	2,430 (56.1)	439 (61.6)
Ever smoke			1.123	0.289
Yes	1,699 (39.3)	265 (37.2)
No	2,629 (60.7)	448 (62.8)
Alcohol consumption			15.442	<0.001
No	566 (13.1)	56 (7.9)
Yes	3,762 (86.9)	657 (92.1)
Stress level			29.499	<0.001
High	209 (4.8)	46 (6.5)
Moderate	918 (21.3)	192 (26.9)
Low	2,420 (55.9)	396 (55.5)
None	779 (18.0)	79 (11.1)
Economic status			23.313	<0.001
Low	853 (19.8)	94 (13.2)
Low to moderate	1,070 (24.8)	162 (22.8)
Moderate to high	1,154 (26.8)	225 (31.6)
High	1,230 (28.6)	230 (32.4)
Residential status			36.253	<0.001
Detached house	1,657 (38.3)	191 (26.8)
Apartment	2,120 (49.0)	413 (57.9)
Row house	295 (6.8)	64 (9.0)
Multiplex house	190 (4.4)	35 (4.9)
Others	66 (1.5)	10 (1.4)
Electronic cigarette			6.846	0.009
Ever-smoker	310 (7.2)	71 (10.0)
Nonsmoker	4,018 (92.8)	642 (90.0)

Values are presented as mean±standard deviation or number (%).

Table 4.

Risk factors for the prevalence of allergic rhinitis, multiple logistic regression

Variable	Odds ratio (95% confidence interval)	VIF	P-value
Age (yr)		2.113
19–29	Reference
30–39	0.840 (0.626–1.127)		<0.001
40–49	0.779 (0.570–1.066)		<0.001
50–59	0.439 (0.306–0.630)		<0.001
60–69	0.328 (0.221–0.485)		<0.001
Sex		1.915
Male	Reference
Female	0.750 (0.592–0.952)		0.018
Ever smoke	0.897 (0.697–1.156)	2.062	0.402
Alcohol consumption	1.189 (0.957–1.243)	1.047	0.016
Stress level		1.068
None	Reference
Low	0.613 (0.395–0.950)		0.029
Moderate	0.666 (0.457–0.971)		0.035
High	0.700 (0.471–1.042)		0.079
Economic status		1.162
Low	Reference
Low to moderate	1.146 (0.828–1.586)		0.412
Moderate to high	1.100 (0.857–1.411)		0.453
High	1.105 (0.886–1.379)		0.374
Residential status		1.041
Detached house	Reference
Apartment	0.908 (0.415–1.987)		0.810
Row house	1.098 (0.505–2.389)		0.814
Multiplex house	1.162 (0.507–2.665)		0.722
Others	1.065 (0.446–2.542)		0.887
Electronic cigarette	1.076 (0.767–1.510)	1.230	0.671

VIF, variance inflation factor.

TOOLS

Similar articles