Association between tobacco & nicotine product use and allergic rhinitis: a cross-sectional study

Allergic rhinitis (AR) affects over 1.4 billion individuals globally and remains one of the most burdensome chronic inflammatory conditions of the upper airway. Whether tobacco and nicotine product use—including combustible products (cigarettes and hookah) and the rapidly growing use of electronic cigarettes (ECs)—contributes meaningfully to AR risk is still contested. This study set out to examine whether current tobacco/nicotine product use, and the type of product used, is associated with AR in a mixed Jordanian and international sample. We conducted a cross-sectional study using a self-administered structured questionnaire. Using an online convenience sample, 500 individuals aged 18–50 years were invited and 385 completed responses were analyzed. AR was identified using the Score for Allergic Rhinitis (SFAR), a validated 12-item tool; a score of ≥ 7 out of 16 was considered diagnostic. Current tobacco/nicotine product users ( n = 137; 35.6%) were compared against non-users ( n = 248; 64.4%) and further categorized by primary product—conventional cigarettes or hookah (combustible) and e-cigarettes (non-combustible). Chi-square tests and multivariable binary logistic regression adjusting for age, gender, education, income, and region examined associations between product use and AR status. AR was identified in 235 participants (61.0%). Neither tobacco/nicotine use status ( p = 0.93) nor product type ( p = 0.99) showed a statistically significant association with AR in unadjusted analyses. After multivariable adjustment, EC use was associated with higher odds of AR compared with non-use (adjusted odds ratio [aOR] 2.18, 95% CI 1.06–4.48), while combustible product use showed a similar, non-significant trend (aOR 2.05, 95% CI 0.89–4.73); female gender was a strong independent predictor of AR (aOR 2.74, 95% CI 1.43–5.29). E-cigarettes were by far the most commonly used product among users in this sample. Tobacco/nicotine product use was not associated with AR in unadjusted analyses; however, after accounting for the marked gender imbalance between users and non-users, EC use was associated with approximately twice the odds of AR. The findings point to AR’s multifactorial nature, the importance of confounder adjustment, and the limitations of cross-sectional, self-reported data in capturing the tobacco/nicotine–allergy relationship. Future work should prioritize objective allergy testing, quantitative exposure measurement, and longitudinal follow-up.