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Table of Content - Volume 12 Issue 3 - December 2019
Associate Professor, Department of Otorhinolaryngology, Parul institute of Medical Sciences and Research Centre, Vadodara, Gujarat, INDIA. Email: drpiyushpujara@gmail.com
Abstract Background and Aim: Multiple co-morbidities like sinusitis, asthma, conjunctivitis, eczema, Eustachian tube dysfunction and otitis media are generally associated with allergic rhinitis. Aim of the present study is to determine the prevalence of allergic rhinitis among school going children in the district of central Gujarat. Material and Methods: Present cross-sectional study was conducted in government and private schools in the district of central Gujarat between for the period of 14 months. A total of 350 students were taken for the study including both male and female students. A detailed clinical history and physical examination was done. Questions were asked regarding the demographic profile, socioeconomic status and residential address. Detailed otorhinolaryngological examination was done which included: Anterior rhinoscopy, otoscopy, oral examination, nasal endoscopy, neck examination tunning fork tests, impedance audiometry. Results: The prevalence of allergic rhinitis was found to be 27.10% in school going children among district of central Gujarat. The percentage of allergic rhinitis in school going children was 51.5% in urban and 48.4% in rural population of school going children. The symptoms in the school going children was found to be Sneezing in 68.42%, watery rhinorrhoea in 65.2%, nasal obstruction in 78.9%, itching of nose in 49.4%, itching eyes in 61% and pharyngeal prutritis in 26.31%. The chest symptoms were found to be cough in 27.05%, nocturnal waking in 17.24%, occasional wheezing in 13.79% and chest tightness in 8.62%. Conclusion: The prevalence of allergic rhinitis shows a significant rise in last few years, more common in rural areas, and existing as co-morbidity in a significant proportion of children demanding a comprehensive strategic approach to deal with them. Key Words: allergic rhinitis, asthma, children, cross-sectional study
INTRODUCTION The prevalence of allergic rhinitis and other allergic diseases has increased globally in the last three decades, and the geographical prevalence rates vary from 10% to 45%.1-4 In addition to genetic factors, lifestyle factors influence the prevalence of allergic rhinitis and other allergic diseases. These include changing life styles, increasing vehicular pollution, increasing ownership of indoor plants and pets, choice of bedding and carpets, and an increasing use of air conditioning. Data suggests that AR is the most common chronic disorder in the pediatric population with up to 40% of children affected.5 The disease along with associated co-morbidities has a profound impact on the daily lives of children. Irritability, sadness, impairment of sleep and limitation of activities at school as well as home are often seen in these children. AR results in day-time fatigue and impairment of cognition and memory in children which significantly affect the learning process and thus impacts on school performance and all these aspects upset the family.5 Multiple co-morbidities like sinusitis, asthma, conjunctivitis, eczema, Eustachian tube dysfunction and otitis media are generally associated with allergic rhinitis. Although AR greatly impacts life at home, school and even while sleeping, it is treated as a trivial and a commonplace disorder. Consequently, it does not receive the attention it deserves from the patient, the family as well as the health care professionals, especially in developing countries like India.6 The concept of allergy was originally introduced in 1906 by Viennese pediatrician Clemens von Pirquet, after he noted that some of his patients were hypersensitive to normally innocuous entities such as dust, pollen or certain foods.6 Pirquet called this phenomenon allergy from the Ancient Greek words allos meaning other and ergon meaning work. All forms of hypersensitivity used to be classified as allergies, and all forms were thought to be caused by an improper activation of the immune system.7,8 thus the aim of the present study is to determine the prevalence of allergic rhinitis among school going children in district of central Gujarat.
MATERIAL AND METHODS Present cross-sectional study was conducted among government and private schools in the district of central Gujarat between for the period of 14 months. The data collection was done after obtaining the permission from the concerned principals of both the government and private schools. A total of 350 students were taken for the study including both male and female students. All students were interviewed. The information was collected from them through interview using a questionnaire after taking informed consent. A detailed clinical history and physical examination was done. Questions were asked regarding the demographic profile, socioeconomic status and residential address. All the school going children in the age group of 6-18 years including both male and female students presented with one or more of the following symptoms: Nasal obstruction, Watery rhinorrhoea , Sneezing, Itching nose , Pharyngeal pruritis , Itching eyes and Itching nose. Each of the above symptoms was scored as described by Wilson et al 2001. 0. Absence of a given symptom 1. Significant symptoms, mild, well tolerated 2. Well defined, discomforting, and affecting activities that require high concentration 3. High intensity barely tolerated hindering daily activities and sleep. Total score for each patient was calculated separately. Detailed general and physical examination was done. Detailed otorhinolaryngological examination was done which included: Anterior rhinoscopy, otoscopy, oral examination, nasal endoscopy, neck examination tunning fork tests, impedance audiometry Investigations
Spirometry
Imaging
All the patients were started on inhalational nasal corticosteroid (flutacasone). Patients were put on. Statistical analysis The data were analyzed using SPSS version 15 (SPSS Inc., Chicago, Illinois, USA). For all tests, confidence level and level of significance were set at 95% and 5% respectively. RESULTS The prevalence of allergic rhinitis was found to be 27.10% among school going children in district of central Gujarat. The percentage of allergic rhinitis in male and females was 55.7% and 43.2% respectively. (Table 1) The percentage of allergic rhinitis in school going children was 51.5% in urban and 48.4% in rural population of school going children. (Table 2) The percentage having persistent allergic rhinitis was 59.5% and intermittent rhinitis was in 39.4%. The symptoms in the school going children was found to be Sneezing in 68.42%, watery rhinorrhoea in 65.2%, nasal obstruction in 78.9%, itching of nose in 49.4%, itching eyes in 61% and pharyngeal prutritis in 26.31%. (Table 3) The chest symptoms were found to be cough in 27.05%, nocturnal waking in 17.24%, occasional wheezing in 13.79% and chest tightness in 8.62%. (Table 4) The distribution of skin prick test was found to be dust mite in 75.4%, pollen in 66.2%, moulds in 14.5%, only dust mite in 24.4%, only pollen in 18.1%, only mould in 9.10%, dust mite + pollen in 42.90%, dust mite +moulds in 5.85% and dust mite + pollen + moulds in 3.9%.
Table 1: Gender distribution of school going children presenting with symptoms of allergic rhinitis (n=95)
Table 2: Geographical distribution of school going children presenting with symptoms of allergic rhinitis (n=95)
Table 3: Distribution of school going children with allergic rhinitis as per symptomatology (n=95)
Table 4: Distribution of chest symptoms suggestive of latent asthma in school going children with allergic rhinitis (n=95)
DISCUSSION This study was conducted for a period of 14 months in patients who met the criteria of allergic rhinitis as per the predetermined proforma was included in the study. Allergic rhinitis is a part of systemic disease complex whose prevalence has risen over the last 10 years and ranks among top 5 chronic medical conditions, affecting 10-40% of the population.9 In the current study out of 350 patients of rhinitis 95 patients were found to have allergic rhinitis, As such the prevalence in this study was found to be 27.1%. Epidemiological studies demonstrate discernible global variation in the prevalence rates of rhinitis symptoms, which might be positive or negative by allergy tests. Self-reported seasonal or perennial rhinitis symptoms significantly overestimate the prevalence of AR well-defined by a positive history and positive allergy tests. However, positive allergy tests are also common in those without self-reported rhinitis symptoms 10. Dykewicz et al reported in their study the prevalence of 10-30% in adults and upto 42% of children.11 Thus the results of our study are consistent with the above discussed studies. incidence between ages of 13-19 years.12 In the present study it was observed that allergic rhinitis was prevalent more frequently in 2nd decade of life. 2nd and 3rd decade accounting for more than 2/3rd of patients, reflecting that children and young adults are the most affected group. Cruz et al, on publications between 2000 and 2005 on allergic rhinitis and its associated co morbidity (bronchial asthma) also found highest incidence rate of allergic rhinitis, in both genders from 17-22 years.13Allergic rhinitis is more common in males than females. It was reported that the prevalence of parallel allergic rhinitis and asthma displays a strong male predominance in childhood and appears to switch to a female predominance in adolescents.14 Cross-sectional study suggested that allergy prevalence in childhood is higher in boys compared to girls, but it remains uncertain whether this inequality changes after puberty.15 The increase in allergic rhinitis has been observed over last few decades and is more common in developed countries and increase in prevalence is seen with urbanization of non-westernized societies.16 Many possible factors suggested such as lifestyle changes, increased exposure to allergens, pollution and irritants, diminution of protective nutrients, decrease in infections (hygiene hypothesis), and stress has been implicated.17,18 Fahrlander et al in their study found reduced incidence of seasonal allergic rhinitis sensitization in farmers children compared to their peers living in the same village in a non-farming family. These epidemiological studies are in accordance with the findings of current study.19 Allergic rhinitis has been recognized as a significant risk factor for adult onset asthma. This result was expected and is consistent with previous studies in the literature.20-22 International studies have demonstrated a varying association between rhinitis and asthma with a range of 40% to 90%. Asthma and rhinitis often represent a spectrum of the same disease (the one-airway hypothesis). The association between asthma and rhinitis is related to several factors, including the neural nasal-bronchial interaction, disturbances of the nasal mucosa warming and humidification functions, drainage of irritant and inflammatory materials into the lungs and the presence of similar cellular infiltrates and proinflammatory mediators in both the upper and lower airways.
CONCLUSION The prevalence of allergic rhinitis shows a significant rise in last few years, more common in rural areas, and existing as co-morbidity in a significant proportion of children demanding a comprehensive strategic approach to deal with them. Further, the results indicated that rhinitis symptoms are also associated with a high frequency of asthma symptoms. REFERENCES
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