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Comparative Study of Allergic Rhinitis in the General Population and Populations in Restricted Premises

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Abstract:

OBJECTIVE:  To compare incidence of allergic rhinitis in different age groups on basis of duration and signs and symptoms in the general population with that of population in restricted premises.
MATERIAL AND METHOD:  The present study was conducted on 100 patients in each group diagnosed as case of allergic rhinitis on basis of history and clinical examination
STUDY DESIGN:  Randomized prospective
SETTING:  Tertiary care centre and jail
PATIENTS:  100 Patient in each group diagnosed with allergic rhinitis
INTERVENTION:  Diagnostic
RESULT:  In general population, maximum number of cases (39%) belong to age group 21-30 yr with rhinorrhoea(95%) and sneezing(90%) as main symptom and inhalant allergans(58%) as main causative factor. 58% cases present with seasonal allergic rhinitis and 57% cases present with associated co-morbid conditions.
In population in restricted premises maximum number of cases (37%) belong to age group 21-30 yr with nasal obstruction (88%) as the main symptom and inhalant allergen (40%) as main causative factor. 73% cases presents with perinneal allergic rhinitis and 87% cases present with associated co-morbid conditions.
CONCLUSION:  There is increase incidence of allergic rhinitis and associated co-morbid conditions in population in restricted premises

 
Introduction:

Allergic rhinitis is a significant health problem worldwide as it’s prevalence is continuously increasing and become modern epidemic. Today 10-25% inhabitant of the world suffer from allergic rhinitis and in past 40 yrs incidence of allergic rhinitis increases due to industrialization and urbanization which cause increase in exposure to allergen, pollution, and irritants as well as life style changes, dietary modification responsible for diminuation of protective nutrients, decrease in infection leading to reduction in immune response (1,2,3)

Though not a serious life threatening condition, the socioeconomic impact of allergic rhinitis is substantial as condition is chronic and cannot be cured which include not only the cost of disease management and associated condition as treatment is unsatisfactory in high prevalence but also affect the quality of daily life with impact on productivity and work performance.

AIMS AND OBJECTIVE:

a)    To compare clinical profile of patients with allergic rhinitis

b) To compare incidence of allergic rhinitis in different age group on basis of duration, signs and symptoms in general population with that of population in restricted population.

Methods:

The present study was conducted on outdoor patients in Department Of Otorhinolaryngology And Head And Neck Surgery, G.R.Medical College And J.A.Group Of Hospital,Gwalior (M.P.) which are taken as general population and male prisoners patients in Central Jail, Gwalior which are taken as population in restricted premises during the year October 2011 to September 2012. Patients are diagnosed as case of allergic rhinitis on basis of thorough preliminary and detailed history, general , systemic and ENT examination aided by haematological and radiological investigations


Discussion:

In present study age ranged from 12yrs to 69 yrs. In general population, max no. of cases (39%) were in the age group 21-30 yrs. followed by 11-20 yrs. in which 24% cases were there and only 1% cases above 61 yrs. of age. In restricted premises, max no. of cases (37%) were in the age group 21-30 yrs. followed by 31-40 yrs. in which 29% cases were there and only 6% cases were present in age group 11-20 yrs and 12% cases with age > 60 yrs. This difference in age group may that most of the prisoners enter the jail only after 2nd decade of their life.

R. Nepali et al (2012) found max no of cases (38.1%) in age group 20-29 yrs. followed by 25.5% cases in 30-39 yrs. (4)

J. Latha et al. (2011) found max patients (48%) in age group 20-40 yrs.(5)
Chaweewan Bunnaj et al. (2000) found max no. of cases (66.65%) in 11-30 yrs. (6)
In our study, female patients were not taken in population in restricted premises, in general population males dominated the study in 65% cases.

Naveen Kumar et al.(2012) found 62%males and 38% females in their study.(7)
In general population, most common etiological factor was inhalants (58%) followed by multiple allergens (12%) ,unknown allergens (10%) ,ingested (9%),infectant (6%) ,contactant (4%) and drug allergy (1%)
In restricted premises, inhalant was most common etiological factor (40%) followed by unknown (16%), contactant (13%) ingested (11%), multiple (10%), infectant (10%), and no case of drug allergy.

A Navaro et al (2005) found 51% patients were allergic to pollen. (8)

In general population 24% cases have family history, 56% cases affected with weather changes and most common is rainy season (17%) followed by humid and dumpy atmosphere (14%), winter (13%), and summer (12%).

In restricted premises, 16% cases have family history, 54% cases affected with weather changes and most common is humid and dumpy atmosphere (20%) which is common in restricted premise like Jail followed by rainy season (14% cases) ,winter season (11% cases) and summer season (09% cases)

Dold Sigrid et al (1992) conducted study in which 16% of children are with one allergic parent and 25% if both patients are allergic. (9)

Navin Kumar et al shows that weather changes are predisposing factors in 62% cases in allergic rhinitis. (7)

In general population, 60% cases present with duration of symptoms < 5 years, 32% cases with 6-10 years duration and 8% cases with duration > 10 years as compared to this population in restricted premises has maximum number of cases (78%) presented with duration < 5 years, 18% with duration 6-10 years and 4% with duration > 10 years. The cause of short duration of symptoms in population in restricted premises may be due to fact that many of the cases develop complain after entering the restricted premises. This leads to conclusion that there is increase incidence of allergic rhinitis in restricted premises.

In general population main symptom is rhinorria (95% cases) and sneezing (90% cases) followed by nasal obstruction (72% cases) and nasal itching (52% cases) with typical triad of allergic rhinitis in 61% cases as compared to population in restricted premises in which nasal obstruction (88% cases) present as main symptom followed by rhinorrhoea (76% cases), sneezing (68% cases), nasal obstruction (44% cases) and typical triad of allergic rhinitis in 44% cases

Most common associated symptom in general population in ocular itching (65% cases) followed by nasopharyngeal itching (61% cases) and lacrimation (60% cases) as compared to population in restricted premises in which headache (76% cases) is main complaint followed by nasopharyngeal itching (68% cases).

The cause of nasal obstruction as main symptom in restricted premises may be due to humid and moist environment and congestion in restricted premises. Headache as most common associated symptom may be due to psychological factor or co-morbid conditions.

In general population 65% cases have pale boggy mucosa, 4% cases have pale bluish mucosa, 6% cases have bluish mucosa and 10% cases have violet mucosa and 15% cases have normal mucosal appearance compared to population in restricted premises in which 59% cases have pale boggy mucosa, 13% cases have pale bluish mucosa, 10% cases have bluish mucosa, 8%cases have purple mucosa and 10% cases have normal mucosal appearance.

In general population 68% cases have hypertrophied terminate compared to 77% cases in population in restricted premises which may because of infection and co-morbid conditions.
In general population watery nasal discharge in 78% cases, mucoid in 8%, purulent in 2% cases and mucopurulent in 12% cases compared to population in restricted premises in which it was watery in 68% cases, mucoid in 8%, purulent in 2% and mucopurulent 22% cases. The increase number of cases with mucopurulent discharge in population in restricted premises may be a result of associated co-morbid conditions and infective etiology.

In general population 68% cases have deviated nasal septum compared to 66% cases in population in restricted premises.

In general population 58% cases present with seasonal and 42% cases present with perineal allergic rhinitis compared to 27% cases with seasonal allergic rhinitis and 73% cases with perineal allergic rhinitis in population in restricted premises. So it can be concluded that perineal allergic rhinitis is more common in restricted premises.

Nabavizadih et al (2007) in his study, show 25% cases have seasonal and 75% cases have perineal allergic rhinitis.(10)

Crown et al (2003) in his study, shows that 79% cases have perineal and 21% have seasonal allergic rhinitis (11).

On the basis of radiological findings and clinical examination it was found that in general population 25% cases have associated sinusitis and 18% cases have associated bronchial asthma while in restricted premises 38% cases have associated sinusitis and 31% cases have associated bronchial asthma. There is increase association of co-morbid conditions like sinusitis and bronchial asthma with allergic rhinitis in population in restricted premises as compared to general population which can be explained on the fact that in restricted premises most patients are in 4th or 5th decade of the life, live in congested condition which is dumpy and moist.

Wu J et al ( 2005) in his study found that 32% cases of perineal allergic rhinitis have associated sinusitis. (12)

S. elango et al (2005) shows that 20% cases of population have asthma associated with allergic rhinitis. (13)

In our study 63% cases in general population and 70% cases in population in restricted premises present with blood eosinophilia.
Radiological finding which shows normal x-ray PNS finding in 78% cases and 66% cases in general population and population in restricted premises respectively.

Conclusion:

• Allergic rhinitis is more common in 3rd and 4th decade in population in restricted premises compared to 2nd and 3rd decade in general population.
• In general population, allergic rhinitis is more common in males
• Different etiological and predisposing factors do not have much influence on allergic rhinitis in two groups.
• On the basis of duration of symptoms, it can be concluded that there is increase incidence of allergic rhinitis in population in restricted population
• Nasal obstruction is the main symptom and headace is the main associated symptom in population in restricted premises compared to rhinorrhoea and sneezing as the main symptom and ocular itching as the main associated symptom in general population.
• Condition of turbinate and septum, mucosal appearance and nature of discharge do not have much influence on allergic rhinitis in two groups.
• On the basis of this study, it can be concluded that perinneal allergic rhinitis is more common in restricted population and seasonal allergic rhinitis in general population.
• Co-morbid conditions associated with allergic rhinitis like asthma and sinusitis are more common in population in restricted premises.
• In population in restricted premises, in x-ray PNS more radiological changes were found

 
References:

1. Wilson KF, Spector ME, Orlandi RR. Types of rhinitis. Otolaryngol Clin North Am. 2011 Jun;44(3):549-59, vii. doi: 10.1016/j.otc.2011.03.016. Epub 2011 Apr 29.  View Abstract

2. Sibbald B. Eplidemology of allergic rhinitis. In Eplidemology of clinical allergy monographs in allergy, Karger. Basel 1993; 61-69

3. Sly. R. M. Changing prevalence of allergic rhinitis and asthma. Ann Allergy Asthma immunol. 1999;82;232-52

4. R. Nepali B. Sigdel, P. Baniya Symptomatology and allergen types in Patients presenting with Allergic rhinitis Bangladesh J. otorhinolaryngology 2012; 18(1) 30-35.

5. Jonnagadala Latha, Vadde Ramakrishna George L Moses and Rallapalli Raman Janeyulu "Allergy specific immunotherapy as an effective therepy for seasonal and perinneal Allergic rhinitis patients" International Journal of microbiology vol. 2 Jan. 2011

6. Chaweewan bunnag, Perapin jareonchaisri et al (2000). Epidemiology of rhinitis in thais; characteristic and risk factors. Asian pacific journal of allergy and immunology.

7. Naveen Kumar et al (2011). A study of eosinophil count in nasal and blood smear in allergic respiratory disease in rural setup. Internet Journal of Medical Update 2012. January2012;7(1):48-6.

8. A. Navarro et al (2009). Epidemiology of allergic rhinitis in allergy consultations in Spain-Alergologica - 2005. J. Investig Allergol Clin Immunol. Vol. 19, Suppl. 2:7-13.

9. Dold S, Wjst M, Mutius EV, Reitmeir P, Stiepel E. Genetic risk of asthma, allergic rhinitis and atopic dermatitis. Arch Dis in Child. 1992; 67: 1018-22.

10. Nabavizadeh, S. Hesamedin, Al-Yasin, Sohila. “distribution of allergans among allergic rhinitis patient living in Shiraz(Iran) region” World allergy organization journal:nov.2007 Asia pac allergy. 2012 april;2(2):93-100.

11. Crown Wlt et al (2003) seasonal versus perinneal allergic rhinitis, drug and medical resource use pattern.

12. Wu J Et al (2005) The Relationship Between Perinnel Allergic rhinitis and chronic sinusutis.

13. S. Elango "recent trends in diagnosis and management of allergic rhinitis. medical Journal of Malaysia Vol 60 No. 5 dec. 2005.   
 

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World Articles in Ear, Nose and Throat  www.waent.org                   Mar. 15, 2013              Vol 6-1

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