Shilpa Susan Mathew, (2022) Association of Polysensitisation with Severity among Adults with Allergic Rhinitis. Masters thesis, Christian Medical College, Vellore.
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Abstract
BACKGROUND: Allergic rhinitis is a common otorhinolaryngological condition and is characterized by at least one or more of the following clinical symptoms based on the ‘ARIA’ (Allergic Rhinitis and its Impact on Asthma) classification: watery nasal discharge, sneezing, intermittent nasal obstruction, epiphora and itching. The ‘ARIA’ classification subdivides allergic rhinitis into ‘intermittent’ and ‘persistent’ and on the basis of severity of illness and its impact on daily activities into ‘mild’ and ‘moderate/severe’. Currently, the percutaneous skin prick test or skin allergy test is considered the gold standard for the diagnosis of allergic rhinitis. Skin allergy test determines if a patient’s symptoms are caused by immediate hypersensitivity to allergens. Each allergen tested induces specific IgE that binds to mast cells. Mast cells on degranulation cause the localized skin response in a positive skin test. Polysensitivity indicates a positive response to 3 or more allergens tested. OBJECTIVE: The aim of this retrospective study is to determine if there is any correlation between the severity of allergic rhinitis (as determined by standard ARIA criteria) and polysensitisation (as determined by the result of skin allergy testing) among adult patients diagnosed with allergic rhinitis who were evaluated at our Rhinology clinic. MATERIALS AND METHODS: Hospital records of all patients of age 18 and older, with a clinical diagnosis of allergic rhinitis were included in the study sample. Grading of severity of allergic rhinitis was done in accordance with the ARIA criteria. Other information regarding demography, exacerbating factors for allergic rhinitis, food allergy, family history of allergy and history of specific allergies was also be collected. The reactivity to each allergen that was part of the ‘common allergen panel’ and additional allergens tested as per patient requests will be tabulated in an excel spreadsheet. A diameter of more 3mm or more was considered a ‘positive’ response for each allergen tested. The data collected was used to correlate the number of patients that are polysensitive (i.e those that test positive for 2 or more allergens) and the severity of their illness. RESULTS: A total of 320 patients were recruited to the study. The majority (223 patients, 69.6%) of those with allergic rhinitis were less than 35 years of age. There were 200 (62.5%) males and 120 (37.5%) females. A total of 190 of the 320 patients (59.4%) resided in an urban locality while 130 (40.6%) resided in a rural area. A little over ¾ of patients (76.8%; 246 patients) complained of nasal block, 83.4% of rhinorrhoea and 274 (85.6%) of sneezing. A positive family history was reported by only 25.3% of patients with allergic rhinitis. The maximum triggers for allergy occurred indoors at home or at work in 65.7%. The vast majority (89%) of patients were symptomatic at the beginning of the day. All patients reported seasonal exacerbation of allergic symptoms with varying intensities, with maximum (39.4%) in winter/rainy season. Household chemicals as their trigger for allergic rhinitis in 49%. The most common inhaled allergens for which patients tested positive were dust mites, D.pteronyssinus and D.farinae. House dust (29.4%) and cockroach (23.8%) were the next most common allergens, indicating a greater preponderance of indoor allergen triggers. The commonest food allergen was lemon (35.3%). Bronchial asthma and allergic dermatitis were seen in 46 (14.4%) and 49 (15.3%) of the 320 patients respectively. A combination of both bronchial asthma and dermatitis was seen in 7 individuals. ❖ A total of 182 patients (56.9%) had intermittent symptoms and 138 (43.1%) of them had persistent symptoms. Mild disease was reported in 152 patients (47.5%) while168 patients; 52.5%) had moderate-severe disease. In this cohort, more patients (188 patients, 58.8%) were polysensitive than monosensitive (132 patients, 41.2%). A comparison of patients with monosensitisation with those with polysensitisation in terms of 6 clinical parameters revealed that the presence of nasal block, seasonal exacerbation and greater severity of disease was more frequently observed in polysensitive individuals on univariate analysis. Multivariate analysis of risk factors, however, showed that only nasal block (p=0.04) and moderate-severe allergic rhinitis (p=0.000) were associated with polysensitisation. Thus, a patient with nasal block was 1.8 times more likely to be polysensitive than monosensitive. Similarly, a patient with moderate/severe allergic rhinitis was 3.7 times more likely to be polysensitive than monosensitive. CONCLUSIONS: Allergic rhinitis is a common problem in India affecting young adults and is chiefly associated with indoor allergens. Polysensitisation is associated with increased severity of the disease. These findings have important implications in clinical practice.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221914358 |
| Uncontrolled Keywords: | Allergic Rhinitis, Sensitization, ARIA, Skin allergy test, Polysensitivity. |
| Subjects: | MEDICAL > Otolaryngology > MEDICAL > Otolaryngology |
| Depositing User: | Subramani R |
| Date Deposited: | 27 Jun 2021 03:09 |
| Last Modified: | 17 Dec 2023 14:59 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/17833 |
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