Allergic rhinitis : present perspective

One hundred patients of allergic rhinitis were diagnosed and treated during the period of January 2006 to December 2006. The patients belonged to different age group. Among them patients from 20 – 29 year of age group are commonly affected (43%). Female (33%) are more sufferer than male. In our study most of the patients are student (38%). House dusts mites (73%), and cold (48%), are the common etiological factors. Majority of the patients presented with sneezing (91%). we got 19% patients with co-morbid allergic conjunctivitis and sinusitis. Patients were treated with more than one drug, mainly with oral antihistamine (91%), nasal steroid (32%) and other medications. In this study, we concluded that oral antihistamine and nasal corticosteroids are the good options to treat allergic rhinitis.


Introduction:
Allergic rhinitis is an IgE mediated immunological response of nasal mucosa to allergens and is characterized by sneezing, watery nasal discharge, nasal obstruction and itching in the nose 1 .Two clinical types have been recognized, seasonal and perennial.
Allergic rhinitis is a global health problem and is increasing in prevalence.The pathophysiology of allergic rhinitis is complex, involving cells, mediators, cytokines, chemokines, and adhesion molecules which co-operate in a complex network to produce the specific symptoms of allergic rhinitis and the non specific hyperactivity.The reaction can be considered in four phases: Sensitization, Subsequent reaction to allergen early phase, Late phase reaction and Systemic activation 2 .
Allergen produce specific IgE antibody in the genetically predisposed individuals 3 .These antibodies become fixed to the mast cells or basophils by its Fc end.On subsequent exposure, antigen combines with IgE antibody.This reaction produces degrenulation of mast cells with release of chemical mediators.The late phase immune response occurring in approximately half of exposed patients, involves the ingress of .eosinophils, basophils, mast cells, T lymphocytes, neutrophils, and macrophage into local tissues, all of which contribute to the inflammatory response which present as nasal obstruction and hyperactivity 4 .

Materials & Methods:
1. Type of study : Prospective study The international study of asthma and allergies in childhood (ISAAC) noted the prevalence of rhinitis with itchy watery eye in six to seven years old as 0.8 to 14.9 percent and 13 -14 years old from 1.4 to 39.7 percent in different countries throughout the world 5-9 .
In our study, prevalence of allergic rhinitis among age group below 9 years was two percent and in the second decade was 24%, which is correlated with above studies.But in our study the people of 20-29 years age group are most commonly affected (43%).
In our study students are most commonly affected (38%), there is occupation which has more predilection for allergic rhinitis.Housewives are also affected in a good number of cases (30%).Then less commonly affected professions are service holder (23%), businessman (4%), garment worker (3%) and others (4%).
House dust mite (73%) is the commonest etiological factor of AR in our study then the next common etiology of AR is cold (48%).
There are some co-morbid conditions associated with AR 15 .From our study we have seen that conjunctivitis (29%) is the common co-morbid condition and sinusitis (21%) is of the second in percentage.Other co-morbid conditions are bronchial asthma (17%) and nasal polyp (2%).Allergic rhinitis and asthma are linked by epidemiological and pathophysiological characteristics and by a common therapeutic approach.AR is the risk factor for the development of subsequent asthma but in our study only 17% cases had co-morbid asthma, which is correlated with other studies.Allergic rhinitis and asthma are considered as same airway same disease [16][17] .
We establish our diagnosis by history, clinical examination, and investigation.We have done serum IgE, and circulating eosinophil count.
In majority of patients' serum IgE, and circulating eosinophil count were high.X-ray Paranasal sinus was done in some cases to exclude sinusitis, but was normal in 60% patients.
In our study we prescribed different groups of drug such as oral antihistamine, nasal steroids, oral decongestants, nasal drops and anti-leukotrines.In this series combination of drugs is used, oral antihistamine (91%), nasal steroid (32%), oral decongestant (27%), nasal drop (24%), and anti-leukotrienes in 5% cases.Due to lack of facilities we did not advise any of our patients to have immunotherapy.
In conclusion, we observed that oral antihistamine in mild to moderate seasonal cases and nasal steroid spray in severe and perennial cases are very effective.Early diagnosis and proper treatment help reduce cost, suffering, complications and school or work absence.

Table - V
Distribution of co-morbidities