Allergic rhinitis is a group of symptoms leading to nasal congestion, itching and inflammation. The symptoms occur when the subject is allergic to dust, mite, pollen (Seidman et al., 2015). It is mediated by IgE antibodies and the mast cells. The prevalence of the disorder is continuously increasing and affecting 10 – 30% of the global population (Ozdoganoglu & Songu, 2012). The most common symptoms of this disorder are divided into physical and mental. Wherein physical symptoms include:
- nasal congestion,
- nasal itching,
- nasal stuffiness,
- excessive tearing
- and rhinnorhea (Small et al., 2011).
And mental symptoms include:
- feeling tired and miserable,
- depression and irritation (Björksten et al, 2008).
Prevalence of allergic rhinitis
The prevalence of allergic rhinitis has increased eventually over the years. It is estimated that 400 million people suffer from allergic rhinitis which affect 20% of adults and 40% of children in the US and UK (Bousquet et al., 2007; Gupta, Sheikh, Strachan, & Anderson, 2004). In the UK, lack of information was the major cause which lead to an average prevalence of 30% of the population (Bauchau & Durham, 2004). Further, it has been reported, that in the US, the symptoms of allergic rhinitis decreases after an age of 34 (Nathan et al., 1997).
In Africa, 20-30% of population is suffer from allergic rhinitis (Pefura-Yone et al., 2015) and in Australia it was 15% (Australian Institute of Health and Welfare., 2011). However, the most alarming results were found in Japan where an average of 60-80% adults and 10-15% of children suffer from the allergy. The most common cause of allergic rhinitis in Japan was found to be latex (Masanari, Jun, Hiroyuki, & Saeko, 2016; Sim Park, Soon Choi, Sang Cho, & Kim, 2009).
In India, the most common factor of allergic rhinitis are pollens of the grasses, weeds and trees. About 20%-30% of the population of India suffer from allergic rhinitis. Furthermore, there is a higher prevalence of 57% among the middle class population as they are exposed to stress and environmental pollution more than others (Isalkar, 2016).
Diagnosis of allergic rhinitis
The diagnosis of this allergy is based on:
- interrogation of nasal symptoms,
- severity of infection of nasal mucosa and is confirmed with percutaneous skin test or a serum specific IgE antibody test (Wallace & Dykewicz, 2008).
These two tests have been found to be most common in India, Australia, Africa, Japan, UK and US. However, other than these, the other less common tests include:
- nasal provocation test,
- nasal cytology (blown secretions, biopsy),
- nasolaryngoscopy and
- inter-dermal skin test.
Nasolaryngoscopy test examines nose, voicebox and upper respiratory tract. It is the most common test used in USA. However, since it is an expensive test it is not very common in other countries (Dykewicz et al., 1998).
Common diagnostic tests in different countries
|India||Skin Prick Testing, Nasal smear, Serum-specific IgE antibody test|
|USA||Skin Prick Testing, Serum-specific IgE antibody test, Nasal cytology, Intra dermal skin testing, nasolaryngoscopy|
|UK||Skin Prick Test, Nasal inspiratory flow test, Blood test, Nasal endoscopy|
|Australia||Skin Prick testing, Serum-specific IgE,|
|Africa||Skin prick tests, Intracutaneous test, Oral Challenge test|
|Japan||Skin Prick tests, Allergen specific IgE antibody test|
Therapeutic consideration for allergic rhinitis
The primary therapeutic consideration is to avoid the allergen which acts as a trigger and causes the allergy. The first line of drug are are antihistamines and corticosteroids (Jean Bousquet et al., 2003). Other drugs which have reflected in favourable efficacy include:
- receptor antagonists,
- chromones and
- topical and oral decongestants.
Furthermore, some of the studies have also reported the importance of sub-cutaneous and sub-lingual immunotherapy (Kay, 2000). It provides a long term control of symptoms without any side effects.
Considering the economics of therapeutics, the total cost for the treatment in allergic rhinitis in Japan was approx. $1.15 billion (William, Leon, Sireesh, & Marc, 2004). In USA, as of 2010 it was approximately 17.5 billion. In Australia, it doubled between 2001 ($107.8 million) to 2010 ($ 226.8 million) (Australian Institute of Health and Welfare., 2011). Furthermore considering its indirect and direct costs, treatment of allergic rhinitis can be expensive.
Therapeutic considerations for different countries
|India||Antihistamines (Fexofenadine, Levocetrizine), Botox, Decongestant, Rmatroban|
|USA||Oral and Topical Decongestants, Intranasal antihistamines, Oral Antihistamines, Oral LT agent, Omalizumab, Oral and Intranasal corticosteroid|
|UK||Oral Antihistamines, Antihistamines plus decongestants, Topical Antihistamines, Topical Corticosteroids, Anticholinergic, Decongestants|
|Australia||Corticosteroid Nasal Spray, Antihistamine Nasal Drop and Eye Drop, Decongestant nasal spray, Combination drug of Antihistamine and Decongestants|
|Africa||Antihistamine, Intra nasal corticosteroids, Allergen Avoidance, Leukotriene receptor Antagonists|
|Japan||Non-Sedating Antihistamines, Oral and Topical Decongestants, Intranasal Cromolyn, Oral Corticosteroid|
Need for low cost diagnostics and treatment
The prevalence of allergic rhinitis is increasing globally at a constant pace. World Health Organization (WHO) is expected to spread awareness regarding this condition especially about detection, prevention and treatment. The cost of the medications and diagnostic tools should be low so that developing countries are able to adopt the treatment methodologies. Further, additional therapies should be devised for unresponsive patients.
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