Prevalence allergic rhinitis and its diagnosis with therapeutic considerations

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,
  • sneezing,
  • 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:

  1. interrogation of nasal symptoms,
  2. 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

Country Diagnosis
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:

  • leukotriene,
  • 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

Country Therapeutic Consideration
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.

References

  • Australian Institute of Health and Welfare. (2011). Allergic rhinitis (’hay fever’) in Australia. Australia: Australian Institute of health and Welfare.
  • Bauchau, V., & Durham, S. R. (2004). Prevalence and rate of diagnosis of allergic rhinitis in Europe. ERS Journals, 24. doi:10.1183/09031936.04.00013904
  • Bousquet, J., Dahl, R., & Khaltaev, N. (2007). Global Alliance against Chronic Respiratory Diseases. Allergy, 62(3), 216–223. doi:10.1111/j.1398-9995.2007.01307.x
  • Bousquet, J., Van Cauwenberge, P., Bond, C., Bousquet, H., Canonica, G. W., Howarth, P., … Wright, A. (2003). MANAGEMENT OF ALLERGIC RHINITIS SYMPTOMS IN THE PHARMACY POCKET GUIDE ALLERGIC RHINITIS AND ITS IMPACT ON ASTHMA A Pocket Guide for Pharmacists. (A Pocket Guide for Pharmacists, Ed.).
  • Dykewicz, M., Fineman, S., Skoner, D., Nicklas, R., Lee, R., & Blessing-Moore, J. (1998). Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol, 81(2), 478–518.
  • Gupta, R., Sheikh, A., Strachan, D. P., & Anderson, H. R. (2004). Burden of allergic disease in the UK: secondary analyses of national databases. Clinical <html_ent Glyph=“@amp;” Ascii=“&amp;”/> Experimental Allergy, 34(4), 520–526. doi:10.1111/j.1365-2222.2004.1935.x
  • Isalkar, U. (2016, April). Allergic rhinitis affects 30% population in India: Experts. The Times of India, p. 1. Pune.
  • Juniper, E. F., Guyatt, G. H., & Dolovich, J. (1994). Assessment of quality of life in adolescents with allergic rhinoconjunctivitis: development and testing of a questionnaire for clinical trials. The Journal of Allergy and Clinical Immunology, 93(2), 413–23.
  • Kay, G. (2000). The effects of antihistamines on cognition and performance. J Allergy Clin Immunol, 105, 622–S627.
  • Kushnir, N. M. (2011). The Role of Decongestants, Cromolyn, Guafenesin, Saline Washes, Capsaicin, Leukotriene Antagonists, and Other Treatments on Rhinitis. Immunology and Allergy Clinics of North America, 31(3), 601–617. doi:10.1016/j.iac.2011.05.008
  • Masanari, W., Jun, K., Hiroyuki, S., & Saeko, T. (2016). Prevalence of allergic rhinitis based on the SACRA questionnaire among Japanese nursing professionals with asthma. Japan.
  • Nathan, R., MELTZER, E., SEINER, J., STORMS, W., Kaliner, M., Eggleston, P. A., … Al., E. (1997). Prevalence of allergic rhinitis in the United States. Journal of Allergy and Clinical Immunology, 99(6), S808–S814. doi:10.1016/S0091-6749(97)80040-1
  • Ozdoganoglu, T., & Songu, M. (2012). The burden of allergic rhinitis and asthma. Therapeutic Advances in Respiratory Disease, 6(1), 11–23. doi:10.1177/1753465811431975
  • Pefura-Yone, E. W., Kengne, A. P., Balkissou, A. D., Boulleys-Nana, J. R., Efe-de-Melingui, N. R., Ndjeutcheu-Moualeu, P. I., … Research Group for Respiratory Disease in Cameroon (RGRDC), R. G. for R. D. in C. (2015). Prevalence of asthma and allergic rhinitis among adults in Yaounde, Cameroon. PloS One, 10(4), e0123099. doi:10.1371/journal.pone.0123099
  • Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., … Guideline Otolaryngology Development Group. AAO-HNSF. (2015). Clinical practice guideline: Allergic rhinitis. Otolaryngology–Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 152(1 Suppl), S1–43. doi:10.1177/0194599814561600
  • Sim Park, H., Soon Choi, G., Sang Cho, J., & Kim, Y.-Y. (2009). Epidemiology and Current Status of Allergic Rhinitis, Asthma, and Associated Allergic Diseases in Korea: ARIA Asia-Pacific Workshop Report. ASIAN PACIFIC JOURNAL OF ALLERGY AND IMMUNOLOGY, 27, 167–171.
  • Small, P., Kim, H., Small, P., Frenkiel, S., Becker, A., Boisvert, P., … Caruso, C. (2011). Allergic rhinitis. Allergy, Asthma & Clinical Immunology, 7(Suppl 1), S3. doi:10.1186/1710-1492-7-S1-S3
  • Wallace, D. V., & Dykewicz, M. S. (2008). The diagnosis and management of rhinitis: An updated practice parameter. J Allergy Clin Immunol, (122), 1–84.
  • William, F., Leon, D., Sireesh, A., & Marc, F. (2004). Economic Impact and Quality-of-Life Burden of Allergic Rhinitis. Medscape.

Anamika

Research analyst at Project Guru
Anamika is Master’s in Pharmacy. She has worked as an Assistant Professor in Pt. B.D. Sharma University and is a published research scholar. She has worked on severalProjects like Anti-Ulcer Drugs, Sustained Release Formulations, Floating Tablet Formulations. Herinterest lies in books, writing and she loves to travel and explore new places.

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