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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 13-21

Prevalence of allergic rhinitis among students in the age group of 16-20 years in a South Indian City


Department of Respiratory Medicine, AJ Institute of Medical Sciences and Research Center, Mangalore, Karnataka, India

Date of Submission11-Apr-2021
Date of Decision12-Jun-2021
Date of Acceptance30-Jun-2021
Date of Web Publication17-Jan-2022

Correspondence Address:
Dr. Vishnu Sharma Moleyar
Department of Respiratory Medicine, AJ Institute of Medical Sciences and Research Center, Kuntikana, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jalh.jalh_8_21

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  Abstract 


Introduction: Allergic Rhinitis (AR) is often viewed as a trivial disease but it can significantly affect the quality of life by causing fatigue, headache, sleep disturbances, cognitive impairment. According to World Health Organization (WHO) report (2007), the global burden of allergic rhinitis was estimated to be 400 million, and the prevalence among adults ranges between 10% and 32% in the Asia Pacific region. The prevalence of allergic rhinitis and other allergic diseases has increased globally in the last three decades. Despite the high burden, there is a paucity of community-based studies in India, determining the burden of allergic rhinitis. Hence we undertook this study to determine the prevalence of allergic rhinitis among students (16-20 Years) of age. Materials and Methods: Students of age group 16-20 years of age, both Girls and boys in and around Mangaluru city, Dakshina Kannada district were included in the study. This was a questionnaire based cross sectional study. A standardized questionnaire (adopted from ISAAC) was prepared and was administered to students of 12 different colleges. The sample size was calculated after carefully analyzing previous Indian studies on the prevalence of allergic rhinitis. Considering an 8% prevalence rate and a 10% allowable error, sample size was estimated as N= 4600. Purposive sampling, among students of various colleges in Mangaluru city was done. The diagnosis of allergic rhinitis was done clinically as per ARIA guidelines. Students were interviewed in their class room for one hour. First the study objectives and the questionnaire was explained to the students. Then each student was given the questionnaire to fill. Informed consent was taken from each student. The statistical analysis was performed by Frequency and percentage method to calculate the prevalence. Chi-square test, odds ratio (OR), and 95% confidence interval (95%CI) were used to measure the association between the variables, and a p-value of <0.05 was considered to be significant. Results: In our study group, the age distribution was from 16-20 years. 961(20.8%) students were 16 years of age, 1196(26.0%) students were 17 years of age, 905(19.7) were 18years of age, 697(15.2%) 19 years of age & 841(18.3%) students were 20 years of age. The prevalence of allergic rhinitis among students (16-20) years of age was 11.9%. The prevalence was higher among girls (12.0%) compared to boys (11.7%). The prevalence of allergic rhinitis was more among students of 20 years of age. The prevalence of allergic rhinitis was more in girls (12.0%) compared to boys (11.7%). Smokers were found to be 2.6 times more prone to develop eczema. Statistically significant correlation between bronchial asthma with allergic rhinitis and eczema was found. Incidence of allergic rhinitis among asthma patients was 5.7times more compared to normal subjects. A significant association of asthma was observed with the incidence of eczema. Incidence of asthma among the people who have a family history of asthma was 7.08 times more compared to other population. Incidence of allergic rhinitis among the people who had a family history of asthma was 2.63 times compared to other population. Incidence of eczema among the people who have a family history of asthma is 11 times compared to other population. Conclusions: The prevalence of allergic rhinitis among students (16-20) years of age was 11.9%. The prevalence was slightly higher among girls (12.0%) compared to boys (11.7%).

Keywords: Allergic rhinitis prevalence, South Indian city, students


How to cite this article:
Sheik IA, Moleyar VS. Prevalence of allergic rhinitis among students in the age group of 16-20 years in a South Indian City. J Adv Lung Health 2022;2:13-21

How to cite this URL:
Sheik IA, Moleyar VS. Prevalence of allergic rhinitis among students in the age group of 16-20 years in a South Indian City. J Adv Lung Health [serial online] 2022 [cited 2022 May 16];2:13-21. Available from: http://www.jalh.com/text.asp?2022/2/1/13/335928




  Introduction Top


Symptoms of allergic rhinitis (AR) are rhinorrhea, recurrent sneezing, itching of the nose, nasal congestion, and/or postnasal discharge.[1] AR if not treated properly can lead to recurrent sinusitis, headache, sleep disturbances, cognitive impairment, and reduced quality of life.[2] As per World Health Organization (2007) estimation, the global burden of AR was 400 million.[3] The prevalence of AR in the Asia Pacific region among adults' is 10% to 32%.[4] In the last three decades' prevalence of AR and other allergic diseases has increased globally.

AR and asthma often coexist. Various studies have shown that up to 28% to 78% of patients with asthma have symptoms of AR. This is high when compared to the general population, where AR occurs in up to 20%.[5] Up to 19% to 38% of patients with AR may have coexistent asthma, which is much more than the 3% to 5% prevalence of asthma among the general population.[5] In the majority of patients, AR precedes the onset of asthma by a few months or few years. According to some studies, 25%–43% of the patients diagnosed with rhinitis develop asthma within the next 10 years.[5],[6] AR is one of the most important risk factors for asthma exacerbation. AR and asthma often have common triggers.

Most of the allergic diseases like asthma and AR start during the first three decades of life. Early diagnosis and treatment of AR will prevent the development of asthma, improve the long-term disease control. There is a paucity of community-based studies in India, especially in teenagers. Knowing the burden of AR will help to institute preventive measures to decrease the burden of the disease and screening for the disease if the prevalence is high.

Objectives of the study

To study the prevalence of AR among students 16–20 years of age.


  Methodology Top


Source of data

Students of the age group 16–20 years of age, including Girls and boys in and around Mangaluru city, Dakshina Kannada district. The study was approved by the institutional ethics committee.

Method of collection

This was a questionnaire-based study. A standardized questionnaire (adopted from ISAAC)[7] was prepared and administered to students of 12 different colleges [Table 1] of age group 16–20 years (Questionnaire in supplementary file).
Table 1: Name of colleges included in the study

Click here to view


Period time

November 2014–October 2015.

Study design

Cross-sectional study.

The sample size was calculated after carefully analyzing previous Indian studies on the prevalence of AR. Considering an 8% prevalence rate and a 10% allowable error sample size was estimated as N = 4600.

Inclusion criteria

College students of age group 16–20 years of age, including girls and boys.

Exclusion criteria

  1. Students with a history of unilateral nasal blockade, epistaxis, purulent nasal discharge
  2. Students diagnosed with systemic illnesses like collagen vascular diseases and autoimmune disorders.


Sampling technique

Purposive sampling, among various colleges of Mangaluru city. The diagnosis of AR was done clinically as per ARIA guidelines,[2] if the student has symptoms such as running nose, blocked nose, and recurrent sneezing or throat clearing ever or within the last 12 months (>2 symptoms).

A standardized questionnaire in English (adopted from ISAAC)[7] was prepared and administered to students of 12 different colleges of age group 16–20 years. The questionnaire was validated with a pilot study. A list of all colleges in and around 5 kilometers of Mangalore city was prepared and representative sample was taken with the following colleges. All types of colleges were included-Arts and Science, Agriculture, Medical and Engineering colleges. Colleges were selected by purposive sampling technique. Following colleges were selected for the study.

  1. Laxmi Memorial College of Nursing, Mangaluru
  2. Laxmi Memorial College of Physiotherapy, Mangaluru
  3. Vikas P. U College Mary hill, Mangaluru
  4. Padua P. U College, Nanthur, Mangaluru
  5. Govinda Dasa P. U College, Surathkal. Dakshina Kannada
  6. Govinda Dasa Degree College. Surathkal
  7. Canara P. U College, Mangaluru
  8. Govt. Polytechnic College for Women, Bondel, Mangaluru
  9. Govt. I. T. I college for Women, Mangaluru
  10. Vijaya P. U College, Mulki, Dakshina Kannada Dist
  11. Vijaya Degree College, Mulki, Dakshina Kannada Dist
  12. A. J. Institute of Medical Sciences, Kuntikana, Mangaluru.


Heads of the institution were met personally and a written request was given. Permission was obtained. Then a particular date was fixed by the head of the institution and the college was visited on that day. Students were interviewed in their classroom for 1 h. First, the study objectives and the questionnaire were explained to the students. Then each student was given the questionnaire to fill. Informed consent was taken from each student. They were asked to clarify doubts if any during the process. All students who were present on the day were included in the student. None of the students declined to participate. Incomplete forms and students who met the exclusion criteria were excluded from the study. Each college was visited only once. Colleges were as follows.

The sample size was 4600.

Statistical methods

The statistical analysis was performed by frequency and percentage method to calculate the prevalence. Chi-square test, odds ratio, and 95% confidence interval 95% were used to measure the association between the variables, and a P < 0.05 was considered to be significant.


  Results Top


In our study group, the age distribution was from 16 to 20 years. Nine hundred and sixty-one (20.8%) students were 16 years of age, 1196 (26.0%) students were 17 years of age, 905 (19.7) were 18 years of age, 697 (15.2%) 19 years of age and 841 (18.3%) students were 20 years of age [Table 2]. Out of 4600 students, 112 (2.4%) students had a history of smoking cigarettes or beedis, more among boys (99.1%) compared to girls (0.8%). Out of 4600 students, only 31 (0.7%) students have a history of chewing one or other forms of tobacco products, all were boys (100%). Out of 4600 students, 34 (0.7%) students have a history of consumption of alcohol in their lifetime, more among boys (76.47%) compared to girls (23.52%). There was no association found between the prevalence of AR and habits like smoking, tobacco chewing, and alcohol consumption.
Table 2: Demographic characteristics of study population

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In our study population 548 (11.9%) students had symptoms like sneezing, rhinorrhea, a nose blockade which is suggestive of AR. Among students who had symptoms suggestive of AR. 88 (16.1%) of them were 16 years of age, 120 (21.9%) of 17 years of age, 100 (18.2%) of 18 years of age, 74 (13.5%) of 19 years of age and 166 (30.3%) belongs to 20 years of age. The prevalence of AR was more among students of 20 years of age. The prevalence of AR was more in girls (12.0%) compared to boys (11.7%) [Table 3].
Table 3: Prevalence of age and gender in bronchial asthma, allergic rhinitis and eczema

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[Table 4] shows the correlation between smoking and incidence of eczema. Out of 112 smoking subjects, 5 (4.5%) had eczema in comparison to 4488 subjects who were not smoking, only 77 (1.7%) had eczema. However positive correlation was found between the history of smoking and symptoms suggestive of eczema and smokers are 2.6 times more prone to develop eczema.
Table 4: Correlation between history of eczema and smoking

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[Table 5] shows a statistically significant correlation between bronchial asthma with AR and eczema. In 4600 study population, 230 had symptoms of bronchial asthma and in them, 92 (40%) patients had AR.4370 subjects didn't have symptoms of asthma and in them, 456 (10.4%) had AR. Association of AR with asthma shows a statistically significant result and the risk of incidence of AR among asthma patients is 5.7 times more compared to normal subjects. A significant association of asthma was observed with the incidence of eczema.
Table 5: Correlation between bronchial asthma with allergic rhinitis and eczema

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In the 4600 study population, 336 had a family history of bronchial asthma, 4264 did not have a family history of bronchial asthma and 230 subjects had symptoms of asthma. Out of this 230 asthma patients, 72 (21.4%) had a family history of asthma and 158 (3.7%) did not have a family history of asthma and this correlation shows the statistical significance and the risk of incidence of asthma among the people who have a family history of asthma is 7.08 times compared to other population. Out of 548 AR patients, 82 (24.4%) had a family history of asthma and 466 (10.9%) did not have a family history of asthma and this correlation shows the statistical significance and the risk of incidence of AR among the people who have a family history of asthma is 2.63 times compared to other population. Out of 82 eczema patients, 36 (10.7%) had a family history of asthma and 46 (1.1%) didn't have a family history of asthma and this correlation shows the statistical significance and the risk of incidence of eczema among the people who have a family history of asthma is 11 times compared to other population [Table 6].
Table 6: Correlation between family history of asthma and prevalence of asthma, allergic rhinitis, eczema

Click here to view


About 24.4% of students having a family history of asthma had symptoms suggestive of AR and 15% of AR students were having a history of bronchial asthma among their family members. This was found to be statistically significant.


  Discussion Top


AR usually starts within the first 3 decades of life. It is common in the age group of 16–20 years. It increases the risk of developing asthma. Early diagnosis and proper management of AR may reduce the incidence of asthma in these patients.

One study based on the ISAAC questionnaire was done on the university population aged 17–53 years' study by Uthaisangsook among the university population of Phitsanulok, Thailand.[8] The prevalence of AR in this study was 57.4%. Oladeji et al.[9] carried out a similar study among university students in a tertiary institution in Nigeria reported AR prevalence of 35.1%. These two studies reported very high incidence, compared to our study which showed an incidence of 11.9%. The high incidence in these studies as compared to our study may be due to differences in the age group of the study population, different geographical regions, genetic variability, and study design. Another study done by Mohammadzadeh et al.[10] using ISAAC questionnaire among students of age group 13–14 years, reported AR prevalence of 17.7% in Hamadan city of Iran. The findings in this study are similar to our study.

A study done by Kumar et al.[11] among school girls in Delhi reported AR prevalence of 21.27%, In contrast to it, another study was done by Gaur et al.[12] among school children of Delhi aged between 5 and 18 years of age reported AR prevalence of 7.3%. This difference among the prevalence of AR among students of Delhi may be due to the gender distribution of the study population. A study done by Kumar et al. was only among school girls. This difference in the prevalence of AR compared to our study may be due to a difference in the study population, geographical variability, differences in genetic composition, industrialization, and air pollution in Delhi.

However, in our study, there was a slight increase in the prevalence of AR among girls (12.0%) compared to boys (11. 7%). Further large-scale studies are required to compare the prevalence of AR among boys and girls, as in our study the number of girls was more than the boys. No similar studies were done in the Dakshina Kannada district.

The prevalence of AR was higher in students of 20 years of age compared to the lower age group in our study. Continued exposure to allergens over a long period may increase the incidence of AR. This may be the reason for the higher prevalence of AR in the age group of 20 years. However further studies are needed to prove whether the incidence of AR increases with age in the second and third decades of life.

There was no association found between the prevalence of AR and habits like smoking, alcohol consumption, and tobacco chewing. Tobacco use and alcohol consumption have no direct effect on allergic diseases and hence does not increase the prevalence of AR.

A study done by poddighe et al.[13] among European countries concluded that the prevalence of AR closely follows bronchial asthma but may be higher up to three times. In our study, the prevalence of AR is 2.3 times is that of bronchial asthma.

In our study, there was a positive correlation between the students who had a family history of asthma, AR, and eczema. 24.4% of students having a family history of asthma had symptoms suggestive of AR. Fifteen percent of AR students had a history of bronchial asthma among one or more of their family members and 11% of students with eczema had a history of bronchial asthma among their family members which are similar to a study done by Alsowaidi et al.[14] among students of the United Arab Emirates. Heritability in Asthma varies between 35% to 95% and for AR 33% to 91% in various studies and 84% for eczema.[15]

However, positive correlation was found between the history of smoking and symptoms suggestive of eczema and smokers are 2.6 times more prone to develop eczema. A study by Kantor et al. showed both active and passive smoking are associated with an increased prevalence of eczema.[16]

Eczema, asthma, and AR are the three common atopic disorders which often co exist.[17] Eczema is part of the atopic march, a progression from eczema to AR and asthma is not uncommon, more so in children and young adults.[18] Hence any patient with any of the allergic manifestations should be evaluated for other allergic disorders by a proper history and relevant investigations. Early diagnosis, avoidance of allergens, and proper treatment of atopic dermatitis and AR may prevent the development of asthma and may halt or reverse the progression of atopic march.


  Conclusions Top


The prevalence of AR among students (16–20) years of age was 11.9%. The prevalence was higher among girls (12.0%) compared to boys (11.7%).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Questionnaire

Demography

  1. Name
  2. Age
  3. Place (native)
  4. Sex A. Male B. Female
  5. College
  6. Class
  7. Height weight
  8. Do you smoke: (yes/no). No of cigarettes/beedis per day: years
  9. Do you chew tobacco; (yes/no)
  10. Do you consume alcohol: (yes/no).


Questionnaire on rhinitis

1. Did you ever had a problem with sneezing or a runny or blocked nose, when you DID NOT had a cold or the flu?



2. In the past 12 months did you had a problem with sneezing or a runny or blocked nose when you DID NOT had a cold or flu?



3. In which of the past 12 months has this nose problem occurred?

(Please tick any which apply)



4. Do you have ear itching/blocked ear/pain in the ear when you had the nose problem?



5. Do you need to clear your throat often?



Questionnaire on eczema

1. Did you ever had any itchy rash which was coming and going for at least six months?



2. Did you had this itchy rash at any time in the last 12 months?



3. Has this itchy rash at any time affected any of the following places: the folds of the elbows, behind the knees, in front of the angles under the buttock or around the neck Eyes or ears?



4. Has this rash cleared completely at any time during the last 12 months?




  Respiratory questions Top


Cough and phlegm

1. In the last 12 months, have you ever felt like congestion in the chest or coughed up phlegm (mucus) with colds?



2. In the last 12 months have you ever felt like congestion in the chest or coughed up phlegm (mucus) when you did not have a cold?



3. Have you ever felt like congestion in the chest or cough up phlegm (mucus) on most days (4 or more days a week) for as much as 3 months of the year?



4. In the last 12 months did your chest sounded wheezy during or after exercise?



5. In the last 12 months did your chest sounded wheezy when you had not recently exercised?



6. In the last 12 months did you had wheezing or whistling in the chest when you had a cold or the flu?



7. In the last 12 months, did you had wheezing or whistling in the chest when you did not had cold or the flu?



8. Have you ever woken up with tightness of the chest at any time in your life?



9. Have you woken up at night with tightness of the chest in the last 12 months?



10. In the last 12 months did your chest sounded wheezy during or after exercise?



11. Did you ever felt like difficulty in breathing/tightness of chest after exposure to dust?



12. Did you ever had a dry cough at night apart from a cough associated with a cold or chest infection?



13. Did you ever had an asthma attack?



14. If yes, do you take any regular asthma medications (yes/no)

15. Which medications - oral medications/inhalational medications (DPI/MDI)

16. Does the symptoms gets subsided after medications



17. Does any of your family members have asthma/known allergic conditions



Specify: (How you are related to them)



 
  References Top

1.
International Consensus Report on the diagnosis and management of rhinitis. International Rhinitis Management Working Group. Allergy 1994;49:1-34. PMID: 8080072.  Back to cited text no. 1
    
2.
Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA (2) LEN and AllerGen). Allergy 2008;63 Suppl 86:8-160.  Back to cited text no. 2
    
3.
World Health Organization. Global Surveillance, Prevention, and Control of Chronic Respiratory Diseases: A Comprehensive Approach; 2007. Available from: http://www.who.int/gard/publications/GARD%20Book%202007.pdf. [Last accessed on 2013 Mar 03].  Back to cited text no. 3
    
4.
Pawankar R, Baena-Cagnani CE, Bousquet J, Canonica GW, Cruz AA, Kaliner MA, et al. State of world allergy report 2008: Allergy and chronic respiratory diseases. World Allergy Organ J 2008;1:S4-17.  Back to cited text no. 4
    
5.
Jianu E, Ulmeanu R. Links between allergic rhinitis and asthma. Roman J Rhinol 2013;3:???.  Back to cited text no. 5
    
6.
Corren J. Allergic rhinitis and asthma: How important is the link? J Allergy Clin Immunol 1997;99:S781-6.  Back to cited text no. 6
    
7.
The International Study of Asthma and Allergies in Childhood. Available from: https://isaac.auckland.ac.nz. [Last accessed on 2021 Jun 12].  Back to cited text no. 7
    
8.
Uthaisangsook S. Prevalence of asthma, rhinitis, and eczema in the university population of Phitsanulok, Thailand. Asian Pac J Allergy Immunol 2007;25:127-32.  Back to cited text no. 8
    
9.
Oladeji S, Nwawolo C, Adewole O. Allergic rhinitis among adult bronchial asthmatic patients in lagos, Nigeria. J West Afr Coll Surg 2013;3:1-4.  Back to cited text no. 9
    
10.
Mohammadzadeh I, Barari-Savadkoohi R, Alizadeh-Navaei R. The prevalence of allergic rhinitis in Iranian children: A systematic review and descriptive meta-analysis. J Pediatr Rev 2013;1:19-24.  Back to cited text no. 10
    
11.
Chhabra SK, Gupta CK, Chhabra P, Rajpal S. Prevalence of bronchial asthma in schoolchildren in Delhi. J Asthma. 1998;35:291-6. doi: 10.3109/02770909809068220. PMID: 9661682.  Back to cited text no. 11
    
12.
Gaur SN, Gupta K, Rajpal S, Singh AB, Rohatgi A. Prevalence of bronchial asthma and allergic rhinitis among urban and rural adult population of Delhi. Indian J Allergy Asthma Immunol 2006;20:90-7.  Back to cited text no. 12
    
13.
Poddighe D, Gelardi M, Licari A, Del Giudice MM, Marseglia GL. Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management. World J Methodol 2016;6:200-13.  Back to cited text no. 13
    
14.
Alsowaidi S, Abdulle A, Bernsen R, Zuberbier T. Allergic rhinitis and asthma: A large cross-sectional study in the United Arab Emirates. Int Arch Allergy Immunol 2010;153:274-9.  Back to cited text no. 14
    
15.
Ober C, Yao TC. The genetics of asthma and allergic disease: A 21st century perspective. Immunol Rev 2011;242:10-30.  Back to cited text no. 15
    
16.
Kantor R, Kim A, Thyssen JP, Silverberg JI. Association of atopic dermatitis with smoking: A systematic review and meta-analysis. JAAD 2016;75:1119-25.e1.  Back to cited text no. 16
    
17.
Pol DH, Wartna JB, Van Alphen EI, Moed H, Rasenberg N, Bindels PJ, et al. Interrelationships between atopic disorders in children: A meta-analysis based on ISAAC questionnaires. PLoS One 2015;10:e0131869.  Back to cited text no. 17
    
18.
Zheng T, Yu J, Oh MH, Zhu Z. The atopic march: Progression from atopic dermatitis to allergic rhinitis and asthma. Allergy Asthma Immunol Res 2011;3:67-73.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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