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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 57-60

The prevalence of allergic rhinitis and its complications: A survey from Al-Ahssa, Saudi Arabia


1 Department of Otolaryngeology, College of Medicine, Head and Neck Surgery, King Faisal University, Al-Ahssa, Saudi Arabia
2 Assistant Professor of Otolaryngology, Head and Neck Surgery, King Faisal University, Al-Ahssa, Saudi Arabia

Date of Web Publication2-Apr-2019

Correspondence Address:
Noor Nabil Albaloushi
King Faisal university
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JNSM.JNSM_46_18

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  Abstract 


Objectives: Allergic rhinitis (AR) is an inflammatory disorder induced by immunoglobulin E-mediated response after allergen exposure. It is the most common allergic disorder with a high burden on patients and society. The purpose of this study is to report the prevalence and severity of AR and its complications among the population of Al-Ahssa in the Eastern Province of Saudi Arabia. Materials and Methods: This study analyzed observational, descriptive, cross-sectional data. Our sample includes males and females from all age groups from Al-Ahssa, Saudi Arabia, in October 2017. Our sample size was 807 with a confidence level of 95% and a confidence interval of 3.45. Results: The study suggested that 48% of the samples were diagnosed with AR, 28% had symptoms suggestive of AR, and 24% did not have any symptoms. Results suggest a great association between AR, eczema, and asthma. About 53% of patients who live near a farm were diagnosed with AR and 28% of them had symptoms. This indicates an association between living near a farm and AR. In addition, there was a clear relationship between owning a pet and AR. In 44% of cases, recurrence occurred in winter. Eighty-one percent of patients either with AR or who have symptoms of AR are triggered when exposed to a certain stimulus. Sixty-four percent reported that symptoms are provoked by dust. The most common symptoms reported were nasal itching followed by sneezing. Fifty-seven percent of patients who have AR or symptoms of AR have severe disease. Seventy-five percent of them complain of sleep disturbance. Twenty-seven percent of patients reported 0 effect on life, 14% scored 5, and 14% scored 10 on the daily activity scale. Conclusion: We concluded that 76% of the samples were either diagnosed with AR or have symptoms suggestive of AR. These symptoms are mainly triggered by dust and are associated with living near farms.

Keywords: Al-Ahssa, allergic rhinitis, atopy, prevalence, Saudi Arabia


How to cite this article:
Albaloushi NN, Alyahya K. The prevalence of allergic rhinitis and its complications: A survey from Al-Ahssa, Saudi Arabia. J Nat Sci Med 2019;2:57-60

How to cite this URL:
Albaloushi NN, Alyahya K. The prevalence of allergic rhinitis and its complications: A survey from Al-Ahssa, Saudi Arabia. J Nat Sci Med [serial online] 2019 [cited 2019 Aug 21];2:57-60. Available from: http://www.jnsmonline.org/text.asp?2019/2/2/57/254480




  Introduction Top


Allergic rhinitis (AR) is an inflammatory disorder induced by immunoglobulin E (IgE)-mediated response after allergen exposure.[1] It is considered the most common allergic disorder with a high burden on patients and society worldwide.[2],[3] Studies show an increased incidence of AR in developing countries.[4],[5] It is estimated that approximately 600 million people worldwide have AR and 200 million of them suffer concomitant bronchial asthma.[4] Symptoms of AR may lead to impaired daily activities such as sleep, productivity, and quality of life.[6],[7] It is one of the disorders with high prevalence that usually goes undiagnosed.[8] A clinical diagnosis of AR is made when patients' history and physical examination are positive for an allergic cause and one or more of the following symptoms: nasal congestion, rhinorrhea, nose itchiness, or sneezing.[9] AR is classified by the AR Impact on Asthma (ARIA) guidelines according to the severity and duration of the disease.[10] It is classified into mild or moderate-to-severe groups according to the severity of symptoms. It is also classified into intermittent or persistent groups according to the duration of symptoms.[10] In patients with clinically identified AR, pharmacological agents could be used as a trial.[7] However, the standard investigation test used is IgE antibody test, in addition to a positive history of symptoms.[8] Other investigations include skin tests in order to identify the specific allergen.[9],[11] It has numerous complications and has a significant impact both mentally and physically. Therefore, it is important not only to detect, investigate, and treat AR but also to actively identify, prevent, and try to treat its complications.[12],[13]

Therefore, we designed this study to assess the prevalence and severity of AR and its complications among the population of Al-Ahssa in the Eastern Province of Saudi Arabia.


  Materials and Methods Top


This study analyzed observational, descriptive, cross-sectional data. Our sample included males and females from all age groups from Al-Ahssa, Saudi Arabia, in October 2017. Our sample size was 807 with a confidence level of 95% and a margin of error of 3.45%. We collected our data through an electronic questionnaire, which was distributed randomly among the population, using the simple random sampling method.

Variables

In the questionnaire, the age groups were divided within intervals of 5 years, below 15 years, and older than 55 years to demonstrate the prevalence of AR among different age groups. In addition, gender and residence were taken into consideration. We asked whether a specialist diagnosed the sample with AR or not. In addition, symptoms suggestive of AR were asked to determine patients who may have AR. Recurrence of symptoms and triggers were also explored. In addition, patients were asked whether they were diagnosed by a physician in the past with asthma and/or eczema. In addition, to classify according to the ARIA classification system, the questionnaire included the period of symptoms and their severity. Finally, a scale was given to the patients to assess the effect on life. It composed of a scale from 0 to 10, 0 being no effect on life and 10 being most effect of life.

Statistical analysis

The data were all analyzed using the IBM statistics SPSS version 22 (IBM Corp., Armonk, NY, USA). The crosstabs analysis was carried out based on the data collected that demonstrated the relationship of AR and other factors. In addition, other data such as age, gender, and residence were analyzed using frequency tables.

Ethical clearance

Ethical clearance was taken from the Ethical Committee of the College of Medicine, King Faisal University. All participants' information was treated with confidentiality. Participants' consent was taken at the beginning of the questionnaire.


  Results Top


The study sample consisted of 78.2% females and 21.8% males. Most individuals included in this study were from the age group of 21–25 years (21.3%). On the other hand, the least participants were either under 15 or above 55 (2.7% or 3.8%, respectively). According to nationality, 99.3% of the samples were Saudi and. 0.7% were of other nationalities. The study suggested that 48% of the samples were diagnosed with AR, 28% had symptoms suggestive of AR, and 24% did not have any symptoms. Cross tabulation of each group with several factors was done to find the factors that influence AR. According to male patients, 47% were diagnosed with AR and 29% experienced symptoms of AR. On the other hand, 48% and 27.5% of females were diagnosed and had symptoms of AR, respectively. The prevalence of AR, symptoms of AR, and having no symptoms within each age group is shown in [Figure 1]. Association with asthma and/or eczema showed 22% prevalence in patients diagnosed with AR, 15% in patients with symptoms suggestive of AR, and 12% prevalence in patients without any symptoms. About 19% of patients with AR, 11% of patients with AR symptoms, and 16% of patients with no symptoms had chronic diseases, which varied and showed no correlation with AR. In addition, 6% of patients with AR and 5% of patients with symptoms of AR are smokers. Moreover, 8% with AR and 11% with AR symptoms are passive smokers. On the other hand, 3% of patients with no symptoms are smokers while 7% of them are passive smokers. In addition, 46% of patients who have AR and 45% of patients with symptoms suggestive of AR had a consanguinity marriage. There was also no association between hours of sleep and the disease as a mean of 76% of the population sleeps <6 h, regardless of AR. Residence in either a city or a town had no effect on the development of the disease. In contrast, 53% of patients who live near a farm were diagnosed with AR and 28% of them had symptoms. In addition, 18% of patients had pets while 82% did not have pets. The prevalence of AR or its symptoms in pet owners was 73%. On the other hand, the prevalence of AR or its symptoms in patients who do not own pets was 85%. In 44% of cases, recurrence occurred in winter, followed by summer (41%), fall (11%), and spring (4%). Statistical analysis showed that 81% of patients either with AR or who have symptoms of AR are triggered when exposed to a certain stimulus. About 64% reported that symptoms are provoked by dust and 42% reported perfumes as their trigger [Figure 2]. The most common symptoms reported were nasal itching followed by sneezing, nasal block, nasal discharge, eye itching and epiphora, and hyposomnia. Moreover, the most common discharge consistency and color were watery (39%) followed by white discharge (31%). Fifty-seven percent of patients who have AR or symptoms of AR have severe disease. Seventy-five percent of the individuals who have severe disease complain of sleep disturbance, 47% have disturbance in daily activities, and 24% have decreased work or school performance. Daily activity scale to assess the effect on life has been given to the patients. Eighty-five percent of the patients reported back. Twenty-two percent of patients reported 0 effect on life, 13% scored 5, and 16% scored 10 on the daily activity scale. The rest 49% of the participants were distributed between the other values as seen in [Figure 3].
Figure 1: Prevalence of allergic rhinitis according to age

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Figure 2: Prevalence of allergic rhinitis triggers among patients affected with the disease

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Figure 3: Daily activity scale showing the effect of allergic rhinitis from 0 to 10, 0 being no effect and 10 being most effect

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  Discussion Top


AR has a high prevalence throughout the world, with a prevalence rate of 45%, and this represents a global health issue.[2] Regardless of the high prevalence rate, a high number of patients remain undiagnosed.[3] In a study done in Western Europe, it was found that an estimate of 45% of their participants were undiagnosed.[3] In our current study, 28% of participants were undiagnosed with positive symptoms suggestive of AR. Detecting AR is of importance because of its subsequent complication and its effect on quality of life and productivity in school or work.[7] In our current study, the assessment of the daily effect of the disease was done using a scale of 0–10, which showed that 57% of the participants have a score between 5 and 10, which suggests a severe disease. The prevalence of atopy worldwide has been increasing over the years.[2] A study done in Southwest London showed an increase in the prevalence of allergen skin test reactivity.[2] In Saudi Arabia, several epidemiological studies have proven an increase in the prevalence of AR.[14] A study done in different regions of Saudi Arabia concluded that 34% of its participants were positive for AR.[15] Another study determined the prevalence of AR disease in children in different cities of Saudi Arabia. They found that the highest prevalence was in Al-Ahssa (48.2%) compared with Riyadh (29%) and Jeddah (24.3%).[14] This has been contributed to various factors that all correlate to the rapidly changing environment of Saudi Arabia.[1] In a study done in Riyadh, it concluded that many plants contain pollens that are allergic in nature.[1] This strongly associates with our findings that establish a relationship between living near farms and developing AR. Several triggers have been known to increase AR attacks. In Saudi Arabia, an increase in exposure to environmental factors particularly smoke and pets has contributed to the development of AR.[14] In addition, a study done in Riyadh suggested that sandstorm dust is a source of potential triggers of allergic substances.[16] In our study, we have found that the majority of cases were provoked by dust, followed by perfumes, smoke, and pets. Most pets owned were found to be birds and cats. A study done in Saudi Arabia concluded that cat dander contributed to inhalant allergens.[1] Moreover, smoking and air pollution damage the respiratory epithelial cells and therefore predispose to AR and asthma.[1] In our study, we have found that 30% of patients who were diagnosed with AR or who have symptoms suggestive of AR were either smokers or passive smokers. This may not show a clear association between smoking and AR. However, it may be due to the fact that the percentage of women who smoke in Saudi Arabia is low due to religious or cultural factors or due to the fact that it is socially unacceptable.[17],[18] The association between bronchial asthma, eczema, and AR has been well known and has been proven in several studies.[1] In our study, 37% of patients with AR had eczema, asthma, or both. Therefore, an association between AR, eczema, and asthma was indicated. The above study also concluded an association between consanguinity and allergic disease.[1] Our study concluded that about half of patients with AR had parents of a consanguinity relationship.


  Conclusion Top


AR is a common disease in the community, which prevalence has been increasing over the years. We concluded that 76% of the participants were either diagnosed with AR or have symptoms suggestive of AR. These symptoms are mainly triggered by dust and are associated with living near farms. In addition, recognition and diagnosis of the disease could lead to early management and improvement in the overall quality of life.

Acknowledgment

We would like to show our sincere gratitude to our colleagues, Sara Alomair, Rehab Almotairi, and Ghofran Essa Mohammed Alsuliman, for their effort in data collection.

Financial support and sponsorship

This study is self-financed.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Alreshidi1 FM, Alrashidi AS, Alshammari FN, Qadi AB, Alrashidi AG, Alghaythi SM, et al. Knowledge, attitude and practice about allergic rhinitis in Saudi Arabia. Egypt J Hosp Med 2017;69:2199-203.  Back to cited text no. 15
    
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Kwaasi AA, Parhar RS, al-Mohanna FA, Harfi HA, Collison KS, al-Sedairy ST, et al. Aeroallergens and viable microbes in sandstorm dust. Potential triggers of allergic and nonallergic respiratory ailments. Allergy 1998;53:255-65.  Back to cited text no. 16
    
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Saeed AA, Khoja TA, Khan SB. Smoking behaviour and attitudes among adult Saudi nationals in Riyadh city, Saudi Arabia. Tob Control 1996;5:215-9.  Back to cited text no. 17
    
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