A Clinicopathological Study of Allergic Rhinitis

Abstract

Objectives: Allergic rhinitis (AR) is on the rise in our society for various reasons. It is said that allergy might represent a primary or secondary factor in up to half the patients encountered in an otolaryngology practice. Thus, the management of AR constitutes a large proportion of the day-to-day practice. In addition to its primary effect, inhalant allergy of the upper respiratory tract might affect the development and clinical course of other disease states such as sinusitis, otitis media, and asthma due to the mucosal continuity. Hence, this study was conducted to know the comorbid associations of AR and also the pathology in inferior turbinate hypertrophy (ITH). Methods:A time-bound, descriptive cross-sectional study was conducted in ENT OPD. Patients were selected for the study after proper history taking, clinical examination, laboratory investigations such as absolute eosinophil count (AEC) and diagnostic nasal endoscopy, and consent for biopsy from inferior turbinate and histopathological examination using predefined inclusion and exclusion criteria. Nasal symptoms of sneezing, rhinorrhea, nasal pruritus, nasal obstruction, anosmia and non-nasal symptoms of eye itching, watering, foreign body sensation, and pharyngeal itching were recorded. Results:The mean age of the patients was 27.08 years with a standard deviation of 6.1. Patients were clinically evaluated regarding symptoms in ear, nose, throat, eyes, and respiratory system. All patients had nasal symptoms whereas 53.34% patients had ophthalmic and pharyngeal symptoms. Aural comorbidity was most common with complaints in 68.33% followed by respiratory symptoms in 30% patients. About 40% patients complained of sleep disturbances. Nearly 31.67% patients had a positive family history. The pale nasal mucosa was seen in 63.33% patients. Almost 70% patients had intermittent AR, of which 43.33% had a mild degree. About 55% cases had AEC <350 cells/cumm. Almost 51.67% patients had more than five eosinophils per high power field in the biopsy of their inferior turbinates. Conclusion:Although most patients presented with nasal symptoms, ophthalmic and pharyngeal symptoms were commonly presented. ITH with pale nasal mucosa were the most common examination findings. Although AEC was not raised in most of the patients, more than half patients had a raised eosinophil count in the inferior turbinate biopsy. Thus, in a patient with AR, special attention has to be given to the ear, throat, eye, and asthmatic aspect. Eosinophil count in inferior turbinate biopsy is fairly reliable indicator in allergic turbinates.

Prospective study on prevalence of aeroallergens in allergic rhinitis in a teaching hospital, Telangana

“…65.5% (95/145) when compared to males ie, 34.4 % (50/145). Bellamkonda M et al 15 in their study observed that female patients were slightly more than the male patients with a male to female ratio of 0.935:1 ie they had 31 females and 29 males in their study. Kammili J et al 12 observed allergic rhinitis more in males than in females, with 66.66% in males and 33.33% in females.…”

“…Wang W et al 14 reported the median age as 19.0 years. Bellamkonda M et al 15 in a similar study observed the youngest patient to be 16 years and the oldest as 45 years. The mean age of their study group was 27 years.…”

“…Bellamkonda M et al 15 observed in a similar study that a total of 19(31.67%) patients had a positive family history of allergy. Two had history of food allergy; one patient to milk and other to peanuts.…”

“…In the present study, majority of the cases presented with nasal obstruction and rhinnorhea ie, 24.1% cases. Next common symptom was only rhinorhea and was seen in 20.6% cases whereas, in the study by Bellamkonda M et al 15 the most common nasal symptom was nasal discharge (80%) followed by sneezing (78.34%) and nasal obstruction (70%). Seven patients (11.67%) had altered sense of smell and headache.…”

“…In the present study 79.3% cases showed AEC > 440 cells/cumm. In the study by Bellamkonda M et al 15 the majority of patients (26.6%) had AEC ranging between 301 and 400 cells/cumm followed by 25% patients in range of 400-500 cells/cumm. Aggarwal D et al 13 observed an absolute eosinophil count (AEC) of >440 cells/mm3 in 50% of patients.…”