Coexistence of allergic rhinitis and asthma in Indian patients: The CARAS survey

Abstract

Context: Asthma patients often suffer from concomitant allergic rhinitis (AR). However, there is paucity of such data from India. Aims: This questionnaire-based survey evaluated the coexistence of AR in Indian asthmatics, and examined the inter-relationship between the two disease conditions. Subjects and Methods: This survey conducted in ten cities across India, aimed to generate information on exposure to risk factors, history of atopy, the severity of asthma, and treatment regimen in patients with physician-diagnosed asthma. Results: Data were obtained from 1161 asthma patients (mean age [±standard deviation]: 40.41 [±17.05] years). Prevalence of coexisting AR was found to be 65.24%, with the highest prevalence (80%) in the southern regions of India. Sneezing (71.78%) followed by watery, runny nose (63.59%) were the most common AR symptoms. Majority (72.32%) of the patients had seasonal AR. Coexistence of AR and asthma was significantly associated with the presence of personal and family history of atopy (odds ratio 2.53 and 1.51 respectively; both P < 0.005). Passive smoking, exposure to biomass fuel, and the presence of pets and animals at home were also significantly ( P < 0.005) associated with AR-asthma coexistence. Prevalence of AR was found to increase with increasing asthma severity. The usage of oral steroids was significantly higher in patients with coexistent AR-asthma. Sixty-six percent of the patients with coexistent AR-asthma were prescribed intranasal corticosteroids. Conclusions: The results of the Coexistence of Allergic Rhinitis and ASthma (CARAS) survey highlight the high prevalence of concomitant AR in Indian patients with asthma, and reinforce the need for early diagnosis and guideline-based management of AR in patients with asthma.

Allergic rhinitis in India

“…Furthermore, it is important to mention here that the coexistence of AR is common among patients with asthma 71,85,88,90 . Indian data suggest that AR and asthma coexist among 70–80% of patients 20 .…”

“…Furthermore, it is important to mention here that the coexistence of AR is common among patients with asthma. 71,85,88,90 Indian data suggest that AR and asthma coexist among 70-80% of patients. 20 While such a high percentage was obtained from only a handful of studies with small patient populations, there is no doubt that combined upper and lower airway inflammation is increasingly common in India particularly due to the increasing burden of air pollution and rapid urbanization.…”

“…One recently conducted Indian survey reported a high prescription of oral H 1 -antihistamines (53%) as monotherapy for treating AR patients by Indian doctors and 25% prescribing dual therapy of secondgeneration H 1 -antihistamines with LTRA, 87 though another study showed a preference for combination therapy with oral antihistamines and LTRA (65%) among Indian prescribers. 88 Interestingly a hospital-based single-centre study in Western India revealed polypharmacy to be common in AR prescriptions; with two drugs per prescription being 79% and three drugs per prescription being 22%. 89 This study also revealed poor patient awareness regarding the prescribed medications for AR.…”

Allergic diseases in India – Prevalence, risk factors and current challenges

“…The GAN adult study observed an increase in prevalence at 9.8% (2019) 22 . Allergic rhinitis is the most frequent co‐morbidity in asthma, and a recent survey of asthmatics from urban areas showed a prevalence of 65.4% 28,29 . In comparison, AR prevalence in US adults was 41.2% and in Europe (ECRHS I) 28.9% 30 …”

Scope of Homoeopathic Intervention for Allergic Rhinitis—A Comprehensive Review

“…3 The approximate worldwide prevalence of AR is 10 to 30% of adults and 40% of children. 4 The high incidence of AR imposes a heavy burden on general well-being, and has a significant financial impact from both direct and indirect costs for management of the disease. 5 AR has a significant genetic component, a positive family history for atopy, which makes the diagnosis more likely.…”