Pattern of Aeroallergen Sensitization and Quality of Life in Adult Thai Patients With Allergic Rhinitis

Puspalal Katel, Bannapuch Pinkaew, Kanokporn Talek, Pongsakorn Tantilipikorn, Puspalal Katel, Bannapuch Pinkaew, Kanokporn Talek, Pongsakorn Tantilipikorn

Abstract

The prevalence of allergic rhinitis (AR) is steadily rising in the Thai population, causing a major impact on the quality of life (QoL). Enhancing knowledge on common aeroallergens in the local setting helps in the appropriate prevention and management of AR. In this study, the demographic characteristics, clinical data, aeroallergen sensitization pattern, allergic symptoms, visual analog scale (VAS) score, and QoL are described. We evaluated the association between VAS, QoL, and severity of symptoms, except the aeroallergen sensitization pattern. We retrospectively reviewed the medical records of adult AR patients with a positive skin prick test (SPT) for at least one aeroallergen from January 2018 to May 2020. Standard descriptive and inferential statistics were used for analysis. A total of 366 patients were enrolled. Indoor aeroallergen sensitization and outdoor aeroallergen sensitization were observed in 32% and 7.9% of patients, respectively. Mono-sensitization was noted in 16.9% of patients, while poly-sensitization was noted in 83.1% of patients. Mites (65%) and sedge (39.3%) were the most common indoor and outdoor allergens. Nasal obstruction (74.6%), runny nose (63.7%), and nasal itchiness (61.5%) were the primary symptoms affecting the QoL. The association between VAS and symptom scores showed a trend of association with AR severity (Allergic Rhinitis and its Impact on Asthma [ARIA] classification) and VAS. AR has a significant effect on QoL in all domains of the validated generic (short-form-36, SF-36) and specific (rhino-conjunctivitis QoL questionnaire, Rcq-36) questionnaires. Mite and sedge remain the most common indoor and outdoor aeroallergens. The pattern of sensitization and number of aeroallergens were not associated with AR based on the ARIA guidelines. Meanwhile, symptoms of patients affected the QoL and VAS scores, which can be used as a quick and reliable tool for monitoring and stepping up or stepping down the treatment according to the next-generation guidelines. AR has a significant impact on the QoL of adult Thai patients.

Keywords: aeroallergen; allergic rhinitis; quality of life; skin prick test; visual analog scale.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Katel, Pinkaew, Talek and Tantilipikorn.

Figures

Figure 1
Figure 1
Pattern of aeroallergen sensitization (n = 366). Abbreviations: MDp, mite/Dermatophagoides pteronyssinus; HD, house dust; CR, cockroach; Sed, sedge; PG, para grass; BG, bermuda grass; CW, careless weed; Kap, Kapok; Typ, Typha; CS, Cladosporium; PNC, Penicillium; ASG, Aspergillum.
Figure 2
Figure 2
Association among TNSS, VAS score, ARIA classification, and type of sensitization and aeroallergen. TNSS, the total nasal symptom score; VAS, visual analog scale; ARAI, Allergic Rhinitis and its Impact on Asthma. *p < 0.05.
Figure 3
Figure 3
Comparison of QoL, SF-36, and Rcq-36 scores among types of aeroallergens. QoL, quality of life; SF, social functioning; Rcq, rhino-conjunctivitis QoL questionnaire; RS, rhinitis symptoms; ES, eye symptoms; OS, other symptoms; PF, physical functioning; SP, sleep; E, emotion. (p < 0.05: Significant difference between the type of aeroallergen and each domain of the SF-36 and Rcq-36 questionnaires using unpaired t-test).
Figure 4
Figure 4
Comparison of QoL, SF-36, and Rcq-36 scores among the different types of sensitizations. QoL, quality of life; SF, social functioning; Rcq, rhino-conjunctivitis. (p < 0.05: Significant difference between the type of sensitization and each domain of the SF-36 and Rcq-36 questionnaires using analysis of variance).
Figure 5
Figure 5
Comparison of QoL between the ARIA classifications (36). QoL, quality of life; ARIA, Allergic Rhinitis and its Impact on Asthma. (*p < 0.05, **p < 0.001: Significant difference among the ARIA classifications using analysis of variance).

References

    1. Pawankar R, Bunnag C, Khaltaev N, Bousquet J. Allergic rhinitis and its impact on asthma in Asia pacific and the ARIA Update 2008. World Allergy Organ J. (2012) 5:S212–7. 10.1186/1939-4551-5-S3-S212
    1. Ciprandi G, Cirillo I. IMonosensitization and polysensitization in allergic rhinitis. Eur J Intern Med. (2011) 22:e75–9. 10.1016/j.ejim.2011.05.009
    1. Yuen AP, Cheung S, Tang KC, Ho WK, Wong BY, Cheung AC, et al. . The skin prick test results of 977 patients suffering from chronic rhinitis in Hong Kong. Hong Kong Med J. (2007) 13:131–6.
    1. Tantilipikorn P, Pinkaew B, Talek K, Assanasen P, Triphoon Suwanwech TS, Bunnag C. Pattern of allergic sensitization in chronic rhinitis: A 19-year retrospective study. Asian Pac J Allergy Immunol. (2020) 39:156–62. 10.12932/AP-080719-0597
    1. Lim MY, Leong JL. Allergic rhinitis: evidence-based practice. Singapore Med J. (2010) 51:542–50.
    1. Bunnag C, Jareoncharsri P, Tantilipikorn P, Vichyanond P, Pawankar R. Epidemiology and current status of allergic rhinitis and asthma in Thailand – ARIA Asia-Pacific Workshop report. Asian Pac J Allergy Immunol. (2009) 27:79–86.
    1. Navarro-Locsin CG, Lim-Jurado M. Aeroallergen sensitization and associated comorbid diseases of an adult Filipino population with allergic rhinitis. Asia Pac Allergy. (2018) 8:e25. 10.5415/apallergy.2018.8.e25
    1. Bunnag C, Leurmarnkul W, Jareoncharsri P, Tunsuriyawong P, Assanasen P, Pawankar R. Quality of life assessment in Thai patients with allergic rhinoconjunctivitis using the SF-36 questionnaire (Thai version). Rhinology. (2005) 43:99–103.
    1. Bunnag C, Leurmarnkul W, Jareoncharsri P, Ungkanont K, Tunsuriyawong P, Kosrirukvongs P, et al. . Development of a health-related quality of life questionnaire for Thai patients with rhinoconjunctivitis. Asian Pac J Allergy Immunol. (2004) 22:69–79.
    1. Bunnag C, Jareoncharsri P, Tunsuriyawong P, Assanasen P, Voraprayoon S, Dachpunpour P, et al. . Adverse reactions to allergen injection: the Siriraj experience. Siriraj Med J. (2002) 54:517–24.
    1. Tantilipikorn P, Saisombat P, Phonpornpaiboon P, Pinkaew B, Lermankul W, Bunnag C. Minimal clinically important difference for the rhinoconjunctivitis quality of life questionnaire in allergic rhinitis in Thai population. Asia Pac Allergy. (2019) 9:e6. 10.5415/apallergy.2019.9.e6
    1. Ellis AK, Soliman M, Steacy L, Boulay MÈ, Boulet LP, Keith PK, et al. . The allergic rhinitis - clinical investigator collaborative (AR-CIC): nasal allergen challenge protocol optimization for studying AR pathophysiology and evaluating novel therapies. Allergy Asthma Clin Immunol. (2015) 11:16. 10.1186/s13223-015-0082-0
    1. Oncham S, Udomsubpayakul U, Laisuan W. Skin prick test reactivity to aeroallergens in adult allergy clinic in Thailand: a 12-year retrospective study. Asia Pac Allergy. (2018) 8:e17. 10.5415/apallergy.2018.8.e17
    1. Tham EH, Lee AJ, Bever HV. Aeroallergen sensitization and allergic disease phenotypes in Asia. Asian Pac J Allergy Immunol. (2016) 34:181–9. 10.12932/AP0770
    1. Li J, Sun B, Huang Y, Lin X, Zhao D, Tan G, et al. . A multicentre study assessing the prevalence of sensitizations in patients with asthma and/or rhinitis in China. Allergy. (2009) 64:1083–92. 10.1111/j.1398-9995.2009.01967.x
    1. Andiappan AK, Puan KJ, Lee B, Nardin A, Poidinger M, Connolly J, et al. . Allergic airway diseases in a tropical urban environment are driven by dominant mono-specific sensitization against house dust mites. Allergy. (2014) 69:501–9. 10.1111/all.12364
    1. Jo EJ, Eom JS, Mok J, Kim MH, Lee K, Kim KU, et al. . Patterns of sensitization to aeroallergens and their effect on airway hyper-responsiveness in Busan, Korea. Asian Pac J Allergy Immunol. (2019) 39:182–9. 10.12932/AP-261118-0447
    1. Beggs PJ. Impacts of climate change on aeroallergens: past and future. Clin Exp Allergy. (2004) 34:1507–13. 10.1111/j.1365-2222.2004.02061.x
    1. Narita D, Oanh NT, Sato K, Huo M, Permadi DA, Chi NN, et al. . Pollution characteristics and policy actions on fine particulate matter in a growing Asian economy: the case of Bangkok metropolitan region. Atmosphere. (2019) 10:227. 10.3390/atmos10050227
    1. Lombardi C, Musicco E, Rastrelli F, Bettoncelli G, Passalacqua G, Canonica GW. The patient with rhinitis in the pharmacy. A cross-sectional study in real life. Asthma Res Pract. (2015) 1:4. 10.1186/s40733-015-0002-6
    1. Klimek L, Bachert C, Pfaar O, Becker S, Bieber T, Brehler R, et al. . ARIA guideline 2019: treatment of allergic rhinitis in the German health system. Allergol Select. (2019) 3:22–50. 10.5414/ALX02120E
    1. Pawankar R, Bunnag C, Chen Y, Fukuda T, Kim YY, Le LT, et al. . Allergic rhinitis and its impact on asthma update (ARIA 2008) – western and Asian-Pacific perspective. Asian Pac J Allergy Immunol. (2009) 27:237–43.
    1. Bousquet PJ, Combescure C, Neukirch F, Klossek JM, Méchin H, Daures JP, et al. . Visual analog scales can assess the severity of rhinitis graded according to ARIA guidelines. Allergy. (2007) 62:367–72. 10.1111/j.1398-9995.2006.01276.x
    1. Bousquet J, Schünemann HJ, Togias A, Bachert C, Erhola M, Hellings PW, et al. . Next-generation allergic rhinitis and its impact on asthma (ARIA) guidelines for allergic rhinitis based on grading of recommendations assessment, development and evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol. (2020) 145:70–80.e3. 10.1016/j.jaci.2019.06.049
    1. Bousquet J, Arnavielhe S, Bedbrook A, Bewick M, Laune D, Mathieu-Dupas E, et al. . MASK 2017: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma multimorbidity using real-world-evidence. Clin Transl Allergy. (2018) 8:45. 10.1186/s13601-018-0227-6
    1. Asha'ari ZA, Yusof S, Ismail R, Che Hussin CM. Clinical features of allergic rhinitis and skin prick test analysis based on the ARIA classification: a preliminary study in Malaysia. Ann Acad Med Singap. (2010) 39:619–24.

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