Research Article: Allergic rhinitis: Disease characteristics and coping measures in Saudi Arabia

Date Published: June 26, 2019

Publisher: Public Library of Science

Author(s): Abdulmohsin A. Almehizia, Reema K. AlEssa, Khalid M. Alwusaidi, Khalid A. Alzamil, Modhi AlJumah, Sarah Aljohani, Adel F. Almutairi, Mahmoud Salam, Konstantinos Kostikas.


Despite allergic rhinitis (AR) being a highly prevalent disease, according to literature, it is often underdiagnosed or undertreated.

This study explored the disease characteristics of AR in the Saudi community and the non-conventional coping measures used to alleviate symptoms.

The study was a nationwide cross-sectional study, using a self-report electronic survey distributed via social media networks in 2018. The survey included an explanatory letter and consent. The sample size comprised 3,458 participants and 2,849 adults had at least one of the four signs of AR, i.e. watery-nose, sneezing, nasal obstruction, itchy nose, watery eyes, in the past year, not related to cold/flu. The outcomes of the study were the triggers, pattern, severity and the classification of AR (2016 ARIA guidelines) and coping measures. Descriptive statistics, univariate analytic statistics and binary logistic regression analyses were conducted. The P-value was considered statistically significant at <0.05. The leading reported trigger of AR was dust (74%, n = 2118), followed by pollen (17%, n = 477), mold (5%, n = 140) and fur (4%, n = 114). The prevalence of intermittent AR was (54%, n = 1,635), while that of persistent AR was (46%, n = 1,314). Almost one-third (34%, n = 959) complained of mild forms of AR, while others complained of moderate to severe forms (66%, n = 1890). The coping measures were mainly shower/humidification 368(12.9%) and herbal hot drinks 266(9.3%). Older participants (adj.OR = 1.3[1.1–1.5]) and overweight participants, (adj.OR = 1.2[1.1–1.4]) reported more persistent forms of rhinitis compared to their counter groups, (adj.P<0.001 and adj.P = 0.032) respectively. Female participants (adj.OR = 0.8[0.7–0.9]) had significantly milder forms of AR, in comparison to males, adj.P = 0.006. This study presented the disease characteristics of self-reported AR and its associated factors in Saudi Arabia. Special attention should be paid to older age groups and overweight patients who reported persistent forms of AR. Males reported more severe and persistent forms of AR.

Partial Text

Allergic rhinitis (AR) is an inflammatory disease of the nasal mucosa caused by indoor or outdoor allergens [1]. In terms of pathophysiology, immunoglobulin E activates the mast cells or basophils in the nasal mucosa, resulting in the production of vasoactive mediators such as histamine which triggers the inflammation [2]. AR manifests as nasal symptoms (congestion, rhinorrhea, itching, and sneezing) and ocular symptoms (itching, redness and tearing) [3]. Significant complaints also include nasal congestion, and in unilateral presentation, it may suggest the possibility of structural obstruction, such as a polyp, foreign body, or a deviated septum [4]. Since both allergic and non-allergic rhinitis are similar in symptoms, laboratory tests remain the most accurate method in discriminating the type of rhinitis and the nature of allergens. AR may develop in upper airway resistance and impediment of air entry [5] which could progress to comorbidities such as asthma [6].

This epidemiological study presents to the public and healthcare community the the patient and disease characteristics of 2,849 participants complaining of AR in a Middle Eastern country with a relatively harsh climate. While the Prick test remains the most accurate diagnostic test to confirm an allergic trigger, there was a need to launch a less costly preliminary community surveillance to evaluate the general status of AR. Prick tests range in cost between $60-$300 and for research purposes; participants need to be followed-up for further observation. However, at this stage results can be generalized to settings with similar environmental conditions. In addition, it provides insight regarding AR for expatriates who are seeking job opportunities and willing to relocate to Saudi Arabia, as well as those visiting this country on a temporary basis. A multisite study conducted in five Middle Eastern countries revealed that only 10% of the 7,411 self-reported AR cases were medically diagnosed with AR [27]. Based on these findings, future diagnostic studies may follow to confirm the true clinical association between AR triggers and severity of symptoms.

This study presented the disease characteristics and associated factors of AR as reported by the public community in Saudi Arabia. AR was mainly triggered by dust, followed by pollen, mold and fur. More than half of the AR cases in Saudi Arabia suffered from moderate to severe symptoms and intermittent pattern of the disease. Factors associated with triggering AR by pollen were male gender, older age group, smoking and persistent AR. AR triggered by mold was associated with persistent forms of the disease, while AR triggered by fur was associated with smoking. AR triggered by dust was associated with the female gender, younger age, smoking, as well as, mild forms of the disease. Patients with AR are advised to adopt weight control measures as they were more likely to endure persistent forms of the disease if overweight.




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