Asia Pac Allergy.  2012 Apr;2(2):93-100. 10.5415/apallergy.2012.2.2.93.

Impact of allergic rhinitis in school going children

• Mir E
• Panjabi C
• Shah A

• KMID: 2397361
• DOI: http://doi.org/10.5415/apallergy.2012.2.2.93

Abstract

Allergic rhinitis (AR) is the most common chronic pediatric disorder. The International Study for Asthma and Allergies in Childhood phase III found that the global average of current rhinoconjunctivitis symptoms in the 13-14 year age-group was 14.6% and the average prevalence of rhinoconjunctivitis symptoms in the 6-7 year age-group was 8.5%. In addition to classical symptoms, AR is associated with a multidimensional impact on the health related quality of life in children. AR affects the quality of sleep in children and frequently leads to day-time fatigue as well as sleepiness. It is also thought to be a risk factor for sleep disordered breathing. AR results in increased school absenteeism and distraction during class hours. These children are often embarrassed in school and have decreased social interaction which significantly hampers the process of learning and school performance. All these aspects upset the family too. Multiple co-morbidities like sinusitis, asthma, conjunctivitis, eczema, eustachian tube dysfunction and otitis media are generally associated with AR. These mostly remain undiagnosed and untreated adding to the morbidity. To compound the problems, medications have bothersome side effects which cause the children to resist therapy. Children customarily do not complain while parents and health care professionals, more often than not, fail to accord the attention that this not so trivial disease deserves. AR, especially in developing countries, continues to remain a neglected disorder.

Keyword

Allergic rhinitis; Asthma; Learning disability; Pediatric; Quality of life; School children; Sinusitis; Sleep disturbances

MeSH Terms

Absenteeism
Asthma
Child*
Conjunctivitis
Delivery of Health Care
Developing Countries
Eczema
Eustachian Tube
Fatigue
Humans
Hypersensitivity
Interpersonal Relations
Learning
Learning Disorders
Otitis Media
Parents
Prevalence
Quality of Life
Rhinitis, Allergic*
Risk Factors
Sinusitis
Sleep Apnea Syndromes

Figure

• 

  Fig. 1 Coronal CT of the paranasal sinuses in a 7-year-old child showing extensive mucosal thickening within all paranasal sinuses, ostiomeatal complexes and nasal cavity.

Reference

1. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FE, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA2LEN and AllerGen). Allergy. 2008; 63(Suppl 86):8–160. PMID: 18331513.

2. Jáuregui I, Mullol J, Dávila I, Ferrer M, Bartra J, del Cuvillo A, Montoro J, Sastre J, Valero A. Allergic rhinitis and school performance. J Investig Allergol Clin Immunol. 2009; 19(Suppl 1):32–39.

3. Shah A, Pawankar R. Allergic rhinitis and co-morbid asthma: perspective from India -- ARIA Asia-Pacific Workshop report. Asian Pac J Allergy Immunol. 2009; 27:71–77. PMID: 19548632.

4. Aït-Khaled N, Pearce N, Anderson HR, Ellwood P, Montefort S, Shah J. Global map of the prevalence of symptoms of rhinoconjunctivitis in children: The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. Allergy. 2009; 64:123–148. PMID: 19132975.

5. Beasley R, Keil U, von Mutius E, Pearce N. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet. 1998; 351:1225–1232. PMID: 9643741.

6. Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, Williams H. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006; 368:733–743. PMID: 16935684.

7. Pawankar R, Bunnag C, Gendeh B. Allergic rhinitis: incidence, treatment strategies, practice guidelines and co-morbidities in Asia. Presented at the 6th Asian Research Symposium in Rhinology. 2001. Hong Kong.

8. Hwang CY, Chen YJ, Lin MW, Chen TJ, Chu SY, Chen CC, Lee DD, Chang YT, Wang WJ, Liu HN. Prevalence of atopic dermatitis, allergic rhinitis and asthma in Taiwan: a national study 2000 to 2007. Acta Derm Venereol. 2010; 90:589–594. PMID: 21057741.

9. Zhao J, Bai J, Shen K, Xiang L, Huang S, Chen A, Huang Y, Wang J, Ye R. Self-reported prevalence of childhood allergic diseases in three cities of China: a multicenter study. BMC Public Health. 2010; 10:551. PMID: 20836838.

10. Droma Y, Kunii O, Yangzom Y, Shan M, Pingzo L, Song P. Prevalence and severity of asthma and allergies in schoolchildren in Lhasa, Tibet. Clin Exp Allergy. 2007; 37:1326–1333. PMID: 17845413.

11. Mygind N. Mygind N, editor. Perennial rhinitis. Nasal allergy. 1979. 2nd ed. Oxford: Blackwell Scientific Publications;p. 224–232.

12. Khanna P, Shah A. Categorization of patients with allergic rhinitis: a comparative profile of "sneezers and runners" and "blockers". Ann Allergy Asthma Immunol. 2005; 94:60–64. PMID: 15702818.

13. Mir E. Assessment of health-related quality of life and work productivity in school going children with allergic rhinitis and/or asthma. 2011. Delhi: Vallabhbhai Patel Chest Institute;Doctoral dissertation submitted to the University of Delhi.

14. McColley SA, Carroll JL, Curtis S, Loughlin GM, Sampson HA. High prevalence of allergic sensitization in children with habitual snoring and obstructive sleep apnea. Chest. 1997; 111:170–173. PMID: 8996012.

15. Kaditis AG, Finder J, Alexopoulos EI, Starantzis K, Tanou K, Gampeta S, Agorogiannis E, Christodoulou S, Pantazidou A, Gourgoulianis K, Molyvdas PA. Sleep-disordered breathing in 3,680 Greek children. Pediatr Pulmonol. 2004; 37:499–509. PMID: 15114550.

16. Mansfield LE, Diaz G, Posey CR, Flores-Neder J. Sleep disordered breathing and daytime quality of life in children with allergic rhinitis during treatment with intranasal budesonide. Ann Allergy Asthma Immunol. 2004; 92:240–244. PMID: 14989393.

17. Meltzer EO. Quality of life in adults and children with allergic rhinitis. J Allergy Clin Immunol. 2001; 108:S45–S53. PMID: 11449206.

18. Marshall PS, O'Hara C, Steinberg P. Effects of seasonal allergic rhinitis on selected cognitive abilities. Ann Allergy Asthma Immunol. 2000; 84:403–410. PMID: 10795648.

19. Urschitz MS, Guenther A, Eggebrecht E, Wolff J, Urschitz-Duprat PM, Schlaud M, Poets CF. Snoring, intermittent hypoxia and academic performance in primary school children. Am J Respir Crit Care Med. 2003; 168:464–468. PMID: 12773324.

20. Sundberg R, Torén K, Höglund D, Aberg N, Brisman J. Nasal symptoms are associated with school performance in adolescents. J Adolesc Health. 2007; 40:581–583. PMID: 17531771.

21. Malone DC, Lawson KA, Smith DH, Arrighi HM, Battista C. A cost of illness study of allergic rhinitis in the United States. J Allergy Clin Immunol. 1997; 99:22–27. PMID: 9003207.

22. Juniper EF, Guyatt GH, Dolovich J. Assessment of quality of life in adolescents with allergic rhinoconjunctivitis: development and testing of a questionnaire for clinical trials. J Allergy Clin Immunol. 1994; 93:413–423. PMID: 8120268.

23. Juniper EF, Howland WC, Roberts NB, Thompson AK, King DR. Measuring quality of life in children with rhinoconjunctivitis. J Allergy Clin Immunol. 1998; 101:163–170. PMID: 9500748.

24. Bousquet J, Bullinger M, Fayol C, Marquis P, Valentin B, Burtin B. Assessment of quality of life in patients with perennial allergic rhinitis with the French version of the SF-36 Health Status Questionnaire. J Allergy Clin Immunol. 1994; 94:182–188. PMID: 8064070.

25. Shedden A. Impact of nasal congestion on quality of life and work productivity in allergic rhinitis: findings from a large online survey. Treat Respir Med. 2005; 4:439–446. PMID: 16336028.

26. Silva CH, Silva TE, Morales NM, Fernandes KP, Pinto RM. Quality of life in children and adolescents with allergic rhinitis. Braz J Otorhinolaryngol. 2009; 75:642–649. PMID: 19893929.

27. Maksimović N, Janković S, Tomić-Spirić V, Marinković J. Health-related quality of life assessment in patients with allergic rhinitis. Srp Arh Celok Lek. 2005; 133:223–228. PMID: 16392276.

28. Roberts G, Mylonopoulou M, Hurley C, Lack G. Impairment in quality of life is directly related to the level of allergen exposure and allergic airway inflammation. Clin Exp Allergy. 2005; 35:1295–1300. PMID: 16238788.

29. Shah A. Rarely does one hear a wheeze without a sneeze. Indian J Chest Dis Allied Sci. 2000; 42:143–145. PMID: 11089317.

30. Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CC, Schuller D, Spector SL, Tilles SA. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008; 122:S1–S84. PMID: 18662584.

31. Shah A, Panjabi C, Maurya V. Asthma and rhinitis: the co-occurrence in Delhi. Proceedings of the Third Malaysian Congress of Allergy and Immunology. 2002. Kuala Lumpur: Malaysia. p. 54. [Abstract].

32. Burgess JA, Walters EH, Byrnes GB, Matheson MC, Jenkins MA, Wharton CL, Johns DP, Abramson MJ, Hopper JL, Dharmage SC. Childhood allergic rhinitis predicts asthma incidence and persistence to middle age: a longitudinal study. J Allergy Clin Immunol. 2007; 120:863–869. PMID: 17825896.

33. Qiao T, Hu Y, Wang Z. Pediatric allergic conjunctivitis and allergic rhinitis. J Nanjing Med Univ. 2008; 22:183–187.

34. Bielory L. Allergic conjunctivitis and the impact of allergic rhinitis. Curr Allergy Asthma Rep. 2010; 10:122–134. PMID: 20425504.

35. Berrettini S, Carabelli A, Sellari-Franceschini S, Bruschini L, Abruzzese A, Quartieri F, Sconosciuto F. Perennial allergic rhinitis and chronic sinusitis: correlation with rhinologic risk factors. Allergy. 1999; 54:242–248. PMID: 10321560.

36. Sahay S, Bhargava SK, Shah A. Co-occurrence of sinusitis in patients with asthma and/or allergic rhinitis in Delhi, India. Proceedings of the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI) and World Allergy Organisation (WAO) Joint Congress 2006 and the 9th West Pacific Allergy Organisation. 2006. Seoul: Korea. p. 263. [Abstract].

37. Fokkens W, Lund V, Bachert C, Clement P, Helllings P, Holmstrom M, Jones N, Kalogjera L, Kennedy D, Kowalski M, Malmberg H, Mullol J, Passali D, Stammberger H, Stierna P. EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy. 2005; 60:583–601. PMID: 15813802.

38. Nguyen LH, Manoukian JJ, Sobol SE, Tewfik TL, Mazer BD, Schloss MD, Taha R, Hamid QA. Similar allergic inflammation in the middle ear and the upper airway: evidence linking otitis media with effusion to the united airways concept. J Allergy Clin Immunol. 2004; 114:1110–1115. PMID: 15536418.

39. Lazo-Sáenz JG, Galván-Aguilera AA, Martínez-Ordaz VA, Velasco-Rodríguez VM, Nieves-Rentería A, Rincón-Castañeda C. Eustachian tube dysfunction in allergic rhinitis. Otolaryngol Head Neck Surg. 2005; 132:626–629. PMID: 15806058.

40. Caffarelli C, Savini E, Giordano S, Gianlupi G, Cavagni G. Atopy in children with otitis media with effusion. Clin Exp Allergy. 1998; 28:591–596. PMID: 9645596.

41. Bousquet J, Reid J, van Weel C, Baena Cagnani C, Canonica GW, Demoly P, Denburg J, Fokkens WJ, Grouse L, Mullol K, Ohta K, Schermer T, Valovirta E, Zhong N, Zuberbier T. Allergic rhinitis management pocket reference 2008. Allergy. 2008; 63:990–996. PMID: 18691301.

42. Ten Eick AP, Blumer JL, Reed MD. Safety of antihistamines in children. Drug Saf. 2001; 24:119–147. PMID: 11235817.

43. Craig TJ, Hanks CD, Fisher LH. How do topical nasal corticosteroids improve sleep and daytime somnolence in allergic rhinitis? J Allergy Clin Immunol. 2005; 116:1264–1266. PMID: 16337455.

44. Passalacqua G, Albano M, Canonica GW, Bachert C, Van Cauwenberge P, Davies RJ, Durham SR, Kontou-Fili K, Horak F, Malling HJ. Inhaled and nasal corticosteroids: safety aspects. Allergy. 2000; 55:16–33. PMID: 10696853.

45. Deepak D, Panjabi C, Gudwani S, Chaudhary N, Shah A. Nasal septal perforation in a patient with allergic bronchopulmonary aspergillosis and rhinitis on long term corticosteroids. Asian Pac J Allergy Immunol. 2001; 19:287–290. PMID: 12009079.

46. Skoner DP, Rachelefsky GS, Meltzer EO, Chervinsky P, Morris RM, Seltzer JM, Storms WW, Wood RA. Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate. Pediatrics. 2000; 105:E23. PMID: 10654983.