EVALUATION OF EFFICACY OF MANAGEMENT PROTOCOL IN ALLERGIC RHINITIS

Abstract

Background: Allergic rhinitis represents a global health issue affecting between 10% to 25% ofthe world population, with increasing prevalence, resulting in a significant impact on quality oflife, multiple comorbidities and the considerable socio-economic burden. Majority of the patientsare younger than 30 years and it may be inherited. Symptoms typically occur as a result ofexposure to dust, dander or certain seasonal pollen. Lack of standardized management protocol isone of the major factors responsible for poor control of this condition. This study was designed toevaluate the patients suffering with allergic rhinitis and manage them with a protocol based on thepathogenesis of the condition. Method: This prospective study was conducted in the Departmentof Ear, Nose & Throat and Head & Neck Surgery, Ayub Teaching Hospital, Abbottabad, over aperiod of two years (2005 – 2006), to assess the efficacy of a standard protocol of treatmentdeveloped and followed in the department. 1167 patients, clinically diagnosed as suffering withallergic rhinitis, were evaluated and managed. Age ranged from 08 months to 64 years. All thepatients were prescribed medical treatment, divided into initial phase of 10 days to two weeksduration followed by a maintenance phase, and a regular follow-up schedule was maintained uptotwo years. Results: 634 (54.32%) patients were male and 533 (45.67%) were female. Age rangedfrom 08 months to 64 years, 85% being between 05 and 45 years. 91% of patients had symptomduration of 06 months to 03 years. 96% of the patients were getting treated on as required basis,whereas 98% had no educational sessions with the treating doctor, especially regarding preventivemeasures. Typical presentation in most of the patients was nasal obstruction, runny & itchy nose,post nasal drip and bouts of sneezing. 90.57% patients reported improvement in symptoms.53.21% patients had a relapse of symptoms at some stage during the study period. 37.53% patientshad surgery done for associated pathologies, mostly a DNS. Compliance regarding medicationwas more than 90% in the initial phase of treatment that dropped to 50% in the maintenance phase.93% of the patients tolerated the treatment well. Conclusion: Allergic rhinitis is a growingproblem worldwide. Optimal treatment protocol is still lacking especially in the developingcountries. Patient’s education on avoidance of allergens must be stressed. Associated problemsthat may need surgical treatment. Regular follow-up must be ensured to monitor the progress oftreatment as well as to identify patients who might be candidates for immunotherapy. Newermodalities of treatment need to be further explored. A team approach is mandatory in the presenceof symptoms related to lower respiratory tract.Key words : Allergic rhinitis; Treatment; Antihistamine; Intranasal corticosteroid; Surgery