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 of
life, multiple comorbidities and the considerable socio-economic burden. Majority of the patients
are younger than 30 years and it may be inherited. Symptoms typically occur as a result of
exposure to dust, dander or certain seasonal pollen. Lack of standardized management protocol is
one of the major factors responsible for poor control of this condition. This study was designed to
evaluate the patients suffering with allergic rhinitis and manage them with a protocol based on the
pathogenesis of the condition. Method: This prospective study was conducted in the Department
of Ear, Nose & Throat and Head & Neck Surgery, Ayub Teaching Hospital, Abbottabad, over a
period of two years (2005 - 2006), to assess the efficacy of a standard protocol of treatment
developed and followed in the department. 1167 patients, clinically diagnosed as suffering with
allergic rhinitis, were evaluated and managed. Age ranged from 08 months to 64 years. All the
patients were prescribed medical treatment, divided into initial phase of 10 days to two weeks
duration followed by a maintenance phase, and a regular follow-up schedule was maintained upto
two years. Results: 634 (54.32%) patients were male and 533 (45.67%) were female. Age ranged
from 08 months to 64 years, 85% being between 05 and 45 years. 91% of patients had symptom
duration 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 preventive
measures. 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% patients
had surgery done for associated pathologies, mostly a DNS. Compliance regarding medication
was 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 growing
problem worldwide. Optimal treatment protocol is still lacking especially in the developing
countries. Patient's education on avoidance of allergens must be stressed. Associated problems
that may need surgical treatment. Regular follow-up must be ensured to monitor the progress of
treatment as well as to identify patients who might be candidates for immunotherapy. Newer
modalities of treatment need to be further explored. A team approach is mandatory in the presence
of symptoms related to lower respiratory tract.
Key words : Allergic rhinitis; Treatment; Antihistamine; Intranasal corticosteroid; Surgery
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