A FORGOTTEN PROBLEM -ALLERGIC RHINITIS

KANWAL SALEEM, LAHORE
Aug 06 - 12, 2007

You might don't know much about Allergic Rhinitis but you must have heard some thing about "Hay Fever" because it is widespread in our country. Well I have heard about different allergies and also suffer with seasonal allergy every spell, after all I am living in Pakistan where environment is rich with such viruses and proved to be favorable for the growth of allergicviruses.

Last Thursday I got a chance to attend a seminar organized by sanofi-aventis, a world wide renowned pharmaceutical company. This seminar was about the WHO's recommendations for allergy management. The seminar was basically arranged for medical practitioners, educators and researchers to update them about the new latest concepts, issues and trends relating to Allergic Rhinitis (AR).

This seminar proved to be very useful for me because I just have heard the name of AR, I wasn't aware about it, but at the end of the seminar I was able to deliver a lecture on this disease. Prof. Wang De Yun from National

University Singapore and highly renowned researcher and epidemiologist made me understand pros and cons of allergic rhinitis. I got to know certain things about AR and its management in Pakistan, in that seminar which made me writes about it.

Allergic rhinitis, more commonly referred to as hay fever, is an inflammation of the nasal passages caused by allergic reaction to airborne substances. AR is the most common allergic condition and one of the most common of all minor afflictions. It affects between 10-20% of all people in the United States, and is responsible for 2.5% of all doctor visits. Two-thirds of all patients have symptoms of allergic rhinitis before the age of 30, but onset can occur at any age. Allergic rhinitis has no sexual predilection, although boys up to the age of 10 are twice as likely to have symptoms as girls. A virtually identical reaction occurs with allergy to mould, animal dander, dust and similar inhaled allergens. Particulate matter in polluted air and chemicals such as chlorine and detergents, which can normally be tolerated, can greatly aggravate the condition.

There are two types of allergic rhinitis: seasonal and perennial. Seasonal AR occurs in the spring, summer, and early fall, when airborne plant pollens are at their highest levels. In fact, the term hay fever is really a misnomer, since allergy to grass pollen is only one cause of symptoms for most people. Perennial AR occurs all year and is usually caused by home or workplace airborne pollutants. A person can be affected by one or both types. Symptoms of seasonal AR are worst after being outdoors, while symptoms of perennial AR are worst after spending time indoors.

The pollens that cause hay fever vary from person to person and from region to region; generally speaking, the tiny, hardly visible pollens of wind-pollinated plants are the predominant culprits. Different trees, grasses and weeds are main source of allergic pollens. In addition to individual sensitivity and geographic differences in local plant populations, the amount of pollen in the air can be a factor in whether hay fever symptoms develop. Hot, dry, windy days are more likely to have increased amounts of pollen in the air than cool, damp, rainy days when most pollen is washed to the ground.

The effect of hay fever or AR can vary greatly: some people may only be mildly afflicted, whereas others may suffer greatly. Common symptoms are coughing, headache, itching nose, running nose, impaired smell, sneezing, fever, fatigue and sore throat. There is strong genetic predisposition to allergic rhinitis. One parent with a history of allergic rhinitis has about a 30 percent chance of producing offspring with the disorder; the risk increases to 50 percent if both parents have a history of allergies.

Before starting treatment, the physician and patient try to identify trigger factors for allergic symptoms. Skin or sometimes blood tests are performed to confirm the specific allergens to which the person has antibodies. The goal of treatment is to reduce the allergy symptoms. Avoidance of the allergen or minimization of contact with it is the best treatment, but some relief may be found with the medications. Oral decongestants alone may be helpful, including pseudo ephedrine. Antihistamines are available as tablets, capsules and liquids, and may or may not be combined with decongestants. Patient can also use nasal spray for treatment.

The allergy rate at national level is around 30 per cent to 40 per cent, according to allergy specialist. But the big difference is that pollen is the major cause of allergies in the green areas like capital whereas in other bigger and less green cities like Karachi or Lahore, the major culprits are dust and other pollutants. In the seminar, I came to know that in Pakistan there is no authentic official data available regarding to AR, the number of patients, usage of different drugs and identification of highly effected areas.

I was fed with some data by the speaker. It was base on the research which had been done in May-Aug 2002. It says 159,196,336 people were tested and the 76% were positive and 24% were negative. This studied was conducted in 20 cities of Pakistan. According to the result it is easy to determine that this is a growing problem in Pakistan.

What is needed is immediate action on the major cause of pollen allergy in the Pakistan. Therefore, any study ought to be conducted with the help of agricultural and biological research institutes on the measures to be taken to gradually phase out the causes of AR.

What is definitely not needed is yet another study to be merely placed on the shelves to gather dust, with allergy patients going through another torturous spring season next year. In fact seminars like I have attended one, is really useful in educating our doctors so that they can cope up with the latest techniques and methods in eradication of this disease.