Allergic rhinitis (AR) is a common chronic condition affecting the nasal mucosa due to exposure to allergens. Among school-aged children, AR is particularly significant due to its impact on quality of life, academic performance, and overall health. The prevalence of AR in this demographic is on the rise globally, necessitating an in-depth understanding of its epidemiology, pathophysiology, clinical features, and management strategies.^1,2 The prevalence of allergic rhinitis among school-aged children has increased over the past few decades. Studies suggest that up to 40% of children globally are affected by AR, with variations based on geographic, environmental, and genetic factors. Urbanization, pollution, and lifestyle changes are significant contributors to this rising trend. For instance, a study conducted in urban China reported a prevalence rate of 30% among children aged 6-14 years. Allergic rhinitis is an IgE-mediated inflammatory response to inhaled allergens such as pollen, dust mites, animal dander, and mold. Upon exposure to these allergens, sensitized individuals experience an immediate hypersensitivity reaction characterized by the release of histamines, leukotrienes, and other inflammatory mediators from mast cells.^3,4 This results in symptoms such as nasal congestion, rhinorrhea, sneezing, and itching. Chronic inflammation can lead to complications like sinusitis and otitis media, further affecting the child's health and well being. Children with AR typically present with a constellation of symptoms that include persistent sneezing, nasal congestion, clear nasal discharge, and nasal itching.⁵ These symptoms often lead to mouth breathing, snoring, and a characteristic "allergic salute" – a habitual upward rubbing of the nose. AR can significantly impair sleep quality, leading to daytime fatigue, irritability, and difficulty concentrating in school, thus affecting academic performance and social interactions. The burden of AR extends beyond physical symptoms, impacting the emotional and social aspects of a child’s life. Children with AR may experience anxiety, depression, and social isolation due to the chronic nature of their symptoms and the stigma associated with frequent sneezing or a runny nose. Moreover, sleep disturbances caused by AR can lead to poor academic performance and cognitive impairments, highlighting the need for effective management strategies.⁶ The diagnosis of AR in children primarily relies on a thorough clinical history and physical examination. Key indicators include a family history of atopy, seasonal variation in symptoms, and the presence of comorbid conditions such as asthma or eczema. Diagnostic tests, such as skin prick tests and specific IgE blood tests, can help identify the specific allergens responsible for triggering symptoms. Nasal cytology may also be used to detect eosinophilia, indicative of allergic inflammation. Management of AR involves a combination of allergen avoidance, pharmacotherapy, and immunotherapy. Allergen avoidance measures include using air purifiers, encasing bedding in allergen-proof covers, and minimizing exposure to known triggers. Pharmacological treatment typically involves antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists, which help alleviate symptoms and control inflammation.

AIM AND OBJECTIVES

To determine the prevalence and assess the impact of allergic rhinitis (AR) in school-aged children, focusing on symptomatology, geographical distribution, and associated chest symptoms.

Present cross-sectional study was conducted in the Department of ENT. A total of 100 students were taken for the study including both male and female students. The study was conducted at Department of Otorhinolaryngology (ENT), Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India. All individuals in this research provided prior informed consent. The study was conducted from February 1, 2013, to November 20, 2013. Keeping power (1-beta error) at 80% and confidence interval (1-alpha error) at 95%, the minimum sample size required was 60 patients; therefore, we included 100 (more than the minimum required number of cases) patients in the present study. All students were interviewed. The information was collected from them through interview using a questionnaire after taking informed consent. A detailed clinical history and physical examination was done. Questions were asked regarding the demographic profile, socioeconomic status and residential address. All the school going children in the age group of 6-18 years including both male and female students presented with one or more of the following symptoms: Nasal obstruction, Watery rhinorrhoea, Sneezing, Itching nose, Pharyngeal pruritis, Itching eyes and Itching nose.

Each of the above symptoms was scored as described by Wilson et al. 2001:

1. Absence of a given symptom
2. Significant symptoms, mild, well tolerated
3. Well defined, discomforting, and affecting activities that require high concentration
4. High intensity barely tolerated hindering daily activities and sleep.

Total score for each patient was calculated separately. Detailed general and physical examination was done. Detailed otorhinolaryngological examination was done which included: Anterior rhinoscopy, otoscopy, oral examination, nasal endoscopy, neck examination tunning fork tests, impedance audiometry, Base line investigations, complete haemogram, Specific investigations, Total serum IgE levels, Blood and eosinohhil count were investigated.

Spirometry: Computed assisted spirometry was done to diagnose the asthma. The parameters used were FEV1/FEF25-75 and FVC. Short acting bronchodilator was given to patients to confirm asthma. An improvement of 10% in FEV1 was taken for inclusion criteria.

Imaging: NCCT PNS was done in school going children with allergic rhinitis with chronic rhinosinusites with asthma. Chest x-ray was done in patients with deranged spirometric parameters. All the patients were started on inhalational nasal corticosteroid (flutacasone). Patients were put on.

Statistical analysis The data were analyzed using SPSS version 20 (SPSS Inc., Chicago, Illinois, USA). For all tests, confidence level and level of significance were set at 95% and 5% respectively.

Table 1: Gender Distribution of School-Going Children Presenting with Symptoms of Allergic Rhinitis

The study revealed a slight male predominance, with 58% of cases being males and 42% females. This gender distribution may reflect higher exposure among males to environmental allergens such as outdoor dust, pollen, and pollution due to activities like playing or commuting. Additionally, gender-related immunological or behavioral differences could influence the manifestation and reporting of symptoms. The balanced overall distribution ensures that findings are representative of both genders.

Table 2: Geographical Distribution of School-Going Children Presenting with Symptoms of Allergic Rhinitis

Children from rural areas constituted a larger proportion (55%) compared to those from urban areas (45%). This difference could be attributed to rural environmental conditions, including increased exposure to agricultural dust, animal dander, and poorly ventilated living spaces, which are common triggers for allergic rhinitis. Conversely, urban children are exposed to vehicular pollution and industrial emissions, but these factors seem less dominant in the present study. This geographic variation highlights the role of environmental factors in the prevalence of allergic rhinitis.

Table 3: Distribution of School-Going Children with Allergic Rhinitis as per Symptomatology

Sneezing (78%) was the most common symptom reported, followed by watery rhinorrhoea (70%) and nasal obstruction (62%). These are hallmark symptoms of allergic rhinitis, reflecting its pathophysiological basis involving allergen induced inflammation of the nasal mucosa. Itching of the nose (55%) and eyes (48%) were also prominent, indicating concurrent allergic conjunctivitis in some cases. Pharyngeal pruritis (40%) suggests postnasal drip or throat irritation, which are common extensions of nasal allergic reactions. The high prevalence of these symptoms underscores the burden of allergic rhinitis and its impact on daily activities like breathing, sleeping, and concentrating in school.

Table 4: Distribution of Chest Symptoms Suggestive of Latent Asthma in School-Going Children with Allergic Rhinitis

Cough (35%) was the most frequent chest symptom, followed by nocturnal waking (28%), occasional wheezing (25%), and chest tightness (20%). These findings suggest a significant overlap between allergic rhinitis and asthma, often referred to as "united airway disease." Allergic rhinitis, as a chronic inflammatory condition, predisposes children to airway hyperresponsiveness and latent asthma. Nocturnal waking and wheezing further indicate impaired respiratory function, particularly during sleep. These findings emphasize the need for early identification and integrated management of allergic rhinitis and asthma in school-going children.

The male predominance observed in this study aligns with earlier findings by Shaaban et al. (2008), who reported a higher prevalence of allergic rhinitis among males, attributing it to increased outdoor activities and greater exposure to environmental allergens.6 Males are more likely to engage in physical activities that expose them to dust, pollen, and other irritants, which could explain the higher prevalence. In contrast, Riedler et al. (2000) observed no significant gender differences in some regions, suggesting that cultural and behavioral factors may play a role in gender variation. The slight male predominance in our study reflects regional environmental and behavioral influences.⁷ The higher prevalence of allergic rhinitis in rural areas (55%) compared to urban areas (45%) contrasts with findings by von Mutius (1998), who reported higher allergic rhinitis prevalence in urban populations due to exposure to vehicular pollution and industrial emissions.⁸ However, rural children in our study may have been more exposed to agricultural dust, animal dander, and poor ventilation, as noted by Nafstad et al. (2001), who linked rural environmental conditions to increased allergic sensitization. This geographical variation highlights the diverse environmental triggers of allergic rhinitis and the need for location-specific preventive measures.⁹ The predominance of sneezing (78%), watery rhinorrhoea (70%), and nasal obstruction (62%) aligns with the hallmark symptoms described by Bousquet et al. (2001) in their characterization of allergic rhinitis.¹⁰ These symptoms result from allergen-induced histamine release and subsequent inflammation of the nasal mucosa. Concurrent itching of the nose (55%) and eyes (48%) reflects overlap with allergic conjunctivitis, a finding consistent with Linneberg et al. (2002), who reported frequent comorbidity between these conditions.¹¹ Pharyngeal pruritis (40%) observed in our study was similarly noted by Small et al. (2007) as an indicator of postnasal drip, underscoring the multi-symptom burden of allergic rhinitis.¹² The significant overlap between allergic rhinitis and asthma, as evidenced by cough (35%), nocturnal waking (28%), wheezing (25%), and chest tightness (20%), supports the concept of "united airway disease" proposed by Braun-Fahrländer et al. (1999).¹³ This overlap reflects shared inflammatory pathways and airway hyperresponsiveness in both conditions. Nocturnal symptoms, such as waking and wheezing, were highlighted by Sporik et al. (1995) as markers of subclinical asthma. These findings emphasize the need for integrated management of allergic rhinitis and latent asthma to prevent disease progression.¹⁴

This study highlights the significant burden of allergic rhinitis among school-going children, with a male predominance and higher prevalence in rural areas. Common symptoms like sneezing, watery rhinorrhoea, and nasal obstruction reflect the classic presentation of allergic rhinitis, while associated chest symptoms underscore the overlap with asthma. Environmental factors such as exposure to agricultural dust and poor ventilation likely contribute to these findings. The results emphasize the importance of early diagnosis, integrated management of allergic rhinitis and asthma, and targeted interventions to address environmental triggers in affected populations.

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