European Journal of Cardiovascular Medicine

Allergic Rhinitis is a symptomatic disorder of the nose induced after allergen exposure due to an IgE-mediated inflammation of membranes lining the nose. It is clinically defined as a symptomatic condition with four major symptoms as anterior or posterior rhinorrhoea, sneezing, nasal itching and nasal congestion. 1,2 Allergic rhinitis is characterized by symptoms such as congestion, rhinorrhoea, sneezing, itching, nasal obstruction etc. It is also associated with fatigue, headache, cognitive impairment and sleep disturbance. Allergic rhinitis represents a global health problem. It is an extremely common disease worldwide, affecting 10 to 25% of the population3-5. An increasing prevalence of AR over the last decades has been recognized6.WHO in collaboration with ARIA (Allergic rhinitis and its impact on asthma) has classified allergic rhinitis as seasonal and perennial, seasonal allergy which is linked to pollen allergy and perennial allergy is linked to house dust mites. ARIA has also classified allergic rhinitis on the basis of duration and severity of symptoms as Intermittent and Persistent. Intermittent AR has symptoms that occur for four or less days per week or for not more than four consecutive weeks and Persistent AR lasts for more than four days per week and for more than four consecutive weeks7.

However, compared to asthma, allergic rhinitis appears to be a transient and somewhat milder disease. It can substantially affect various aspects of quality of life in patients, including work, education and productivity8. Moreover, allergic rhinitis is usually associated with other diseases of the respiratory tract, and the cumulative costs of controlling this condition can negatively affect the socioeconomic aspects of the patient’s life9.

Quality of life is reduced with this condition due to the direct effects of its primary symptoms on the patient’s life. Allergic rhinitis also tends to cause sleep disorders, fatigue, impaired memory, depression, etc., all of which contribute to a reduced quality of life10.

Quality of life (QOL) signifies wellbeing, welfare, and satisfaction of life; Health Related Quality of life (HRQOL) refers to the part of quality of life associated with health. The assessment of quality of life has become a major area of interest for clinical research. QOL questionnaires have been developed to assess the effect of clinical management and of reducing the symptoms of chronic diseases on the patients’ daily life, and to determine the effect of particular methods of treatment on controlling the disease. The rhinoconjunctivitis quality of life questionnaire (RQLQ) was prepared by Juniper and Guyatt in 1991 to assess the quality of life in patients with rhinoconjunctivitis

Since the symptomatology of allergic rhinitis is diverse and there is less data available on its effect on quality of life, so the present study was conducted to assess the quality of life in patients with allergic rhinitis in our region.

Aims And Objectives

The present study is aimed to determine quality of life in patients with allergic rhinitis in our region

This present cross-sectional study is conducted in the Department of ENT, ESIC Medical College and Hospital, Kalaburagi, from the period of October 2023 to March 2024. Ethical clearance was obtained from the Institutional Ethical Committee. An informed consent was obtained from all the patients before the start of study.

Source of Data:

Patients attending the ENT OPD with allergic rhinitis at ESIC Medical College and Hospital, Kalaburagi.

Sample Size: 150

Inclusion Criteria:

• Patients over the age of 10-year-old who suffered from symptoms of rhinitis such as nasal congestion, rhinorrhoea, constant sneezing, and itchy nose for a minimum of four days per week and for a period of at least four consecutive weeks (based on the ARIA guidelines).

Exclusion Criteria:

• Patients not fulfilling the ARIA guidelines.
• Patient not giving consent for the study.
•     Patients with Sino-nasal polyposis.
•  Patients taking immunotherapy.

Methods of collection of data:

• The cases selected for the study were subjected to detailed history taking and examination.
• Each patient underwent a systematic Ear-nose-throat examination.
• Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was given to all the patients and responses from individual was recorded.

Methodology:

All the patients were subjected to detailed clinical history particularly for nasal symptoms, general examination & otolaryngological examination was done. Thereafter, they were given Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) sheet. The participants were provided with all the necessary details on the questionnaires. The patients were interviewed and questionnaires were filled out. The RQLQ contains 16 items on the various aspects of quality of life, including general sleep problems (4 items), having trouble falling asleep (4 items), morning symptoms (4 items), and performance problems during the day (4 items). There were 7 options for answering each item depending on the severity of the symptoms.

The mean score of each individual was calculated based on the answers to the QOL questionnaire and the mean scores for each individual was calculated.

Statistical analysis:

Chi-square tests (χ2 tests) were used to assess the relationship between two categorical variables. The SPSS-16 software was used to calculate the mean, standard deviation (SD), and median for the quantitative variables. P-values less than 0.05 were considered statistically significant.

Table 1: Gender distribution

This study's cohort consisted of 102 participants, with a majority being male (64.8%, n=66) compared to female (35.2%, n=36). Regarding educational background, the largest group was illiterate (32.4%, n=33), followed by those with primary school education (19.6%, n=20). A significant portion of participants had at least some secondary education, with high school (16.7%), intermediate (14.7%), and graduate (14.7%) levels being nearly equally represented. Postgraduates formed the smallest group at 2.0% (n=2).

Table 2: Age Distribution of Male and Female Patients

The majority of patients were concentrated in the 61–80 years age group, comprising 28 males and 16 females, indicating that cardiomyopathy predominantly affects the elderly in both sexes.

Table 3: Distribution of patients on the basis of geographical region, social class, Marital Status and religion wise

The data reveals that the majority of the group resides in hilly regions (59.8%), identifies with the middle or lower-middle social classes (collectively 76.5%), is overwhelmingly married (90.2%), and is predominantly Hindu (86.3%). A notable finding is an exact even split in dietary preferences, with half the group being vegetarian and the other half non-vegetarian. Each category is complete and internally consistent, with all subtotals correctly summing to the overall total of 102 individuals, or 100%.

Table 4: NYHA Functional Classification

The distribution of 102 patients by NYHA Class shows that nearly half (45.1%) were in Class II, indicating slight limitation during ordinary activity. Over a quarter (26.5%) were in Class III with marked limitation, while 22.5% were in the most severe, Class IV. A small minority (5.9%) were in the asymptomatic Class I.

Table 5: Distribution of ECG Findings in the Study Population

The most common ECG pattern was sinus rhythm, seen in 58 patients (56.9 percent), indicating a relatively preserved baseline rhythm in more than half of the patients. Atrial fibrillation was the second most common finding, observed in 19 patients (18.6 percent), which is consistent with the known association between cardiomyopathy and atrial arrhythmias. Ventricular premature complexes (VPC) were present in 13 patients (12.7 percent), suggesting underlying ventricular irritability. Sinus bradycardia was noted in 8 patients (7.8 percent), and a single case each of sinus tachycardia and left bundle branch block was identified (1 percent each), pointing to occasional conduction and rate abnormalities.

Table 6: Symptomatology and clinical findings

In the present study involving 102 patients diagnosed with cardiomyopathy, the most commonly reported clinical symptom was paroxysmal nocturnal dyspnea (PND), observed in 87.25% of patients. This finding suggests a high prevalence of left ventricular dysfunction and pulmonary congestion among the study population. Palpitations were reported by 70.59% of patients, indicating a significant incidence of arrhythmias, which are commonly associated with cardiomyopathy. Orthopnea was present in 54.90% of cases, further supporting the evidence of heart failure-related symptoms. The raised jugular venous pressure (JVP) was present in 52.94% of patients, which is a hallmark of right-sided heart failure and indicates elevated central venous pressure. Basal crepitations were noted in 50% of cases, suggesting the presence of pulmonary congestion due to left ventricular dysfunction.

Table 7: Echocardiography findings

The mean end-diastolic diameter (EDD) was 6.06 cm, suggesting enlargement of the left ventricle during diastole, while the mean end-systolic diameter (ESD) was 4.91 cm, indicating persistent dilation even after contraction. These measurements support the presence of left ventricular remodeling and structural changes that occur in response to chronic myocardial stress or injury.

Table 8: LVEF Category Distribution

The analysis of left ventricular ejection fraction (LVEF) in a group of 102 patients shows that all individuals have reduced systolic function, with none reaching the normal value of 55 percent or above. Among them, 43.1 percent fall in the range of 40 to 45 percent, indicating mild left ventricular dysfunction.

Allergic rhinitis is one of the most common allergic problems affecting 10-40% of the general population and its prevalence is increasing globally11. The present population in our study (60.66% female and 39.33% male) was similar to the previous study conducted by Shariat et al12. in which 62% of the participants were female and 38% were male.

Although the present study found no significant relationships between the quality of life and symptoms (including nasal congestion, itchy nose and rhinorrhoea) (p>0.05), rhinorrhoea was found to be the most common (90%) symptom of allergic rhinitis. In a study conducted by Mohammadi et al13.  rhinorrhoea was also the most common symptom of allergic rhinitis.

Shariat et al. reported nasal congestion to be the most common symptom of the disease and found a significant relationship between nasal congestion and quality of life impairment in patients12.

Moderate to severe intermittent allergic rhinitis was found to be the most frequent (38%) type of the disease in the study group. This is different from a previous study in which Shariat et al12. reported the severe permanent type as the most frequent (34%) type. The disparity of the findings may be attributed to climate differences.

We can see that a total number of 117 patients were found to have concomitant diseases, with the highest frequency pertaining to sinusitis (29%) and then asthma (12%). These findings are in accordance with the prior study by Shariat et al12. which reported the prevalence of these two concomitant diseases with similar frequency percentages. Inflammation of the nasal mucosa causes edema and congestion of the sinus cavities, leading to sinusitis.

The results of the present study showed, in the majority of patients, that their quality of life had been affected by problems caused by allergic rhinitis, including general sleep problems, morning symptoms, and practical problems during wake time. In the studies conducted by Shariat et al.12, Hubert Chen et al.14, and Monique et al.15, more than 60% of the patients suffered from sleep problems and also problems when awake. In the present study, we found that patient quality of life was affected by severe sleep problems (and problems during wake time) in 61.33% of the patients.

In this study, no significant relationship was found between quality of life and gender (p=0.456), although women had a better quality of life compared to men; similar to study conducted by leger et al. 16

In our study, no significant relationships were observed between quality of life and any one of the symptoms (e.g. nasal congestion, itchy nose, rhinorrhoea, and itchy and watery eyes). However, Shariat et al12. found a significant relationship between quality of life and nasal congestion.

The results obtained from the present study showed a significant relationship between quality of life and severity of the disease. Patients with severe permanent or intermittent disease had a poorer quality of life since the severity of the disease and associated symptoms tended to affect the patient’s physical and mental well-being, thus making their life more difficult. These observations are consistent with those from studies conducted by Shariat et al.12, Damian Leger et al.16 which showed that patients with a more severe type of the disease have a poorer quality of life.

Allergic rhinitis can adversely affect sleep quality, mood, and daily activities in the patients. Given the significant effects of these symptoms on the patient’s quality of life, making an early diagnosis of the disease is the first step to overcoming it. The subsequent steps are reducing environmental allergens and taking measures to prevent the incidence of concomitant diseases, such as asthma and sinusitis.

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