CLINICAL AND RISK FACTOR

PROFILE OF RHINITIS AMONG

MEDICAL STUDENTS OF
ALLAMA IQBAL MEDICAL
COLLEGE

MUHAMMAD AZIZ UR REHMAN ROLL NO.169

MUHAMMAD ARSLAN MAZHAR ROLL NO.161
MUHAMMAD AWAIS SALEEM ROLL NO.164
MUHAMMAD AWAIS AMJAD ROLL NO. 163
MUHAMMAD AMMAR KHAN ROLL NO.145
MUHAMMAD TALAL AHMAD MUGHAL ROLL NO.349
SR.NO CHAPTER PAGE
1 ABSTRACT 4,5
2 INTRODUCTION 6
3 MATERIALS AND METHOD 8,9
4 RESULTS 10

5 MAIN FINDINGS 11-20

TABLES AND GRAPHS
6 DISCUSSION 21
7 CONCLUSION 22
8 REFERENCES 23-26
9 QUESTIONNAIRE 27-28

1
DEPARTMENT OF COMMUNITY MEDICINE
ALLAMA IQBAL MEDICAL COLLEGE, LAHORE

INDEX

SR.NO TITLE
1. Table no.1 (Student profile)
2. Table no.2 (risk factors of rhinitis)
3. Table no.3 (severity of attack of rhinitis)
4. Table no.4 (clinical symptoms of rhinitis)
5. Bar diagram no.1 (Sore throat)
6. Bar diagram no.2 (Fever)
7. Bar diagram no.3 (seasonal influence)
8. Bar diagram no.4(Duration of rhinitis)
9. Bar diagram no.5 (Environmental cause of rhinitis)

ACKNOWLEDGEMENT

We are extremely grateful to Prof. Dr. Arif Tajammul, our dynamic principal and
our visionary former Head of community medicine department Prof. Dr.
Rakhshanda Farid and current Dr.Naeem for providing us such an excellent

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opportunity for completion of our first research activity and their support and
supervision

We are also very thankful to our respected facilitator Dr. Tahir Ismail and
Dr.Mehwish for their encouragement and guidance throughout this research
project

BATCH H
4th Year MBBS
SESSION 2019

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ABSTRACT
Background and Objective

Allergic rhinitis and asthma are chronic inflammatory conditions of airways having
same pathophysiology. The objective of this study was to determine the
frequency of rhinitis and its association with gender and age among population.
Further, this research aims to contribute to bridge the gap of knowledge in
understanding pathogenesis of accelerated effects of factors which are causing
rhinitis

Materials and Methods

A cross-sectional study was done among 300 medical students fulfilling the
inclusion criteria. Ethical approval was obtained from all the participants of the
study. After informed consent, detailed demographic information of the
participants was obtained. Participants of the study were asked some questions
to fill a well-designed questionnaire which was aimed to get necessary
information in order to fulfil the objectives of the research.

Results

153 male and 147 female patients with 90 and 210 patients belonging to below
and above 20 years were included in the study. Association of allergic rhinitis whit
gender and age were statistically significant. Multiple regression analysis showed
predictability of rhinitis from cold air. Rhinitis is frequently associated with sore
throat watering of eyes deflected nasal septum and fever .

4
Conclusion
Most people suffer from acute rhinitis because of cold air exposure, winter
season and show symptoms of fever watering of eyes along with sore throat

Key Words
Sore throat, fever, age, gender, sneeze, deflected nasal septum. Rhinitis
medicamentosa Rhinitis sicca, Allergic rhinitis, chronic rhinitis, vasomotor rhinitis.

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 Rhinitis, also known as coryza, is irritation and inflammation of
mucous membrane inside the nose. Common symptoms are stuffy nose, runny
nose, sneezing and post-nasal drip. Rhinitis is characterized into three types: (1)
Infectious rhinitis includes acute and chronic bacterial infections; (2) non-allergic
vasomotor rhinitis including idiopathic ,hormonal, atrophic, occupational, and
gustatory rhinitis as well as rhinitis medicamentosa (drug-induced); (3) allergic
rhinitis, triggered by animal dander, pollen , dust. Non-allergic was due to
vasodilation due to over activity of sympathetic nervous system. As additional
causes were identified, additional types of non-allergic rhinitis were recognized.
Allergic rhinitis is a diagnosis associated with a group of symptoms affecting the
nose as noticed. These symptoms occur upon exposure to some irritants present
in your surroundings. Rhinitis medicamentosa is a drug induced non-allergic
rhinitis. Rhinitis sicca is a chronic form of dry nose. Rhinitis polypus is chronic form
of rhinitis associated with the nasal polyps.
Previous researches conducted on this topic highlighted many causes
of rhinitis in various ratios among general population with the result as follows:
research on house dust mite establish a better awareness epidemiological status
of HDM(house dust mite)[1]. Strong IgE of protein fragments from cannabis sativa
pollen suggest its allergic potential[2]. Lipid based ointment is an adjuvant
therapy for allergic rhinitis[3]. IL-13 imposes increasing effect on allergic rhinitis
occurrence [4]. IL-17 and eotaxin are important factors in asthma[5]. Free
dominant symptoms of rhinitis are sneezing(90%), rhinorrhea (75%) and nasal
congestion (48%)[6]. Drug -induced can be treated by stopping nasal
decongestant drops[7]. IL-4 plays an important role in the pathogenicity of
rhinitis[8]. Patients having rhinitis should avoid marijuana[9]. Cannabis sativa is
also related to serve respiratory allergies[10].role of flavors and chemicals in
inducing TRPA-1 ( transient receptor potential cation channel) associated
rhinitis[11]. Administration of zataraimultiflora decreases the IL-17 expression
among patients[12]. Milk products of cows have proteins that can trigger
rhinitis[13]. Exposure to allergens during fetal life produces antibodies causing
hypersensitivity in response [14]. Some proteins in wheat can produce allergic
rhinitis particularly in people of Hyderabad[15]. Analysis of occupational allergic
disorders causing asthma dermatitis and anaphylaxis [16]. Gestational week and
BMI with its relation to pregnancy rhinitis[17]. Angiotensin converting enzyme

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mutation associated with allergic rhinitis[18]. Enhance risk of exposure to fine
particulate method as well as bio aerosol in Urban residential buildings of
Pakistan[19]. Phosphorus flame retardants in indoor dust and its association with
allergic rhinitis[20]. Animal cockroach, food fungus and house dust mite are the
common allergens among general population [21].
As rhinitis is a common disease so it Is need of time to determine
its prevalence, comorbidities and risk factors associated with it in order to
increase awareness among people in an effort of decreasing rhinitis prevalence in
our country.
OBJECTIVES
CLINICAL AND RISK FACTOR PROFILE OF RHINITIS AMONG
MEDICAL STUDENTS OF ALLAMA IQBAL MEDICAL COLLEGE
Operational definitions.
Non-allergic or vasomotor rhinitis: includes idiopathic, hormonal, gustatory,
occupational and atrophic.
Chronic rhinitis: is a type of atrophy of mucous membrane and glands of nose.
Rhinitis sicca: a chronic form of dryness of mucous membrane.
Rhinitis medicamentosa: is a drug-induced non-allergic rhinitis
Allergic rhinitis : triggered by pollens
, dust, animal dander etc.

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Material and Method
Study design:
Descriptive cross sectional study.
STUDY SETTING AND DURATION:
Study was conducted in Allama Iqbal Medical College Lahore, from March 2019 to
June 2019.

Sampling Technique
● Non-probability/ purposive sampling
SAMPLE SELECTION:
Inclusion criteria
● Students from first to final year of Allama Iqbal Medical College Lahore.
●Either gender
Exclusive criteria
● drop out students.
Sample size:
300 students
Data collection and Analysis:
A cross sectional study was performed among 300 students fulfilling the inclusion
criteria. Ethical approval was obtained from all participants. After informed
consent detailed demographic information of participants was gained.
Participants were separately asked questions was aimed to gain some important
information. Inclusion and exclusion criteria were strictly followed.

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Data analysis and procedure:
Data was entered and analysed in SPSS. Results were recorded as frequencies ,
percentages and showed in the form of tables , pie-charts and bar graphs. Cross
tables made.

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RESULTS:
Research was performed among 300 people with 153 males and 147 females
divided in two age groups with 90 students below 20 years old and 210 above 20
years old
Discussing the risk factors, deviated nasal septum was found in 21 students while
thyroid problem was also present in 21 students
18 students presented with nasal fracture. Students with positive smoker status
were 12 in number. A previous family history of rhinitis was found in 114
students.
Students that suffered from rhinitis in a year 1-2 times, 3-4 times, 4-5 times and
more than that are 174, 84, 27 and 15 respectively.
Majority of students suffered from an acute attack of rhinitis of 3-4 days with 150
students reported. 120 reported attacks for 1 week and 30 reported for longer
duration of attacks
Interference of rhinitis with daily activities was found positive in 216 students.
A great number of students;162 suffered from rhinitis in winter while those
suffered in summer were 36, spring 33, autumn 9 and without any specific season
60.
Students suffered from acute attack of rhinitis in morning were 159, in evening
114 and those who suffered for the whole day long were 27
The usual appearance of symptoms includes 99 complaints of headache, 66
complaints of redness of eyes, 54 complaints of both headache and redness of
eyes and 81 reported none of these complaints were present.
Nasal blockage or runny nose was found 153 and excessive sneezing was also
present in 84 students. Emotional relation was found positive in 132 students
Sore throat was present in 210 students. Fever was also present in 186 students.
Environmental trigger for rhinitis in majority of the students was cold air by 111 in
number, smoke on the second by 66, dust 63, pollen 42 and any kind of smell 18

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Table no.1 Student profile
Age of students
Frequency Percent

below 20 90 30.0

210 70.0
above 20

Total 300 100.0

Gender of students
Frequency Percent

147 49.0
male

153 51.0
female

300 100.0
Total

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Table no.2 Risk factors of rhinitis

Risk factors Frequency Percentage

Yes 21 7
Deviated Nasal No 279 93
Septum
Yes 21 7
Thyroid problem
No 279 93

Yes 18 6
Nasal Fracture
No 282 94

Yes 12 4
Smoking status
No 288 96

Yes 114 38
Family history
No 186 62

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Table no.3 Severity of attack of rhinitis

Frequency Percentage

1-2 times 174 58

Frequency of 3-4 times 84 28
rhinitis events in
4-5 times 27 9
a year
More than that 15 5
3-4 days 150 50
Duration of 1 week 120 40
rhinitis attack
More than that 30 10
Yes 216 72
Interference with
No 84 28
daily activities
Winter 162 54
Seasonal Summer 36 12
occurring of
Autumn 9 3
rhinitis
Spring 33 11
No specific 60 20
season
Morning 159 53
Timing of severe Evening 114 38
attack of rhinitis
Whole day 27 9

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Table no.4 symptoms of rhinitis

Symptoms Frequency Percent

Usually Headache 99 33
appearing
Redness of eyes 66 22
symptom
Both 54 18
None 81 27
Emotional Yes 132 44
relation with
appearance No 168 56
of symptoms
Nasal Yes 153 51
blockage or
runny nose No 147 49

Excessive Yes 84 28
sneezing
No 216 72

Sore throat Yes 210 70

No 90 30

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Fever Yes 186 62

No 114 38

Environmental Smoke 66 22
factors
causing Dust 63 21
symptoms of Pollen 42 14
rhinitis
Any kind of smell 18 6
Cold air 111 37

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DISCUSSION
Allergic rhinitis is one of the most common allergic problems affecting 10-40% of
the general population and its prevalence is increasing globally [22].
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 [23] Hubert Chen et al. [24], and
Monico Mit et al. [25] more than 60% of the patients suffered from difficulty in
performing daily tasks like doing jobs and have disturbed sleep. In the present
study, we found that patient quality of life was affected by interference of rhinitis
in their daily activities in 72% of the patients
Monico Mit et al. [25] more than 60% of the patients suffered from severe attacks
on the morning while present research shows that 53% people suffered from
acute rhinitis attack in the morning.
In a study conducted by Damian Leger, no significant relationships were reported
between gender and quality of life, but the overall performance of women was
reported to be better than that of men (Leger et al., 2006).
It was shown by international study of allergic rhinitis survey nasal symptoms of
AR were more intense in the spring (51.92%), in autumn (28.85%), and
throughout the year (26.92%). However, in the summer (15.38%) and winter
(13.46%), the symptoms were not intense [26] however our research depicts that
most of the patients suffered from rhinitis in winter season 54%, summer 12%,
autumn 9%, spring 11% and 20% patients’ complaint of rhinitis attack with no
specific seasonal association
Allergic rhinitis is considered to be a major health problem that impairs quality of
life. A possible relationship with psychological stress may exist. In a research on
nasal symptom assessment and quality assessment were performed in all patients
after treatment. Of the 166 patients with prolonged allergic rhintis, 122 (73.5 %)
were positive on the Kessler Psychological Distress Scale [27] however our study
shows not a significant relationship of rhinitis with stress as only 44% of cases
were recorded

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CONCLUSION:
. Most of the people suffer from acute rhinitis because of cold air
and show symptoms of fever, watering from eyes along with sore throat.
• Rhinitis occurrence is prominent during morning time
• Rhinitis occur majorly in winter season
• Rhinitis leads to fever
• Rhinitis leads to watering of eyes, nose and sneezing.
• Rhinitis is accompanied by sore throat

RECOMMENDATIONS:
Multi-disciplinary approach is required, especially the doctors should impart
awareness and precautionary measures to the population and make sure that the
population do follow the precautionary measures.

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allergens
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2. Choudhary S, Murad S, Hayat MQ, Shakoor Z, Arshad M. Identification of IgE-

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Polymorpjism in the IL-4,IL-4 receptor and IL-13 genes and allergic phenotype:
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case control study.Advances in medical science.2016 Mar 1;61(1):40-5.

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estimation
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22. C.H.M.d. Silva, Tais Estevao da Silva, Karla P. Fernandes, Rogerio M. C. & Pinto.
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CLINICAL AND RISK FACTOR PROFILE OF RHINITIS
AMONG MEDICAL STUDENTS OF ALLAMA IQBAL
MEDICAL COLLEGE

QUESTIONNAIRE
Age: Gender:
SECTION A
1. Did you have any treatment for deviated nasal septum?
a. Yes b. No
2. Any nasal fracture before?
a. Yes b. No
3. Are you suffering from thyroid problem?
a. Yes b. No
4. Do you smoke?
a. Yes b. No

SECTION B

5. Do you have sudden outburst of sneezing in the morning?

a. Yes b. No c. Sometimes
6. Which of these symptoms appear usually?
a. Headache b. Redness of eyes c. Both d. None
7. Do above mentioned symptoms appear when you are emotionally
disturbed?
a. Yes b. No c. Sometimes
8. Do you have nasal blockage or runny nose?
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 a. Yes b. No
9. Are you suffering from excessive sneezing?
a. Yes b. No
10. Do your symptoms aggravate during August to mid-September or spring
season?
a. Yes b. No c. Sometimes
11. How often do you suffer from rhinitis in a year?
a. 1-2 times b. 3-4 times c. 4-5 times d. more than that
12. How many days one episode of rhinitis remains?
a. 3-4 days b. 1 week c. 2 weeks d. more than that
13. Do these symptoms interfere with your daily activities?
a. Yes b. No c. Sometimes
14. Which of the following cause symptoms?
a. Smoke b. Dust c. Pollen d. Any smell e. Cold air
15. Do you have sore throat with symptoms?
a. Yes b. No c. Sometimes
16. Do you experience fever associated with these symptoms?
a. Yes b. No c. Sometimes
17. In which season symptoms occur intensively?
a. Winter b. Summer c. Autumn d. Spring e. No specific season
18. When are these symptoms more severe?
a. Morning b. Evening c. Whole day
19. Is there a family history of rhinitis?
a. Yes b. No

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