Impact of Allergic Rhinitis on exam performance and quality of life
Dr Dinkar Bakshi, MBBS MD(Paed) MRCPCH FRCPCH MSc(Allergy)
Advance copy, Pulse GP magazine, 2017
Epidemiology of allergic rhinitis in the UK:
Allergic rhinitis is the commonest chronic allergic disorder in children and is increasing in prevalence worldwide. About 1 in 4 adults in the UK suffer from some form of allergic rhinitis. The worldwide incidence of allergic rhinitis in adolescents is 14.6%.1 The pathogenesis is influenced by both genetic and environmental factors. It is caused by stimulation of specific IgE antibodies to airborne allergens, which in turn stimulate the mast cells to release histamine, leading to an inflammatory response.
Most people associate allergic rhinitis with ‘seasonal’ hay fever symptoms triggered by pollen in spring/ summer.
However, many patients have ‘perennial’ symptoms triggered by allergens in the home environment, i.e. house dust mite, moulds, cat and dog dander. A more recent classification of allergic rhinitis is ‘intermittent’ for symptoms lasting less than four days a week or less than four consecutive weeks, and ‘persistent’ for longer duration symptoms.
Impact of allergic rhinitis on quality of life:
Allergic rhinitis has a significant impact on quality of life and workforce productivity. The symptoms of rhinorrhea, nasal irritation, sneezing, nasal congestion, watery eyes and smell disturbance are more prominent in adolescents and young adults. It causes sleep deprivation, impairs concentration and alertness during the day, makes patients uncomfortable and causes a feeling of unease.
The symptoms reach their peak during the spring and summer months, restricting outdoor activities in patients. There is robust evidence from clinical trials regarding detrimental effects especially during driving, and a negative effect on performance in the job. In extreme cases, this could lead to behavioural problems in children and/ or depression in teenagers and young adults.
Depending on the symptoms and their effect on quality of life, allergic rhinitis is classified as ‘mild’, or ‘severe’ if sleep and daily activities are affected.
In some cases, allergic rhinitis may be a trigger for asthma causing worsening of clinical symptoms and the need for more frequent use of inhalers.
Therefore, allergic rhinitis may affect the earning potential of an individual, having a knock-‐on effect on the family, and by extrapolation on a larger scale have a negative impact on the health budget and national economy.
Impact of allergic rhinitis on exam performance
School examinations in the UK are conducted in the months between May and June, which are the peak time period for allergic rhinitis (especially hay fever triggered by grass and tree pollen). In a significant study conducted by Education for Health in the UK in 2007, statistically significant results determined that children with allergic rhinitis symptoms, are likely to drop a grade between the ‘mock’ and ‘final’ GCSE.
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