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  • Dr. Dinkar Bakshi

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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