What is the burden and prevalence of chronic allergic rhinitis in India and globally?

Burden and Prevalence of Chronic Allergic Rhinitis in India and Globally

Allergic rhinitis affects approximately 22% of adolescents in India, while globally it represents a significant health burden impacting quality of life and causing substantial economic costs. 1

Prevalence

India

• Approximately 22% of adolescents currently suffer from allergic rhinitis in India 1
• According to physician perceptions, 42.5% of Indian doctors report that allergic rhinitis prevalence in their clinical practice is between 21-40% 2
• Around 40% of physicians note a substantial burden of allergic rhinitis with comorbid asthma 2
• The true burden may be underrepresented due to lack of adequate epidemiological studies, particularly in rural and suburban areas 1

Global

• Chronic rhinitis (both allergic and nonallergic) affects a significant portion of the population worldwide 3
• There has been a reported rise in the prevalence of allergic rhinitis globally, including in India 4

Disease Burden

Health Impact

• Allergic rhinitis significantly impacts patient quality of life 3, 1
• It is associated with numerous comorbid conditions, particularly asthma 2, 4
• In India, 40-50% of pediatric asthma cases are uncontrolled or severe 4

Economic Impact

• Allergic rhinitis carries an important societal economic burden 3
• In India, treatment is suboptimal in a significant proportion of cases due to:
  • Unaffordability of medications
  • Low national gross domestic product
  • Religious beliefs and myths regarding chronic ailments
  • Stigma associated with chronic conditions
  • Illiteracy
  • Lack of allergy specialists 4

Risk Factors in India

• Traditional risk factors: environmental exposures and genetic factors 1
• Emerging risk factors specific to India:
  • Presence of dumpsters near residences
  • Movement of vehicles near homes
  • Exposure to artificial light at night
  • Unacceptably high levels of exposure to particulate matter (PM2.5) from:
    • Traffic pollution
    • Use of fossil and biomass fuels
    • Burning of incense sticks and mosquito coils 4, 1

Diagnostic and Treatment Challenges in India

• Lack of specialized training in allergy and immunology among Indian clinicians 1
• Limited diagnostic facilities 1
• High cost of medications 1
• Lack of access to allergen-specific immunotherapy 4
• Unavailability of high-quality allergen extracts for skin tests 4
• Absence of adrenaline auto-injectors 4
• No higher postgraduate specialist training programs in Allergy and Immunology 4

Current Management Practices in India

• 47.5% of physicians report total IgE count as mandatory for diagnosis 2
• For mild seasonal or perennial allergic rhinitis:
  • 60.9% of physicians prefer fexofenadine as oral antihistamine of choice 2
• For moderate to severe allergic rhinitis:
  • 67.1% of physicians prefer fluticasone furoate as intranasal corticosteroid 2
  • Recommended duration of intranasal corticosteroid therapy is 2-4 months (40.9% of physicians) 2
• 75.6% of physicians prefer using fexofenadine in combination with montelukast 2
• 52.2% of physicians believe oral montelukast-fexofenadine has 60-90% efficacy in mild-moderate allergic rhinitis 2
• Around 55.3% of physicians have not used immunotherapy in clinical practice 2

Urgent Need for Action

• Strategic multipronged approach needed to enhance quality of care 4, 1
• Infrastructure creation for education and training of healthcare professionals and patients 4
• Regulatory involvement to make essential treatments accessible at subsidized prices 4
• Research into better phenotypic characterization of allergic disorders specific to Indian population 4
• Western evidence not directly applicable to India due to confounders such as:
  • Ethnicity
  • Air pollution
  • High rates of parasitic infestation
  • Other infections 4