Research | Volume 40, Article 70, 30 Sep 2021 | 10.11604/pamj.2021.40.70.30719

Patterns of allergic rhinitis among adults in Qassim region, Saudi Arabia: a cross sectional study

Sultan Alanazy, Mazyad Alenezi, Ibrahim Al-Quniabut, Ibrahim Aljuraifani, Malek Alburayh, Abdullah Altuaysi, Yahya Alyahya, Hajaj Al-Homaidan, Osama Al-Wutayd

Corresponding author: Osama Al-Wutayd, Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Al Qassim, Saudi Arabia

Received: 08 Jul 2021 - Accepted: 12 Sep 2021 - Published: 30 Sep 2021

Domain: Family Medicine

Keywords: Allergic rhinitis, ENT, complications, presentation, triggers, Qassim, Saudi Arabia

©Sultan Alanazy et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Sultan Alanazy et al. Patterns of allergic rhinitis among adults in Qassim region, Saudi Arabia: a cross sectional study. Pan African Medical Journal. 2021;40:70. [doi: 10.11604/pamj.2021.40.70.30719]

Available online at: https://www.panafrican-med-journal.com/content/article/40/70/full

Home | Volume 40 | Article number 70

Research

Patterns of allergic rhinitis among adults in Qassim region, Saudi Arabia: a cross sectional study

Patterns of allergic rhinitis among adults in Qassim region, Saudi Arabia: a cross sectional study

Sultan Alanazy1, Mazyad Alenezi2, Ibrahim Al-Quniabut1, Ibrahim Al-juraifani3, Malek Alburayh3, Abdullah Altuaysi3, Yahya Alyahya3, Hajaj Al-Homaidan3, Osama Al-Wutayd4,&

 

1Department of Surgery, Ears Nose and Throat Unit, Unaizah College of Medicine and Medical Sciences, Qassim University, Al Qassim, Saudi Arabia, 2Department of Otolaryngology, Head and Neck Surgery, College of Medicine, Qassim University, Al Qassim, Saudi Arabia, 3Unaizah College of Medicine and Medical Sciences, Qassim University, Al Qassim, Saudi Arabia, 4Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Al Qassim, Saudi Arabia

 

 

&Corresponding author
Osama Al-Wutayd, Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Al Qassim, Saudi Arabia

 

 

Abstract

Introduction: developing and developed countries have a high prevalence of allergic rhinitis (AR). Severe AR has negative impacts on sleep, quality of life, and work performance. The study aimed to identify the patterns of AR among patients attending the ears nose and throat Unit (ENT) clinic at King Saud Hospital, Qassim, Saudi Arabia.

 

Methods: this study was a cross-sectional study conducted at the ENT clinic of King Saudi Hospital, Unaizah City, Qassim region, Saudi Arabia. We examined outpatients diagnosed with AR using an interview questionnaire and clinical examination.

 

Results: the sample included 455 patients. Of these, 23.7% were 21-30 years old, 65.7% had a family history of AR, 57.8% had no general symptoms, 75.6% reported runny nose as the most common nasal symptom, and 35.4% reported no complications. Dust was the most common trigger of AR (82.4%), 49.2% reported allergic symptoms in all seasons, 96% of patients have inferior turbinate hypertrophy, and oral histamine was the most commonly used treatment (33.2%).

 

Conclusion: perineal AR and inferior turbinate hypertrophy were very common findings comparing to previous studies, further studies to assess the risk factors are highly recommended.

 

 

Introduction    Down

Rhinitis is a common inflammatory disorder of the nose, which affects approximately 40% of the population [1]. There are several different types of rhinitis, but allergic rhinitis (AR) is the most common type, reported to affect approximately 10%-20% of the population [2]. Allergic rhinitis prevalence is high in both developing and developed countries [3], affecting almost 400 million individuals worldwide [4,5]. In Jazan City in Saudi Arabia, an AR incidence of approximately 44% has been reported, substantially exceeding the global average of 10%-20% [6]. Symptoms of AR typically emerge after exposure to an allergen due to IgE mediated inflammation of the membranes lining the nose [7]. The symptoms of AR result in fatigue, cognitive function decline which impairs quality of life, depressed mood and sleep disturbances [8]. There are several triggers for AR, including domestic animals, mites, allergens of plant origin or animal origin, common outdoor allergens such as mold and pollens, tobacco smoke, occupational triggers such as latex, sulfur oxide and oxides of nitrogen, aspirin, ozone, and other non-steroid anti-inflammatory medications [7]. The major symptoms of AR include nasal obstruction, itching postnasal drip, sneezing and rhinorrhea [9]. AR can be classified into seasonal or perennial the former occurs during a specific season, whereas the later occurs throughout the year [10].

 

However, because this classification is not able to describe all patients, another classification system was established in which AR is classified according to symptom duration, as either intermittent (inflammation duration of less than 6 months) or persistent (symptoms continue throughout the year) and severity is classified as mild (where the patient can sleep normally), moderate or severe (where sleep and daily activity are affected) [11,12]. Because AR is commonly undetected in primary care settings, with patients suffering from the condition often being unable to recognize the impact of the disease and physicians failing to regularly ask patients about the condition, screening for AR is recommended [13]. Saudi Arabia is known for its frequent and periodic sandstorms in all seasons. Sandstorms transport many types of microorganisms and dust particles that can trigger or exacerbate respiratory diseases such as AR and asthma [14]. Qassim region is a central area in the kingdom of Saudi Arabia, and is well known agricultural zone, and has the desert climate, with frequent dust storms, and low humidity [15]. In unpublished communication, medical practitioners in various specialties have thought that a large number of people in Qassim region suffer from AR compared to other regions. However, few studies of this widespread disease have been conducted in Saudi Arabia, and the patterns of the disease remain to be clarified. To the best of our knowledge, this is the first study of AR to be conducted in Qassim region. The present study was conducted to identify patterns of AR among patients attending the ear, nose and throat (ENT) outpatient clinic at King Saud Hospital, Unaizah City, Qassim region, Saudi Arabia.

 

 

Methods Up    Down

Study design and setting: we conducted a quantitative observational descriptive cross-sectional study among outpatients from the ENT clinic of King Saud Hospital, which has a capacity of 294 beds and is the only governmental hospital in Unaizah city, Qassim region, between January 2019, and December 2019.

 

Sample size: the sample size was calculated based on assuming that the prevalence of perineal allergic rhinitis was 50% to get the maximium sample size, type I error 5%, adequate power (80%), and 15% of expected incomplete data. The minimium sample size was 443.

 

Sampling, data collection and analysis: a systematic sampling technique was used to enroll participants over 18 years of age. Patient's who were under 18 years of age were excluded. An interview questionnaire was used to collect data, and was given to the doctors to fill in during the interview with patients. The questionnaire focused on personal data, clinical presentation, recurrent triggers, family history, and co-morbidities according to the study objective and based on previous studies [6,16-18]. Clinical examinations were performed, including a detailed ENT examination using an endoscope. The diagnosis of AR was based on clinical diagnosis when patients have a history, and physical findings which compatible with allergic cause according to American academy of otolaryngology head and neck surgery [19]. The data were entered into excel then transferred into STATA v16 for analysis. Description of data was conducted using frequency and percentages for categorical variables.

 

Ethical considerations: ethical approval was obtained from the regional committee of bioethics in Qassim region before we began the process of data collection. Written consent was obtained from all participants before participation in the study.

 

 

Results Up    Down

The response rate was 97%, and 455 participants were recruited to the study. The most common age group was 21-30 years old (n= 108 23.7%). There were more male than female participants (n=286 62.9% vs n= 169 37.1%, respectively). The most common body mass index category was normal weight (n=203 44.6%). The sample contained 53 (11.6%) office workers, and most participants lived in the city (n= 420 72.3%). The most commonly reported type of home was villa (n=198 43.5%). More than three quarters of participants were non-smokers (n= 363 79.8%), whereas there were 44 (9.7%) smokers. Of the 44 smokers, 24 (54.5%) participants reported smoking for more than 10 years, and 25 (65.8%) participants reported smoking ≤ 1 pack per day. Most participants (412 90.5%) reported that they did not undergo an allergy test, while 43 (9.5%) participants had undergone an allergy test. Of the 43 participants who underwent the allergy test, 15 (34.9%) participants reported that they underwent an allergy test more than 5 years earlier, and the skin test was the most common type (n= 36 83.7%). More than half of the participants reported having a family history of allergy (n= 299 65.7%), as shown in Table 1. The clinical presentations of participants are shown in Table 2. More than half of participants (n= 263 57.8%) reported no general symptoms, while 188 (41.3%) and 68 (14.9%) reported fatigue and malaise, respectively. Commonly, the onset of symptoms was ≤10 years (n= 216 47.5%). The most common nasal, throat and sinus symptoms were runny nose 344 (75.6%), frequent clearing 205 (45.1%) and headache 215 (47.3%), respectively. Among the 215 participants who reported headache characteristics, the most commonly reported location of headache was frontal (n= 106 49.3%). Most participants experiencing headache (n= 20595.3%) reported tension as the type of headache, and more than half of them (n= 124 57.7%) reported that it occurred occasionally.

 

Most participants reported no skin symptoms (n= 325 71.4%), more than half (n= 269 59.1%) reported no lung symptoms, and 244 (53.6%) reported no ear symptoms, whereas the most commonly reported eye symptom was redness of the eye (n= 237 52.1%). The results revealed that 161 (35.4%) participants reported no complications, whereas the most commonly reported complications were sleep disturbance, acute or chronic sinusitis, dental problems, and otitis media (n= 126 27.7%, n= 85 18.7%, n= 69 15.2% and n= 9 2%, respectively. The majority of patients reported mild symptoms (n= 368 80.9%), and 340 (74.7%) participants reported that symptoms were intermittent. Regarding the situations in which patients experienced their symptoms, the most common response was any place (n= 397 87.3%). Regarding triggers of allergic rhinitis, dust (n= 375 82.4%), perfume (n= 264 58%), and cold weather (n = 17939.3%) were the most common triggers, while 224 (49.2%) participants reported that their symptoms occur in all seasons of the year. There were 314 (69%) participants who reported that they avoid certain triggers to control their symptoms, as shown in Table 3. Patients´ examination results are shown in Table 4. Regarding the nose, 436 (96%) participants had hypertrophy inferior turbinate, while 345 (76%) participants had pale bluish discoloration of the nasal mucosa. Eye examination results revealed that 67 (14.7%) participants had watery discharge. Throat and pharynx examination revealed that 227 (50%) participants had post nasal drip. Regarding ear examination, 109 (24%) participants had tympanic membrane retraction and three (0.7%) participants had otitis media with effusion. Examination of nasopharynx revealed that 32 (7%) participants had hypertrophy mucosa and nine (2%) participants had discharge. Moreover, seven (1.5%) and four (0.9%) participants exhibited allergic shiner and salute, respectively, as additional findings. Regarding the treatments used for allergic rhinitis, 166 (36.5%) participants used no medication, 151 (33.2%) used oral histamine, and 141 (31%) used intranasal steroid

 

 

Discussion Up    Down

Clinically, AR is defined as a symptomatic nose disease evoked by IgE-mediated inflammation of the nasal membrane after exposure to an allergen [20]. It is the most common respiratory disease, affecting 19% and 8.8%-16% of the general population in Europe and the United States, respectively [21,22]. AR affects both young adults and teenagers frequently. However, the prevalence of AR has been found to decrease after the age of 20 years old [23]. A previous study from Jazan region in Saudi Arabia reported that the prevalence of AR was 44% among adults [6]. In the present study, the findings indicate that AR prevalence peaked at between 22-31 years old, and decreased with increasing age. A study with a similar finding in Jazan city reported that, the peak of age of AR was 22 years old, which constitutes 25.8% [6]. Also in our study, 62.9% was male and 37.1% was female which is inconsistence with study conducted in Saudi Arabia using electronic survey found more females with AR than males, however this is may be due to selection bias [24]. It was previously reported that having a parent with AR increased the risk of having AR [25], while other reported risk factors include exposure to cigarette smoke, obesity, increased blood eosinophils, amplified IgE in the serum, and environmental factors such as environmental exposure in urban areas [26,27]. In contrast, growing up in a farming environment was associated with reduced risk of AR [28]. In the current study, 65.7% of patients reported having a family history of AR. This consistent with study conducted in Saudi Arabia, in which most of AR patient have positive family history (64.1%) [24].

 

Regarding obesity, half of participants were overweight and obese. The percentage of normal weight is consistent with study conducted in Saudi Arabia, in which AR occurred in normal weight individual constituting 38%, while overweight and obesity constitute 58% [24]. A previous study reported association between the high body mass index and AR [29], while another study reported no association [30], suggesting that this issue may require further investigation. Moreover, 79.8% of our patients reported that they were not smokers, 9.7 % of them are smoker and 10.5 % are passive smoker indicating that smoking was not a risk factor for this study group. This consistence with study done in Al-Ahssa in which 6% of patients are smokers and 8% are passive smokers [31], but in contrast to a study done in western area of Saudi Arabia concluded that 84.8% are either smokers or ex-smokers and only 15.2% non-smoker [16]. Regarding residence area, 92.3% of participants were living in the city which is similar to the study of western area of Saudi Arabia reported that 91% are urban citizen [16].

 

The majority of patients reported mild symptoms 80.9%), and (74.7%) participants reported that symptoms were intermittent. This inconsistent with study done in Riyadh, where 34% of AR reporting mild symptoms and 54% reporting intermittent symptoms [24]. Skin symptoms, lung symptoms, and ear symptoms were uncommon in this study, and more than half of the participants had no general symptoms. The most common reported nasal symptoms were runny nose (75.6%), nasal obstruction (75.5%) and frequent sneezing (73.8%). This is consistence with a study where the most common present symptoms were runny nose (82%), nasal itching (70%) and nasal obstruction (69%) [32], also in the study survey conducted an Middle East in five countries Saudi Arabia one of them, the percentage of symptoms reported by the participants were runny nose (57%), nasal itching (56%), nasal congestion (55%), throat itching (52%), reduced sense of smell (51%), and postnasal drip (50%) [17]. Complications of AR included chronic and acute sinusitis, apnea or sleep disturbance, dental problems and otitis media [18]. The current results revealed that 35.4% of patients had no complications, while the most common complications were sleep disturbance, acute or chronic rhinitis and dental problems, whereas otitis media represented only 2% of cases among all complications. In present study, sleep disturbance present in 27.7% of cases with AR. In the study done in Al-Ahssa, sleep disturbance were reported in 75% of cases with AR [31], and in the study survey conducted in Middle East in five countries Saudi Arabia one of them, the percentage of sleep disturbance were reported by about 80% [31]. The goal of AR treatment is to relieve symptoms, and there are several therapeutic options, including oral histamines, leukotriene, allergen immunotherapy, avoidance measures and intra-nasal corticosteroids [13]. In the current study, the most common treatments were oral histamine (33.2%), intranasal steroids (31%), and nasal decongestant. Although the study was selecting a representative sample from the study population, however, there are some limitations that should be considered. First, the study design was descriptive cross sectional that providing a snapshot of the frequency of each variable and did not asses the relationship between exposure and outcome. Second, recall bias cannot be rule out as the nature of the study design.

 

 

Conclusion Up    Down

Allergic rhinitis decreases with increasing age. Most patients with AR were living in urban areas and had a family history of AR. Thus, these characteristics appear to constitute risk factors for AR. The most common symptoms of AR were non-specific and mild, and nasal symptoms were the most frequent. Perineal allergic rhinitis was the common type and inferior turbinate hypertrophy with pale bluish discoloration was the most common finding during the clinical examination. Dust was the most common trigger for AR. Oral histamine and intranasal steroids were the most commonly used treatments.

 

What is known about this topic

  • Allergic rhinitis has wide varities of presentations and complications;
  • Allergic rhinitis had negative impact on quality of life;
  • Allergic rhinitis management are avoidance, medications and immunotherapy.

What this study adds

  • This is the first study to assess common presentations and patterns of allergic rhinitis in Qassim region;
  • Significantly, the perineal allergi rhinitis was the most common frequent type;
  • Interestingly, the inferior turbinate hypertrophy was common finding in physical examination.

 

 

Competing interests Up    Down

The authors declare no competing interests.

 

 

Authors' contributions Up    Down

Conceptualization: Sultan Alanazy, Osama Al-Wutayd and Mazyad Alenezi. Methodology: Sultan Alanazy and Osama Al-Wutayd; formal analysis: Ibrahim Al-juraifani and Malek Alburayh; writing original draft preparation: Ibrahim Al-Quniabut, Malek Alburayh, Abdullah Altuaysi, Yahya Alyahya and Hajaj Al-Homaidan; writing review and editing: Sultan Alanazy, Mazyad Alenezi and Osama Al-Wutayd. All the authors have read and agreed to the final manuscript.

 

 

Acknowledgments Up    Down

We thank Renad Sulaiman Alkhalifah, and Riman Mohammed Alrayes for helping in data collection. Also, we thank Benjamin Knight, from Edanz Group for editing a draft of this manuscript.

 

 

Tables Up    Down

Table 1: number and percentage of descriptive data of the studied participants (n=455)

Table 2: number and percentage of clinical presentation of the studied participants

Table 3: number and percentage of description of allergic rhinitis of the studied participants

Table 4: number and percentage of clinical examination of the studied participants

 

 

References Up    Down

  1. Small P, Frenkiel S, Becker A, Boisvert P, Bouchard JMD, Carr S et al. Rhinitis: a practical and comprehensive approach to assessment and therapy. J Otolaryngol. 2007:36(Suppl 1)S5-S27. Google Scholar

  2. Dykewicz MS, Hamilos DL. Rhinitis and sinusitis. J Allergy Clin Immunol. 2010;125: S103-115. Google Scholar

  3. Beasley R. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: the International Study of Asthma and Allergies in Childhood (ISAAC). Lancet. 1998;351(9111); 1225-1232. PubMed | Google Scholar

  4. Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet. 2011 Dec 17;378(9809):2112-22. PubMed | Google Scholar

  5. Pawankar R, Bunnag C, Khaltaev N, Bousquet J, Takeshi F, You-Young K, Lan Thi TL. Allergic rhinitis and its impact on asthma in Asia Pacific and the ARIA update 2008. Asian Pac J Allergy Immunol. 2009 Dec;27(4):237-43. PubMed | Google Scholar

  6. Yassin A, Maashi R, Zila A, Dilyh N, Dilyh S, Ezzi F et al. Prevalence of allergic rhinitis among adults, Jazan Region, Saudi Arabia. Int J Life Sci Res. 2017;5(1): 10-19. Google Scholar

  7. Varshney J, Varshney H. Allergic rhinitis: an overview. Indian J Otolaryngol Head Neck Surg. 2015 Jun;67(2):143-9. PubMed | Google Scholar

  8. Meltzer EO. Quality of life in adults and children with allergic rhinitis. J Allergy Clin Immunol. 2001 Jul;108(1 Suppl):S45-53. PubMed | Google Scholar

  9. Alreshidi FM, Alrashidi AS, Alshammari FN, Qadi AB, Alrashidi AG, Alghaythi SM et al. Knowledge, attitude and practice about allergic rhinitis in Saudi Arabia, 2017. Egyptian J Hosp Med. 2017;69(4):2199-2203. Google Scholar

  10. Lee P, Mace S. An approach to allergic rhinitis. Allergy Rounds. 2009;1: 1.

  11. Leynaert B, Bousquet J, Neukirch C, Liard R, Neukirch F. Perennial rhinitis: an independent risk factor for asthma in nonatopic subjects: results from the European community respiratory Health Survey. J Allergy Clin Immunol. 1999 Aug;104(2 Pt 1):301-4. PubMed | Google Scholar

  12. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008 Apr;63 Suppl 86:8-160 PubMed | Google Scholar

  13. Small P, Kim H. Allergic rhinitis. Allergy Asthma Clin Immunol. 2018 Sep 12;14(Suppl 2):51. PubMed | Google Scholar

  14. Meo SA, Al-Kheraiji MFA, AlFaraj ZF, Abdulaziz Alwehaibi N, Aldereihim AA. Respiratory and general health complaints in subjects exposed to sandstorm at Riyadh, Saudi Arabia. Pak J Med Sci. 2013 Apr;29(2):642-6. PubMed | Google Scholar

  15. Alharbi, Abdulaziz B, Gomaa FA. "Physio-chemical properties of airborne particles collected from some locations in Qassim region." Life Science Journal. 2014;11(9):1031. Google Scholar

  16. Badran HS, Ahmed H, Mohamad S, Wassim TL et al. "Identification and prevalence of allergic, nonallergic, and local allergic rhinitis patients in western area, Saudi Arabia." Ann Otol Rhinol Laryngol. 2016 Aug;125(8):634-43. PubMed | Google Scholar

  17. Abdulrahman Hussain, Usamah H, Hisham T, Mohammad G, Mohamed K, Alaa S et al. "Nasal allergies in the Middle Eastern population: results from the “Allergies in Middle East Survey”''. Am J Rhinol Allergy. Nov-Dec 2012;26 Suppl 1:S3-23. PubMed | Google Scholar

  18. Adegbiji WA, Olajide GT, Olajuyin AO, Aremu SK, Olusola AG. Pattern of allergic rhinitis among children in Ekiti, Nigeria. Int J Pediatr Otorhinolaryngol. 2018 Mar;106:75-79. PubMed | Google Scholar

  19. Seidman MD, Gurgel RK, Lin SY, Seth RS, Fuad MB, James RB et al. Clinical practice guideline: allergic rhinitis. Otolaryngol Head Neck Surg. 2015 Feb;152(1 Suppl):S1-43. PubMed | Google Scholar

  20. Bousquet J, Khaltaev N, Cruz A, Denburg J, Fokkens W, Togias A et al. Allergic rhinitis and its impact on Asthma (ARIA) 2008. European Journal of Allergy and Clinical Immunology. 2008;63(86):7-160. Google Scholar

  21. Bauchau V, Durham SR. Prevalence and rate of diagnosis of AR in Europe. Eur Respir J. 2004 Nov;24(5):758-64. PubMed | Google Scholar

  22. Basak P, Arayata R, Brensilver J. Prevalence of specific aeroallergen sensitivity on skin prick test in patients with AR in Westchester County. Internet J Asthma Allergy Immunol. 2008 6(2).

  23. Gern JE, Busse WW. Contemporary diagnosis and management of allergic diseases and asthma. Handbook in Health Care Co. 2007.

  24. Almehizia AA, Reema KA, Khalid MA, Khalid AA, Modhi A, Sarah A et al. "Allergic rhinitis: disease characteristics and coping measures in Saudi Arabia." PloS one. 2019:14.6:e0217182. PubMed | Google Scholar

  25. Westman M, Kull I, Lind T, E Melén, P Stjärne, E Toskala et al. The link between parental allergy and off-spring allergic and nonallergic rhinitis. Allergy. 2013 Dec;68(12):1571-8. PubMed | Google Scholar

  26. Wright AL, Holberg CJ, Halonen M, Martinez FD, Morgan W, Taussig LM. Epidemiology of physician-diagnosed allergic rhinitis in childhood. Pediatrics. 1994 Dec;94(6 Pt 1):895-901. PubMed | Google Scholar

  27. Musaad SM, Patterson T, Ericksen M, Lindsey M, Dietrich K, Succop P et al. Comparison of anthropometric measures of obesity in childhood allergic asthma: central obesity is most relevant. J Allergy Clin Immunol. 2009 Jun;123(6):1321-7.e12. PubMed | Google Scholar

  28. Law M, Morris JK, Wald N, Luczynska C, Burney P. Changes in atopy over a quarter of a century, based on cross sectional data at three time periods. BMJ. 2005 May 21;330(7501):1187-8. PubMed | Google Scholar

  29. Ciprandi G, Pistorio A, Tosca M, Ferraro MR, Cirillo I. "Body mass index, respiratory function and bronchial hyperreactivity in allergic rhinitis and asthma". Respir Med. 2009;103(2):289-95. PubMed | Google Scholar

  30. Sybilski AJ, Raciborski F, Lipiec A, Tomaszewska A, Lusawa A, Furmańczyk K et al. "Obesity - a risk factor for asthma, but not for atopic dermatitis, allergic rhinitis and sensitization". Public Health Nutr. 2015;18(3):530-6. PubMed | Google Scholar

  31. Albaloushi NN, Khalid A. "The prevalence of allergic rhinitis and its complications: a survey from Al-Ahssa, Saudi Arabia." Journal of Nature and Science of Medicine. 2019;2(2):57. Google Scholar

  32. Kalmarzi RN,Khazaei Z, Shahsavar J, Gharibi F, Tavakol M,Khazaei S et al. "The impact of allergic rhinitis on quality of life: a study in western Iran". Biomedical Research and Therapy. 2017;4(9):1629-1637. Google Scholar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Research

Patterns of allergic rhinitis among adults in Qassim region, Saudi Arabia: a cross sectional study

Research

Patterns of allergic rhinitis among adults in Qassim region, Saudi Arabia: a cross sectional study

Research

Patterns of allergic rhinitis among adults in Qassim region, Saudi Arabia: a cross sectional study