The Impact of Vitamin-D Supplementation on Individuals with Allergic Rhinitis

Abstract

Introduction

Allergic rhinitis is a common disease affecting 10 percent people. Sleep, quality of life, and productivity at work are all significantly impacted by severe allergic rhinitis. An increase in allergic diseases has been associated with a lack of vitamin D.

Methods

It is a case control study in which all patients with allergic rhinitis were included and their vitamin d levels were evaluated. Case group was given vitamin d supplementation weekly and their TNSS score was evaluated against those control group where no supplementation was given.

Results

A total of 80 individuals were diagnosed with Allergic Rhinitis. At the time of presentation, the average age of the people was 24.5 years. The average TNSS value before therapy for the study group that took oral vitamin D3 medicine was 11.10 ± 2.10, and after treatment it dropped to 3.2 ± 0.5. The average TNSS score before to therapy was 12.40 ± 2.50 in the control group, which utilised medicines devoid of oral vitamin D3.

Discussion

The link between low vitamin D levels and an increased incidence of allergic disorders has recently attracted more attention on a worldwide scale. But studies on this area have shown contradictory results. The purpose of this study was to determine whether or not supplementing with vitamin D3 helped individuals suffering from allergic rhinitis.

Conclusion

Vitamin D3 significantly improves the clinical manifestations of allergic rhinitis when administered. Noticeable clinical benefits are achieved when the therapy method for allergic rhinitis is changed by injecting vitamin D3.

Introduction

Ten to twenty percent of people experience allergic rhinitis, making it the most common type of chronic rhinitis. This disease seems to be becoming more common, according to studies [1, 2]. Sleep, quality of life, and productivity at work are all significantly impacted by severe allergic rhinitis. Medications include antihistamines, decongestants, intranasal corticosteroids, and immunotherapy are among the potential therapeutic options. An increase in allergic diseases has been associated with a lack of vitamin D, which is especially noticeable in industrialised nations [3]. People nowadays spend more time indoors than in the past, which means they don't get nearly as much sun exposure and hence don't produce as much vitamin D in their skin [4].

Curiosity about vitamin D's potential effects on non-skeletal illnesses, such as the regulation of the innate and adaptive immune systems, has been prompted by the discovery of vitamin D receptors in various cells and the recognition of widespread vitamin D deficiency [4–6]. The prevalence of allergic disorders has been rising steadily during the last several years. Some research has linked vitamin D deficiency to an increased risk of allergy disorders. [7].

Research has shown that T-cells produce less proinflammatory cytokines when blood 25(OH)D levels are higher [8]. In a mouse model of asthma, researchers found that vitamin D enhanced the efficacy of sublingual immunotherapy (SLIT) and increased the production of interleukin (IL)-10 by CD4 + T cells. Latest research from Heine et al. shows that 25-hydroxyvitamin D3 improves the efficacy of targeted immunotherapy over the long run in an allergic mouse model. Along with this impact, the expression of Th2 cytokines in the lungs decreases [9]. These findings suggest that vitamin D3 could be used to treat allergic rhinitis, which would alleviate some of the symptoms experienced by patients. Hence, the study's overarching goal is to assess whether or not vitamin D3 supplementation can lessen the acute phase of allergic rhinitis symptoms.

Methodology

From October 2023 to March 2024, the ENT outpatient department served as the site of the ongoing experiment. The institutional ethics committee gave their stamp of approval to the study. A hundred individuals diagnosed with allergic rhinitis were given a clinical evaluation. The primary symptoms of this disorder, as described in the literature, include a stuffy nose with watery discharge, a blocked nose, itching in the nose, eyes, palate, or pharynx, sneezing suddenly and repeatedly, and a history of hives. A horizontal crease in the nose, enlarged turbinates, thin, watery, or mucoid discharge, and pale and spongy nasal mucosa are the clinical signs that have been documented.

Eighty people, including both sexes, with a history of allergic rhinitis and vitamin D insufficiency were included in the study. The participants' ages varied from fifteen to fifty. The study group and the control group were chosen at random from among the patients. Eosinophilia was found in the blood smear or nasal smear of the eligible patients who had a history of allergic rhinitis (AR). Each patient underwent a full ENT (ear, nose, and throat) evaluation, which included in-depth interviews. Both pre- and post-treatment data on the total nasal symptoms score (TNSS) were collected. Intranasal steroid spray and oral vitamin D (60,000 IU) were administered to the study group over the course of eight weeks as part of the routine pharmacotherapy.

Traditional treatment for allergic rhinitis was administered to the control group. Serum vitamin D3 levels were measured before and after treatment. Both before and after the intervention, the TNSS (Total Nasal Symptom Score) was assessed. The severity of the symptoms was used to calculate the total score for nasal symptoms.

The inclusion criteria for the study required patients to have a clinical diagnosis of allergic rhinitis (AR), either seasonal or perennial, be within the age range of 15–50 years, and have vitamin D levels below 20 ng/mL. The exclusion criteria ruled out individuals with non-allergic rhinitis and those with concomitant nasal co-morbidities, including autoimmune disorders, sinusitis, nasal polyposis, and deviated nasal septum (DNS). Additionally, patients with other co-morbidities or those who had been previously using drugs such as immunomodulatory or hormone-based immunotherapy were excluded from the study.

Statistical Analysis

After data organisation, SPSS 17.0 was used for analysis. The data were displayed with both the average and variability. For this reason, we compared the research and control groups' means using the unpaired t-test. Statistical significance was determined by a p-value that was less than 0.05.

Results

There were a hundred cases of allergic rhinitis. Nevertheless, the research only included 80 cases where the blood vitamin D deficiency was less than 20 ng/ml; 20 cases were not included since their vitamin D levels were adequate. A total of 80 individuals were diagnosed with Allergic Rhinitis, with 48 being female and 32 being male. Most of the people who took part were between the ages of fifteen and thirty-five. At the time of presentation, the average age of the people was 24.5 years.

The study group had an initial mean serum vitamin D level of 13.15 ± 1.42 ng/ml, while the control group had a level of 14.50 ± 2.10 ng/ml. The two groups were not significantly different from one another. We calculated the subjects’ TNSS (Total Nasal Symptom Score) by comparing their symptoms before (pre-treatment score) and after (post-treatment score) the intervention. Forty percent of the 80 patients exhibited low-grade Allergic Rhinitis (AR) symptoms, defined as a TNSS below 7, while twenty-six percent exhibited high-grade AR symptoms, defined as a TNSS above 10, and thirty-three percent exhibited moderate-grade AR symptoms, defined as a TNSS between 7 and 10. Table 1 displays the TNSS grades for both the study and control groups.

Table 1.

TNSS scoring in patients of allergic rhinitis

Symptoms	Score
Rhinorrhoea 0–3	0–3
Obstruction 0–3	0–3
Sneezing 0–3	0–3
Itching 0–3	0–3
Anosmia 0–3	0–3
TNSS	Total-15

The average TNSS value before therapy for the study group that took oral vitamin D3 medicine was 11.10 ± 2.10, and after treatment it dropped to 3.2 ± 0.5. The average TNSS score before to therapy was 12.40 ± 2.50 in the control group, which utilised medicines devoid of oral vitamin D3. The TNSS score dropped to 4.5 ± 1.05. following therapy.

Using an unpaired student's “t” test, we compared the two groups’ TNSS ratings before treatment and did not find a statistically significant difference in nasal symptom assessments. The total scores of nasal symptoms showed a significant difference after four weeks of treatment, with a p value < 0.05 (Figs. 1, 2, 3).

Fig. 1.

Showing the TNSS scoring comparison between controls and study groups. 0 = Absent; 1 = Mild; 2 = Moderate; 3 = Severe; TNSS = total nasal symptoms score

Fig. 2.

Showing vitamin D levels before and after the treatment with vitamin D3

Fig. 3.

Showing gender distribution

Discussion

The link between low vitamin D levels and an increased incidence of allergic disorders has recently attracted more attention on a worldwide scale. But studies on this area have shown contradictory results. The prevalence of allergic disorders has been rising steadily during the last several years. Some research has linked vitamin D deficiency to an increased risk of allergy disorders [7]. The purpose of this study was to determine whether or not supplementing with vitamin D3 helped individuals suffering from allergic rhinitis as measured by the Total Nasal Symptom Score. There was a 100-patient cohort in the trial; 80 were assigned to the study group because they had a vitamin D deficiency of 20 ng/ml or below, and 20 were assigned to the control group because they had adequate vitamin D levels.

There were 80 participants from AR; 48 were girls (or 60%) and 32 were males (or 40%). At the time of initial presentation, the mean age of individuals with AR was 24.5 years. Vitamin D3 average levels were 13.15 and 14.50 in the study group and control group, respectively, suggesting no significant differences. Fifty people who suffer from allergy rhinitis (AR) were studied by Arshi et al. [10] to determine their vitamin D levels. Severe vitamin D deficiency was shown to occur more frequently in AR patients, according to the study. The average serum vitamin D3 levels in the research group differed significantly from their pre-treatment levels after 4 weeks of taking oral vitamin D3 supplements. These results highlight the need of checking vitamin D3 levels in people with allergic rhinitis before starting treatment. Severe vitamin D insufficiency was more common in AR patients than in the general population.

Researchers Moulya et al. [11] found that people with moderate symptoms (28.6 ng/dl) and mild symptoms (34.4 ng/dl) of allergic rhinitis had higher vitamin D levels than those with severe symptoms (19.6 ng/dl). A statistically significant difference was discovered (p < 0.04). Thus, the researchers concluded that vitamin D may lessen allergy symptoms by increasing anti-inflammatory effects.

For each patient, we took two scores—one before treatment and one after—to get their TNSS (Total Nasal Symptom Score). Of the 80 patients, 40% displayed moderate Allergic Rhinitis (AR) symptoms, as measured by a Total Nasal Symptom Score (TNSS) below 7.20.A total of 6% experienced severe AR symptoms as measured by a TNSS higher than 10, while 33.3% exhibited moderate AR symptoms ranging from 7 to 10. The average TNSS score in the study group that took oral vitamin D3 medicine dropped from 11.10 ± 2.10 before therapy to 3.2 ± 0.5 after treatment. The average TNSS score before to therapy was 12.40 ± 2.50 in the control group, which utilised medicines devoid of oral vitamin D3. The TNSS score dropped to 4.5 ± 1.05. following therapy. Vitamin D deficiency was linked to allergic rhinitis, according to research by Guo et al. [12]. Patients' TNSS ratings improved after taking vitamin D supplements, indicating that the supplement had a positive impact on their symptoms. Agarwal S et al. [13] found that when vitamin D tablets were given to patients with allergic rhinitis, their symptoms were improved and their Total Nasal Symptom Score (TNSS) went up.

The total eosinophilic count (TEC) is a helpful biomarker for allergy detection, and our work suggests that vitamin D supplementation leads to a decrease in this count. Vitamin D, according to this research, can modulate the immune system and be used as a medication to treat allergic rhinitis (AR). Serum vitamin D levels should be checked in AR patients and, if necessary, supplements should be given. [14] Bruce W. Hollis claims that vitamin D testing is rapidly becoming an important tool in the medical diagnostic and treatment toolbox [15]. Vitamin D3 supplementation and blood vitamin D level monitoring for allergic rhinitis sufferers may thus be useful.

Conclusion

Vitamin D testing is rapidly becoming an important tool for the diagnosis and treatment of a number of diseases. Vitamin D3 significantly improves the clinical manifestations of allergic rhinitis when administered. Noticeable clinical benefits are achieved when the therapy method for allergic rhinitis is changed by injecting vitamin D3. To confirm that vitamin D supplementation is effective when used in conjunction with initial allergy treatment, however, more research with bigger patient populations is needed.

Funding

None.

Declarations

Conflict of interest

No conflict of interest.