Abstract
Allergic rhinitis is one of the most rampant diseases in the world and many studies have been conducted to find its risk factors. Various studies have shown that there is a correlation between allergic rhinitis and increased Body Mass Index (BMI). Obesity has several effects on the immune system that could play a major role in increasing allergic disease. Allergic rhinitis is known to produce mild eosinophilia. The purpose of this study is to assess the correlation between BMI and allergic rhinitis using the Absolute Eosinophil Count (AEC). Over a period of 6 months, 55 cases of allergic rhinitis were selected. The patients were investigated by Absolute Eosinophil Count and their Body Mass Index values were calculated based on weight and height measurement. There was a positive correlation between Absolute Eosinophil Count and BMI with a p value of < 0.0001 which in turn revealed a positive correlation between BMI and allergy. We conclude that patients with high BMI are more prone to allergic rhinitis and have higher Absolute Eosinophil Counts probably due to the immunological effects of adipose tissue on the progress of the allergic disease.
Keywords: Allergic rhinitis, Absolute Eosinophil Count, Body Mass Index
Introduction
Allergic rhinitis is one of the most prevalent diseases in the world. The complex interplay between genetic and environmental factors is what leads to the manifestation of this condition. Many times there are several forms such as asthma, allergic rhinitis, rhinoconjunctivitis, and eczema—all due to the same underlying pathophysiology. There is an increasing prevalence of allergic rhinitis observed in India [1].
The association between allergic rhinitis and obesity in terms of increased body mass index (BMI) has been suggested but has not been conclusively proven [2].
Allergic rhinitis causes a considerable level of economic burden to the country. Obesity, a lifestyle disorder caused mainly due to physical inactivity and changing trends in the modern life-style may lead to several ill effects on the immune system. This may in turn lead to an increase in allergic diseases [3].
Numerous studies have formulated the correlation between obesity and asthma, atopic dermatitis, and allergic sensitization to edible items. However, often the results have been conflicting with no clear conclusive evidence [2].
Eosinophils have been recognized to play a role as pro-inflammatory granulocytes and are known to have a role in allergic rhinitis, asthma, and atopic dermatitis. They are known to be in circulating in higher amounts in peripheral blood in conditions such as allergic rhinitis [4].
Obesity is closely linked to the immune system and this could explain its possible role in allergic diseases [3].
The Body Mass Index (BMI) is widely referred to as far as overweight and obesity are concerned in several epidemiological data. The relationship between BMI and allergic rhinitis is not clear [5–7]. Hence this led us to investigate these parameters in this study.
Objective
The aim of this study is to assess the correlation between allergic rhinitis and Body Mass Index (BMI) using the Absolute Eosinophil Count (AEC).
Materials and Methods
This is an observational study conducted at the ENT and HNS outpatient department of KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum. 55 patients with signs and symptoms of allergic rhinitis aged between 11- and 70-years during January 2019–June 2019 were included in the study.
All patients having symptoms of allergic rhinitis—sneezing, nasal pruritis, rhinorrhea or nasal congestion (a combination of 2 or more) and patients who are taking medication for allergic rhinitis and are willing to discontinue medications for a period of 48 h before giving a blood sample for AEC were included in the study. Pregnant women, patients with tumors of the nose and paranasal sinuses, known cases of asthma on medication, and those with congenital defects affecting the BMI were excluded.
Informed consent and detailed history were obtained for the duration of allergic rhinitis and the nature of any previous treatment. Also, a detailed ENT examination to assess the common signs of allergic rhinitis were assessed.
Body Mass Index: Study participant’s height was measured with individuals standing upright without shoes by using the meter scale. By dividing weight in kilograms by the square of height in meters (kg/m2), the BMI was calculated and classified into four groups according to the World Health Organization BMI cut-offs as follows [8]:
Underweight: BMI < 18.5 kg/m2
Normal weight: BMI = 18.5–24.9 kg/m2
Overweight: BMI = 25–29.9 kg/m2
Obese: BMI ≥ 30 kg/m2
The Absolute Eosinophil Count was measured using Pilot’s Solution [9].
After obtaining AEC values, patients were divided into 3 groups of less than 400, between 401–1000 and greater than 1000 respectively.
The correlation between symptoms of allergic rhinitis using the Absolute Eosinophil Count and Body Mass Index was assessed. Patients were also assessed based on whether they were taking medications for allergic rhinitis or not.
Statistical Methods Used:
The analysis was done using IBM Statistical Package for Social Sciences (SPSS) software. Diagrammatic representation, mean standard deviation, and Karl Pearsons correlation coefficient method was applied to check the correlation wherever relevant.
Results
Out of total 55 patients of allergic rhinitis in the study there were 22 females (40%) and 33 (60%) males.
The mean age among all the patients was 35.60 years with a standard deviation of 16.74. The patients were distributed into five groups as shown in Fig. 1. The highest number (18) of patients were in the age group of 20–29 years (32.73%) and the lowest number (7) belonged to the age group of 10–19 years (12.73%).
Fig. 1.
Showing bar diagram of age distribution
The height of the patients ranged from 124 to 180 cm with a mean of 163.28 cm and a standard deviation of 10.20. The average weight was 67.78 kg and ranged from 41 to 87 kg.
The calculated mean BMI (body mass index) was 25.29 which falls into the pre-obese criteria as per the WHO. There was a standard deviation of 3.38 with minimum being 16 kg/m2 and maximum BMI being 31.2 kg/m2. Out of all the patients there were 37 over weight patients and 18 in the normal category.
The Absolute Eosinophil Count was as high as 489.81/µl in the overweight patients ranging from 250 to 625/µl. The same count was relatively low in patients with normal weight with mean AEC being 281.36/µl and minimum and maximum values being 150 and 500/µl as seen in Fig. 2.
Fig. 2.
Showing Absolute Eosinophil Count (AEC) Values in normal and over weight patients
The Pearsons correlation coefficient was applied to formulate the association between Body Mass Index and Absolute Eosinophil Count among all the 55 patients. As the Body Mass Index increased, the AEC count increased with a Pearson coefficient of 0.7950 indicating a good correlation. The p value was < 0.0001 suggestive of a highly significant correlation as depicted below.
Discussion
Skin conditions such as dermatitis, allergic rhinitis, asthma, diabetes, gastroesophageal reflux disease, sleep disorders, and cardiovascular diseases are attributed due to weight gain during adolescence and adult life [10]. The increasing role of obesity in its contribution to allergy is due to its impact on the immune system. This could possibly be due to the production of adipokines and macrophages [3, 11]. A commonly used indicator for obesity is BMI. A positive correlation between BMI and allergy does exist according to a few studies [12, 13]. Leptin is known to be elevated in obese individuals and this is known to activate and increase the survival of eosinophils [14, 15].
The mean age in our study was 35.60 years. According to a study done to assess the impact of high BMI on allergic rhinitis patients by Vatankhah et al., the mean age of cases was 31.92 years and controls were 34.94 and there was no difference between the age groups on comparison [2]. This suggests that the most common age group affected is the fourth decade of life. This is when obesity and its ill effects on the immune system start manifesting and showing symptoms. The average BMI observed in our study was 25.29 kg/m2. There was also a statistically significant difference in the average Absolute Eosinophil Count amongst the overweight patients (489.81/µl) as opposed to the normal patients (281.36/µl). Studies done by Ciprandi et al. and Forno E et al. have suggested a positive correlation between BMI and allergic rhinitis [12, 13]. On the contrary, there is evidence that there is no relationship between obesity and allergic rhinitis according to a few studies [16, 17].
Eosinophil specific chemokines such as eotaxins are elevated in obesity due to the continuous stimulation of adipocytes by leptin [15, 18–20]. Also, a study done by Engeli S et al. suggested that the plasma adiponectin is inversely related to obesity. Therefore as the BMI increases, the adiponectin levels decrease [21].
Eosinophils were once regarded as protective cells are now considered as pro-inflammatory cells which mediate allergic disease. This is mainly due to the presence of granules such as Major Basic Protein (MBP), Eosinophil-derived Neurotoxin (EDN), Eosinophil Cationic Protein (ECP), and Eosinophil Peroxidase (EPO). These are toxic to tissues and cause damage in the brain, heart, skin, and lungs. At the cellular level, eosinophils are known to react with Antigen Presenting Cells, Mast Cells, and T-lymphocytes. This is could possibly explain the need for Absolute Eosinophil Count as an easy marker for diagnosis and its role in the pathophysiology allergic rhinitis [10].
There is also evidence that there is a higher prevalence of allergic rhinitis amongst the female population [2]. Our study also had 60% of the patients as females and this could attribute to the increased prevalence of allergic rhinitis in this study. A possible explanation could be due to the hormonal influence of the adipose tissue on the immune system [22, 23].
Ciprandi et al. concluded that allergic rhinitis and obesity are closely associated with males. But this could be due to the differences in the gender distribution of the study population [12]. Hence, muticentric studies with a larger sample size could give us a better understanding of the association between BMI and allergic rhinitis.
Conclusion
Patients with allergic rhinitis have mild eosinophilia (> 450/µl) and tend to have higher Body Mass Index values. There is a correlation between being overweight and having an allergic predisposition. With a healthier lifestyle and an active one, patients with allergic rhinitis can improve the overall quality of life. Though it often adversely affects the quality of life; in India, allergic rhinitis is often regarded as a trivial disease and patients fail to attribute the ill-health to symptoms of allergic rhinitis. Allergic rhinitis has a negative impact on the quality of life. Allergic rhinitis can have a significant impact on the physical, psychological, and social aspects and impact work productivity. Hence controlling the BMI will definitely help to reduce the burden of the disease.
Funding
None.
Compliance with Ethical Standards
Conflict of interest
None.
Availability of Data and Material
Not applicable.
Code Availability
Not applicable.
Consent to Participate
Written informed consent was obtained from the relatives/legal guardians of the study participant.
Ethics Approval
Approval was obtained from the ethics committee of KLE Academy of Higher Education and Research. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
Footnotes
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Contributor Information
Anil S. Harugop, Email: aharugop@yahoo.com
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