Abstract
Allergic Rhinitis is one of the most commonly recognised rhinitis globally. Though its not a life threatening entity but it is associated with severe impairment of quality of life along with substantial financial burden on patient. There has been a substantial rise in number of patients of allergic rhinitis over years and researchers worldwide have also found low levels of vitamin D in patients of allergic rhinitis. It is a randomised control trial with 87 subjects divided into two groups. Pre-treatment total nasal symptom score (TNSS) were recorded for these patients. The Group A was given intranasal steroidal spray while Group B was given vitamin D supplementation along with intranasal steroidal spray. Post treatment TNSS scores and rhinitis control assessment test scores were calculated and analysed. 38 patients had severe Vit D deficiency with average TNSS score as 11.3 while 49 patients had insufficient Vit D levels with average TNSS as 8.6. The pre-treatment TNSS score in Group A was 12.5 ± 2.68 while post-treatment score was 8.98 ± 1.009 with difference in both scores of Group A as 3.52. The pre-treatment TNSS score in Group B (fluticasone spay with Vit D) was 11.64 ± 3.09 while post-treatment score was 6.3 ± 1.45 with difference in both scores of Group A as 5.34. The post treatment RCAT in Group A and Group B was 19.72 ± 2.84 and 28.2 ± 1.53 respectively with difference between two groups as 8.48. Though Intranasal steroidal sprays are the first line of management of allergic rhinitis however vitamin D supplementation can have a role in better relief of symptoms when used in conjunction. More multi-institutional studies are encouraged to confirm the validity of results before it can be incorporated in standard treatment guidelines.
Similar content being viewed by others
References
Small P, Frenkiel S, Becker A, Boisvert P, Bouchard J, Carr S et al (2007) The Canadian Rhinitis Working Group. Rhinitis: a practical and comprehensive approach to assessment and therapy. J Otolaryngol. 36(Suppl 1):S5–S27
Dykewicz MS, Hamilos DL (2010) Rhinitis and sinusitis. J Allergy Clin Immunol 125:S103–S115
Berger WE (2003) Overview of allergic rhinitis. Ann Allergy Asthma Immunol 90(Suppl. 3):7–12
Malone DC, Lawson KA, Smith DH et al (1997) A cost of illness study of allergic rhinitis in the United States. J Allergy Clin Immunol 99:22–27
Foresi A (2000) A comparison of the clinical efficacy and safety of intranasal fluticasone propionate and antihistamines in the treatment of rhinitis. Allergy 62:12–14
Bousquet J, Van Cauwenberge P, Khaltaev N, ARIA Workshop Group, World Health Organization (2001) Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 108(Suppl. 5):S147–S334
Global strategy for asthma management and prevention. Global initiative for asthma (GINA). http://www.ginasthma.com/Guidelineitem.asp?11=2&12=1&intId=60. Accessed 16 Sept 2008]
Litonjua AA (2009) Childhood asthma may be a consequence of vitamin D deficiency. Curr Opin Allergy Clin Immunol 9(3):202–207
Gupta A (2014) Vitamin D deficiency in India: prevalence, causalities and interventions. Nutrients 6(2):729–775
Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S et al (2017) Allergic rhinitis and its impact on asthma (ARIA) guidelines—2016 revision. J Allergy Clin Immunol 140(4):950–958
Meltzer EO, Schatz M, Nathan R et al (2013) Reliability, validity, and responsiveness of the rhinitis control assessment test in patients with rhinitis. J Allergy Clin Immunol 131:379–386
Martin BG, Ratner PH, Hampel FC, et al (2007) Optimal dose selection of fluticasone furoate nasal spray for the treatment of seasonal allergic rhinitis in adults and adolescents. Allergy Asthma Proc 28(2):216–225. https://doi.org/10.2500/aap.2007.28.2983
Stanford R, Philpot E, Faris M et al (2007) Fluticasone furoate nasal spray once-daily improves quality of life in subjects with seasonal allergic rhinitis (SAR). Ann Allergy Asthma Immunol 98:A90
Nathan R, Berger W, Yang W et al (2007) Once daily fluticasone furoate nasal spray (FFNS), a novel enhanced affinity steroid, provides 24-hour relief for the nasal symptoms of perennial allergic rhinitis (PAR). J Allergy Clin Immunol 119:S65
Fokkens WJ, Jogi R, Reinartz S et al (2007) Once daily fluticasone furoate nasal spray is effective in seasonal allergic rhinitis caused by grass pollen. Allergy 62:1078–1084
Kaiser HB, Naclerio RM, Given J et al (2007) Fluticasone furoate nasal spray: a single treatment option for the symptoms of seasonal allergic rhinitis. J Allergy Clin Immunol 119:1430–1437
Baroody FM, Lane J, Watanabe S, DeTineo M, Pinto J, Naclerio RM (2012) The addition of vitamin D (VitD) to an intranasal steroid (INS) improves control of symptoms in seasonal allergic rhinitis (SAR). J Allergy Clin Immunol 129(2):AB134
Upadhyay P, Jain R (2017) The effect of vitamin d supplementation on children with allergic rhinitis. Pediatric Oncall J 14(3):56–59
Akbar NA, Zacharek MA (2011) Vitamin D: immunomodulation of asthma, allergic rhinitis, and chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 19:224–228
Norman AW (2008) From vitamin D to hormone D: fundamentals of the vitamin D endocrine system essential for good health. Am J Clin Nutr 88:491S–499S
Wang Y, Zhu J, DeLuca HF (2012) Where is the vitamin D receptor? Arch Biochem Biophys 523:123–133
Van Schoor NM, Lips P (2011) Worldwide vitamin D status. Best Pract Res Clin Endocrinol Metab 25:671–680
Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA et al (2009) Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20:1807–1820
Suryanarayana P, Arlappa N, Sai Santhosh V, Balakrishna N, Lakshmi Rajkumar P, Prasad U et al (2018) Prevalence of vitamin D deficiency and its associated factors among the urban elderly population in Hyderabad metropolitan city, South India. Ann Hum Biol 45:133–139
Kapil U, Pandey RM, Goswami R, Sharma B, Sharma N, Ramakrishnan L et al (2017) Prevalence of vitamin D deficiency and associated risk factors among children residing at high altitude in Shimla district, Himachal Pradesh, India. Indian J Endocrinol Metab. 21:178–183
Chowdhury R, Taneja S, Bhandari N, Sinha B, Upadhyay RP, Bhan MK et al (2017) Vitamin-D deficiency predicts infections in young North Indian children: a secondary data analysis. PLoS ONE 12:e0170509
Srimani S, Saha I, Chaudhuri D (2017) Prevalence and association of metabolic syndrome and vitamin D deficiency amongpostmenopausal women in a rural block of West Bengal, India. PLoS One 12:e0188331
Misra P, Srivastava R, Misra A, Kant S, Kardam P, Vikram NK et al (2017) Vitamin D status of adult females residing in Ballabgarh health and demographic surveillance system: a community-based study. Indian J Public Health 61:194–196
Osguthorpe JD (2013) Pathophysiology of and potential new therapies for allergic rhinitis. Int Forum Allergy Rhinol 3:384–392
Heine G, Anton K, Henz BM, Worm M (2002) 1alpha,25-dihydroxyvitamin D3 inhibits anti-CD40 plus IL-4-mediated IgE production in vitro. Eur J Immunol 32:3395–3404
Yenigun A, Dadaci Z, Oncel M (2015) Plasma vitamin D levels of patients with allergic rhino-conjunctivitis with positive skin prick test. Am J Rhinol Allergy 29:46–49
Vatankhah V, Lotfizadeh M, Iranpoor H, Jafari F, Khazraei H (2016) Comparison vitamin D serum levels in allergic rhinitis patients with normal population. Revue Française d’Allergologie 56:539–543
Sudiro M, Lestari B, Madiadipoera T, Setiabudiawan B, Boesoirie T (2017) Vitamin D deficiency is correlated with severity of allergic rhinitis. Open Access Libr J 4:1–9. https://doi.org/10.4236/oalib.1103813
Arshi S, Ghalehbaghi B, Kamrava SK, Aminlou M (2012) Vitamin D serum levels in allergic rhinitis: any difference from normal population? Asia Pac Allergy 2:45–48
Moradzadeh K, Larijan B, Keshtkar AA, Hossein-Nezhad A, Rajabian R, Nabipour I et al (2008) Normative values of vitamin D among Iranian population: a population based study. Int J Osteoporos Metab Disord 1:8–15
Wjst M, Hyppönen E (2007) Vitamin D serum levels and allergic rhinitis. Allergy 62:1085–1086
Modh D, Katarkar A, Thakkar B, Jain A, Shah P, Joshi K (2014) Role of vitamin D supplementation in allergic rhinitis. Indian J Allergy Asthma Immunol 28:35–39
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest whatsoever.
Ethical Statement
Before starting the study ethical clearance was taken from institutional ethical committee as per Declaration of Helsinki.
Consent for Publication
Informed consent was taken by all the patients before surgery and enrolment into the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Bhardwaj, B., Singh, J. Efficacy of Vitamin D Supplementation in Allergic Rhinitis. Indian J Otolaryngol Head Neck Surg 73, 152–159 (2021). https://doi.org/10.1007/s12070-020-01907-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12070-020-01907-9