Prevalence and risk factors for allergic rhinitis in two resource-limited settings in Peru with disparate degrees of urbanization

BackgroundAllergic rhinitis is a disease with a high global disease burden, but risk factors that contribute to this condition are not well understood. ObjectiveTo assess the prevalence and risk factors of allergic rhinitis in two Peruvian populations with disparate degrees of urbanization. MethodsWe conducted a population-based, cross-sectional study on 1441 children aged 13-15years at enrollment (mean age 14.9years, 51% boys) to investigate the prevalence of allergic disease. We used a standardized, Spanish validated questionnaire to determine the prevalence of allergic rhinitis and asked about sociodemographics and family history of allergies. Children also underwent spirometry, exhaled nitric oxide, allergy skin testing to 10 common household allergens and provided a blood sample for measurement of 25OH vitamin D and total serum IgE. ResultsOverall prevalence of allergic rhinitis was 18% (95% CI 16% to 20%). When stratified by site, the prevalence of allergic rhinitis was 23% Lima vs. 13% in Tumbes (P<0.001); however, this difference was no longer significant after controlling for subject-specific factors (P=0.95). There was a strong association with other allergic diseases: 53% of children with asthma had allergic rhinitis vs. 15% in those without asthma (P<0.001) and 42% of children with eczema vs. 17% of those without eczema (P<0.001). Important risk factors for allergic rhinitis were parental rhinitis (adjusted OR=3.0, 95% CI 1.9-4.7 for 1 parent and adjusted OR=4.4, 95% CI 1.5-13.7 for 2 parents); allergic sensitization to common household aeroallergens (1.6, 1.1-2.3); being overweight (1.5, 1.0-2.3); exhaled nitric oxide 20ppb (1.9, 1.3-2.7); and total serum IgE 95th percentile (2.4, 1.2-4.8). Population attributable risk of important factors for allergic rhinitis were 25% for high exhaled nitric oxide, 22% for allergic sensitization to common household aeroallergens, 22% for paternal rhinitis, 10% for being overweight and 7% for an elevated total serum IgE. Conclusion and Clinical RelevanceAllergic rhinitis was prevalent in both settings, and important risk factors include elevated exhaled nitric oxide, allergic sensitization to common household aeroallergens, parental rhinitis, being overweight and high total serum IgE. When considering subject-specific factors, the difference in prevalence between the urban and rural settings became non-important.