Introduction

The symptoms of allergic rhinitis (AR) result from inflammatory mediators released after immunoglobulin E (IgE) production, driven by cytokines from T cells responding to allergens. Vitamin D, traditionally linked to bone health, also influences immunity, as its receptors are present on many inflammatory cells. Studies show conflicting findings on the role of vitamin D in AR: some studies report increased AR with higher vitamin D levels or supplementation. One study concluded that maternal intake of vitamin D reduces the risk of AR. Another study conducted in Iran highlighted higher prevalence of vitamin D deficiency in patients with AR.

Aim

To assess the correlation between vitamin D levels and severity of AR.

Method

Study Design

Treatment Strategy 

• The AR group comprised of 49 patients with clinically confirmed AR diagnosis as per AR and Its Impact on Asthma (ARIA) guidelines
• Runny nose and nasal obstruction were the main complaints reported by the AR group
• The control group included 50 apparently healthy volunteers aged between 20-50 years, with no history of AR
• The cohort underwent blood tests to determine the levels of IgE and 25-hydroxyvitamin D3 
• Vitamin D levels of <10 ng/ml, 10-12 ng/ml, 12.1-20 ng/ml and >20ng/ml were considered as severe deficiency, moderate deficiency, insufficiency and normal respectively
• AR was classified as intermittent or persistent based on the frequency of symptoms
• AR was also classified as moderate to severe if one or more of the following symptoms were present; abnormal sleep, impairment of daily activity, abnormal work at school or troublesome symptoms
• Mild AR was considered if none of the symptoms were present

Results

• Among the AR group, 71% had moderate to severe persistent AR
• The mean levels of vit. D and IgE in both groups is shown in Figure 1 and 2, respectively

 

Figure 1. Serum vitamin D levels

Figure 2. Serum IgE levels

 

• Deficiency of vitamin D level was observed in 93% of AR patients, whereas 56% of this group had severe deficiency
• Insufficient level of vitamin D was noted in 34% of the control group
• Serum IgE levels in the AR group are shown in Figure 3.

 

Figure 3. Serum IgE levels in AR group

 

• AR group had significantly higher prevalence of low levels of vit. D as compared to the control group (p<0.001)
• A significant negative correlation was noted between the serum IgE and vitamin D levels in the AR group; whereas the correlation was statistically insignificant in the control group

Conclusion

• Vitamin D deficiency is significantly associated with the severity of allergic rhinitis (AR) and monitoring levels of serum vitamin D is recommended in this group of patients
• Subclinical deficiency is common in healthy individuals, and future studies should assess vitamin D supplementation as add-on therapy in AR patients with low vitamin D levels.

 

J Med Life. 2020 Oct-Dec;13(4):463–468.