Title: CONCOMITANT PRESENCE OF ALLERGIC RHINITIS (AR) IN CHRONIC/FIBROTIC HYPERSENSITIVITY PNEUMONITIS (C/F-HP) PATIENTS: COINCIDENCE OR CORRELATION?

Abstract:

Background:
Owing to cumbersome diagnostic process of chronic/fibrotic hypersensitivity pneumonitis (C/F-HP) - necessitating lung biopsy which is usually fraught with complications in very sick patients, C/F-HP remains under-diagnosed inspite of its high prevalence. There is a need to find out clinical indicators to ease up the process of diagnosing C/F-HP. The concomitant presence of Allergic Rhinitis (AR) in C/F-HP patients may fulfill the need.
Objective:
To elucidate the concomitant finding of Allergic Rhinitis(AR) in C/F-HP , and its utility as one of the clinical indicator for the non-invasive diagnosis of C/F-HP. Thereby obviating the need for lung biopsy.
Method:
This cross sectional descriptive study was conducted in the pulmonology departments of BakhtawarAmin Medical College &Trust Hospital from July 1, 2021 to December 31, 2022. It comprised 107 patients of C/F-HP. Sample size was calculated assuming 50% prevalence of AR, 95% CI, and 9% margin of error. The patients aged 18 to 60, were enrolled by consecutive sampling technique. Prior approval from Ethical Board of the hospital was taken. The patients with C/F-HP without any comorbidities were included and ILD patients with known causes like connective tissue disorders; severe pulmonary hypertension, respiratory failure, BMI <18 or >30, and comorbidities like diabetes mellitus, hypertension, CKD, CLD, CCF, were excluded. Allergic Rhinitis was diagnosed by the history (most relevant)and serum IgE levels as per AAFP criteria. Once
registered, frequency of AR in C/F-HP patients was calculated.
Results:
107 patients of C/F-HP patients were divided into two age groups viz, group A 18-40 years old, group B 40-70. Mean age +/- SD 46.73 +/- 9.363. Group A comprised 29/107 (27.10%) patients, and group B 78/107 ( 72.90%).
Male 64/107 (59.8%), female 43/107 (40.2%). Paint factory workers were 21/107 (19.6&), pigeon/parrot breeders 55/107 (51.4%), and power loom workers 31/107 (29.0%).
Allergic Rhinitis was diagnosed in 99/107 (92.5%) patients with C/F-HP patients. Mean +/- SD of total serumIgE in these AR patients was 542.65 +/- 182.930. Of these 99/107 AR patients, 4 had normal serum IgElevel (may be due to prior use of high dose corticosteroids)but with clinical features of AR. In group A 28/29 patients, and in group B 71/78 patients fulfilled AAFP criteria for the diagnosis of AR. In the patients with positive diagnosis of AR male patients were 62/64, and female patients 37/43. Whereas C/F-HP patients displayed male:female ratio of 64:43, and in these patients AR was elicited in 99 patients with male:female ratio of 62:37. Of the 8/107 C/F-HP patients who were negative for AR, 1/20 patients was paint factory worker, 4/51 pigeon/parrot breeders, 3/28 power loom workers.
Conclusion:
This study illuminates the so far unearthed coincidence/correlation of AR in C/F-HP patients and lays premium upon AR to be employed as one of the clinical indicators for the diagnosis of C/F-HP, as very high frequency of the AR was noted in C/F-HP patients. It seems our hypothesis that "in an uncertain ILD patient, if AR is concomitantly present, C/F-HP should be sought out", stands validated. This study holds the potential to obviate the need of lung biopsy for the diagnosis of C/F-HP. To firmly establish it, more rigorous studies are warranted in this regard

Biography:

Mudassar Rasool is one of the best Medical Specialist in Lahore with a high patient satisfaction rate. He has the following qualifications: MBBS, FCPS. He continued serving in different general medicine departments for years treating all kinds of health conditions. Mudassar Rasool aims to provide the best healthcare services to people of all age groups.