Dr. Samar Ghazal/Musmar*, Dr. Mohammed Musmar**, W. A.Minawi ***
* Consultant, Family Medicine, NGHAKH, Al-Hasa, KSA and Clinical Assistant Professor, Family Medicine, An-Najah University College of Medicine
**Associate Professor An-Najah University College of pharmacy
*** Instructor, An-Najah University

Correspondence:
Samar Ghazal/Musmar, MD, FAAFP
Consultant, Family Medicine
King Abdulaziz Hospital National Guard Health Affairs,
P.O. Box 2477
Al-Hasa, KSA

Clinical Assistant Professor, Family Medicine, An-Najah University, College of Medicine, Nablus Palestine, Al-Quds University, College of Medicine, Palestine.
P.O. Box 608
Nablus/ West Bank, Palestine
E-mail: smusmar1@yahoo.com
Ph: +970-9-2338722
Mobile: +970-599-840440, +966-56-698750

Allergic rhinitis, especially in adolescents and children, has become a major public-health problem in developed and developing countries¹. A large - scale cohort study in the UK revealed a rising trend of allergic rhinitis, from 12 to 23% during 1958-1970². Several large surveys in Switzerland also showed increasing prevalence of self-reported hay fever from 9.6% in 1985 to 13.5% in 1992³. Similar results have also been reported all around the world^4,5,6.

Inhalant allergic conditions such as seasonal and perennial allergic rhinitis are becoming quite common⁷. The effect of allergy on an individual's quality of life and the extent to which it may restrict daily activities is often overlooked.

Controlling allergies can significantly decrease health care costs^8,9. The purpose of this study is to estimate the prevalence of allergic rhinitis among young adults in Palestine represented by An-Najah University students.

Nablus district is located in the northern part of the West bank. It is bounded by Jenin from the north; Tulkarm from the west; Ramallah and Jericho from the south and the Jordan river from the east¹⁰. The geographical position of Nablus district in the northern part of west bank gives it a comparatively low temperature range. Located in Nablus, An-Najah National University, is currently the largest University in the West Bank, with 16 colleges and around 13,000 enrolled students¹¹.

Population of the Study

The study population was chosen from An-Najah university in Nablus. The study sample consisted of a total of 1000 randomly selected students from all colleges of the University, whether scientific, humanitarian, or community college. The percentage of students in the sample represented the percentage of students in each college.

The age of the students was at a range of (18-27). Both males and females were included in almost equal percentage.

Data Collection

Data were collected during the period of the first of September 2004 to the end of December 2004, using structured interview. A questionnaire was designed, evaluated, and reviewed by an expert statistician. A pilot test was carried out on 30 students to find the capacity of students to understand the questionnaire wording then the questionnaire layout was modified accordingly. A total of 1,116 questionnaire forms were distributed; the total response rate in this study was 90%, 1007) questionnaires were returned.

Questionnaire Component

The questionnaire spotlighted several parts that play important roles in triggering allergy. The following are important components of the questionnaire:

• Sociodemographic factors including age, sex, college, weight, sport, and smoking.
• Environmental history including residence, trees, allergens, inside the home, type of cooling, type of heating, indoor animal and type of pillow.
• Triggers that cause or worsen the subject's symptoms including exercise, respiratory infections, weather changes, foods. The symptoms included nasal, sinus, eyes, chest, eczema, asthma and allergy problem (frequency and severity), and health problems other than asthma and allergy.
  
  

Data Analysis

All data from questionnaires for the 1007 student sample were entered into the computer and computed using SPSS program and applying Chi - square test, with 95% level of significant (P value = 0.05).

Analysis of Descriptive Studies

Tables containing descriptive studies were obtained, such as sex, age, residence, environmental, social and living factors.

Analysis of Relationship

Relationship between risk factors, triggers, and some disease with allergic rhinitis among An-Najah University students was obtained; also relationships between sex, age, residence, smoking, sport practicing and allergic rhinitis were obtained.

Table 1 describes the demographic and anthropometric characteristics of The study sample. Males and females were almost equal. Most of the study sample were single (94.9%), not working (93.6%), and non smokers (81.1%).

Table (2) describes the place of living whether it is dormitory or own house; it also describes some environmental factors of the place of residence. More than half the sample live in the city, and about half live in the university dormitory. 60% live in relatively new houses, which were either stone buildings or brick buildings. Using fan was the major cooling method, with only 1.3% using air conditioning.

Table 3 shows the prevalence rate of allergic rhinitis in this study and the distribution of allergic rhinitis according to gender and place of residence.

Prevalence rate of allergic rhinitis was calculated as follows:

*The number of An-Najah University students in the year 2004 was 12,500 students.

Table 4 shows the percentage of triggers in relation to allergic rhinitis in our study sample. The triggers that have a large effect on health of population sample for rhinitis were respiratory infections (49.7%), tyre burning and war gases 49.1%, house dust 46.7%, strong odours 40.6%, auto exhaust 33.9%, smoke 33.8%, weather changes 34.2%, grass and trees 20.9%, and cosmetics 20.1%. All other triggers appear to have less effect.

Table 5 shows that there was a statistically significant relationship (p value < 0.05) between allergic rhinitis and weight loss, deep sleeping, chronic respiratory infections, chronic abdominal pain, nasal polyps, anxiety, sleep apnea, chronic diarrhea, migraines and anemia. However there was no statistically significant relationship (p value > 0.05) between allergic rhinitis and gender, smoking, smoker at home, living place, the tree and grass around the house, kind of building, kind of heating source, kind of cooling source, kind of animals in house, kind of animal around the house, kind of pillow, practice of sports, heart problems, diabetes, thyroid disorders, skin allergy, and glaucoma.

* These percentages of triggers apply for only those who have symptoms.

Table 1 gives a comprehensive demographic and anthropometric description to the study sample. Our study sample, represents the typical profile of university students in Palestine, where we have a fair mix of males and females; most of them were single and around 20 years of age. All colleges of the university were well represented in this study sample.

Exposure to smoking whether directly and indirectly affects more than half of the sample study, and about half of this sample practice sports.

When the target population were distributed according to their residence, 46.1% of the target population were living in dormitories, which can be explained by the political situation after AL Aqsa Intifada in which closure and checkpoints make transportation between Palestinian cities very difficult. In regards to house conditions, the results show that majority of students live in relatively new stone buildings with quiet lay out in the city. Although the percentage of asbestos buildings was low, it indicates an important need for raising awareness among students about asbestos and its hazardous effects on the lungs.

The triggers that have a large effect on the health of population study sample for allergic rhinitis were respiratory infections, tyre burning and war gases, house dust, strong odours, auto exhaust, smoke and weather changes (Table 4).

These results indicate that war gases and tyre burning play an important role in worsening allergic rhinitis symptoms which points to the effect of political conflict and the use of war gases and tyre burning on the health of Palestinian society.

Furthermore our results indicate that triggers in this study are mainly non allergic in nature. Previous studies show that, AR triggers can be allergic or non allergic in nature¹². The allergic triggers are house dust mite, pollen, animals, such as dogs and cats, fungal spores and cockroaches, particles. The non-allergic triggers include smoke and pollution from cooking fuels, wood smoke, smog, viral respiratory tract infections and weather changes. All the above triggers are found in urban, camp and rural environments albeit to different extents¹².

Our results show a statistically significant relationship between allergic rhinitis and weight loss, deep sleeping, chronic respiratory infections, chronic abdominal pain, nasal polyps, anxiety, sleep apnea, chronic diarrhea and migraines at p value < 0.05 (Table 5).

Several studies in other parts of the world have shown similar relationship results^13,14. The gender relationship with Allergic Rhinitis was not statistically significant in our study (Table 5). A Swedish study also did not find a difference between men and women in the general population regarding allergic rhinitis¹⁵. However a study in Tehran, found a significant relationship between gender and Allergic Rhinitis¹⁶.

The same study in Tehran and another study in Finland¹⁷ also found that environmental and social factors are important risk factors in the incidence of Allergic Rhinitis¹⁶. On the contrary this relationship in our study was not statistically significant, (Table 5).

This difference in prevalence, triggers and risk factors for allergic rhinitis among different countries has been demonstrated repeatedly in the epidemiological studies.

The international study of asthma and allergies in childhood (ISAAC)¹⁸ steering committee, which conducted a study to investigate worldwide prevalence of asthma, allergic rhino conjunctivitis, and atopic eczema was a very obvious example.

The multifactorial factors and the presence of several types of allergic rhinitis are possible explanations.

Palestine, as a country in transition shifting from a traditional to a modern society, has several unique features that put the population at risk of developing allergic conditions.

This is the first study to determine the prevalence of allergic rhinitis and its risk factors among young adults in Palestine. Our results show relatively lower allergic rhinitis prevalence in Palestine compared to some neighbouring countries, but were consistent with studies done in Turkey.

The results also show a statistically significant relationship between allergic rhinitis and weight loss, deep sleep, chronic respiratory infections, nasal polyps, anxiety, sleep apnea, and migraines but neither gender nor residence and environmental factors have a statistically significant relationship with Allergic Rhinitis.

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