Insights into Diagnosis and Management of Allergic Rhinitis Based on Perceptions of Indian Physicians

Insights into Diagnosis and Management of Allergic Rhinitis Based on Perceptions of Indian Physicians

Published: March 26, 2024

Introduction

Allergic rhinitis (AR) is increasingly recognized as a major public health concern in India, significantly impairing quality of life and productivity. According to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, the management of AR involves allergen avoidance, pharmacotherapy, and allergen immunotherapy (AIT). Intranasal corticosteroids (INCS) and oral antihistamines remain the mainstay of treatment.

However, treatment decisions are largely driven by physicians’ perceptions of disease severity, patients’ preferences, and safety profiles of available therapies. With multiple treatment options, uncertainties persist regarding optimal therapeutic regimens. This nationwide survey was conducted to understand the perceptions and clinical preferences of Indian physicians in the diagnosis and management of AR.

Aim

To evaluate the perceptions of Indian physicians regarding AR prevalence, diagnostic approaches, and management strategies, including their clinical preferences for pharmacotherapy and immunotherapy.

Methodology

Study Design: Cross-sectional, digital questionnaire-based survey
Study Period: September 2022 – March 2023 (6 months)
Participants: Physicians from 28 Indian states, including chest physicians, ENT surgeons, and consulting physicians managing AR cases.

The survey explored:

• Reported prevalence and common symptoms of AR
• Diagnostic approaches (e.g., mandatory tests)
• Preferred treatment regimens for varying AR severities
• Use and perception of INCS, oral antihistamines, and immunotherapy

Results

Physician Demographics

• Total participants: 1,608
• Practice setting: 70.8% private consultants, 11.3% corporate hospitals, 9.6% nursing homes

Prevalence and Diagnosis

• AR prevalence: Reported between 21–40% by 42.5% of physicians (Table 1).
• Diagnostic tests:
  • Total IgE: 47.5% considered mandatory
  • Allergen-specific IgE: 35.1%
  • Skin-prick test: 17.4% (Figure 1)

Pharmacotherapy Preferences

• Oral Antihistamines:
  • Fexofenadine preferred by 60.9% for mild AR
  • Levocetirizine (18.8%) and bilastine (16.8%) also used
• Intranasal Corticosteroids (INCS):
  • Fluticasone furoate: preferred by 67.1%
  • Fluticasone propionate: 24.3%
  • 77.8% found INCS safe and well tolerated

Combination Therapy

• Montelukast-antihistamine combination used by 51.6% for:
  • Mild AR not responding to antihistamine alone
  • Moderate to severe AR with INCS
  • AR with mild asthma
• Fexofenadine + montelukast preferred by 75.6% of physicians

Immunotherapy Trends

• 55.3% did not prescribe AIT
• Among those who did:
  • 23.6% preferred sublingual
  • 21.1% preferred subcutaneous

Treatment Duration

• INCS therapy recommended for 2–4 months by 40.9% of physicians
• Fexofenadine preferred for 1–2 months in most cases

Conclusion

The survey highlights a substantial AR burden in India (21–40% prevalence) with frequent asthma comorbidity. Fexofenadine, often in combination with montelukast, is the leading oral antihistamine of choice for AR management, while fluticasone furoate dominates the INCS category. Despite strong evidence, awareness and uptake of immunotherapy remain low, underlining the need for more education among clinicians on its long-term benefits.

Table 1. Physician-reported prevalence of AR in India

Figure 1. Preferred diagnostic tests for AR by Indian physicians

(Insert pie chart: Total IgE – 47.5%, Allergen-specific IgE – 35.1%, Skin-prick – 17.4%)

Reference: Cureus. 2024; 16(2): e55032.