Rhinitis (allergic and nonallergic) in an atopic pediatric referral population in the grasslands of inland South Africa.
BACKGROUND
Allergic rhinitis is a common condition, which causes considerable morbidity. South African data are scarce.


OBJECTIVE
We sought to describe allergic rhinitis in atopic children in inland South Africa.


METHODS
An observational, descriptive study of rhinitis occurring in 771 new patients seen consecutively by a single observer at a referral pediatric allergy clinic (Universitas Hospital, Bloemfontein) over an 8 1/2-year period (August 1984 to March 1993) was carried out. A detailed questionnaire was used to record clinical data. Chest and sinus x-rays, skin prick testing, and radioallergosorbent test were performed, and serum immunoglobulin E levels were determined. Response to drug treatment regimens was recorded at subsequent followup visits.


RESULTS
Significant rhinitis was reported in 78.1% of patients, and mild intermittent rhinitis was reported in 21.4%. Male to female ratio was 1.6:1. Median age at onset of rhinitis symptoms was 6 months (range 0 months to 12 years), with 30.1% experiencing symptoms from birth. Rhinitis was chronic in 61.3%, although 53.5% reported seasonal variation. More children with rhinitis were born in midsummer than during other seasons, although this did not reach statistical significance (P = 0.46). Breast-feeding had no protective effect, and parental smoking and household pets were not found to be risk factors. Family history was positive for allergic rhinitis in 88% of patients. Exposure to dust, weather changes, strong odors, pets, pollens, and tobacco smoke were the most common trigger factors. Sinus x-ray findings associated poorly with clinical findings. The most common allergens identified were grass pollen, tree pollen, and cat. Oral antihistamines provided good symptomatic relief in 62.9% of patients who used them. Intranasal corticosteroids provided good relief in 78.0% of those who used them, and ketotifen provided relief in 54.4% of those who used it.


CONCLUSIONS
Rhinitis is a common manifestation of allergy in the population studied. Onset occurs early in childhood. A family history of allergy is a risk factor for the development of the condition, and grass pollen is the most common allergen involved. Special investigations are of limited value. Appropriate treatment is very effective.
Mercer
Madeleine J
MJ
Department of Paediatrics and Child Health, University of the Orange Free State, Bloemfontein, South Africa. househam@shisas.com
van der Linde
Gidea P
GP
Joubert
Gina
G
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012017:Referral and Consultation; D012220:Rhinitis / Q000453:epidemiology* / Q000209:etiology* / Q000276:immunology; D006255:Rhinitis, Allergic, Seasonal / Q000453:epidemiology* / Q000209:etiology* / Q000276:immunology; D012307:Risk Factors; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires
D007073:Immunoglobulin E