Gender Differences and Respiratory Symptoms affecting Quality of Life in Allergic Rhinitis: A Clinical Analysis Utilizing Artificial Intelligence

This study investigated the prevalence and presentation of allergic and respiratory symptoms among male and female South Indian patients to elucidate their quality of life. To some extent Artificial Intelligence was inferred to perform tasks typically associated with human intelligence and has the capacity to impact millions of patients by changing the way medicine is practiced to improve their quality of life. A cohort of 15 patients presenting with various symptoms related to allergies and respiratory conditions was analyzed in this investigation. The patients were categorized based on gender, and their symptoms, duration, and smoking history were recorded. While several studies have explored the prevalence and etiology of allergic and respiratory conditions, but there is very little information on the potential gender differences in symptom presentation and severity. Our findings reveal distinct patterns in symptomatology between males and females, highlighting the importance of considering gender-specific factors in clinical management. This study leveraged AI to enhance clinical analysis and demonstrated new perspectives on the intersection of gender, respiratory health, and QoL in allergic rhinitis patients. While there isn't a single, universally accepted score chart for comparing all parameters of Quality of Life in allergic rhinitis patients directly, several validated instruments and scales were used to quantify and compare aspects of QoL among these patients. These tools often include scoring systems that allow for the assessment of symptom severity, impact on daily activities, and overall well-being.

Allergic and respiratory symptoms are common presentations in clinical practice, often causing discomfort and impairment in patients' daily lives. Understanding the demographic and clinical characteristics of patients with such symptoms is crucial for effective diagnosis and management. The etiology involves a complex interplay of genetic predisposition and environmental factors. People with a family history of allergies are more likely to develop allergic rhinitis. Additionally, exposure to allergens, air pollution, smoking, and respiratory infections can increase the risk. The impact of allergic rhinitis on quality of life can be significant. Symptoms can be bothersome and persistent, leading to sleep disturbances, fatigue, impaired concentration, and decreased productivity at work or school. Moreover, allergic rhinitis is associated with comorbid conditions such as asthma and sinusitis, further exacerbating its impact on health and affecting the quality of life. By incorporating AI, we aim to achieve a more nuanced understanding of how gender differences influence respiratory symptoms and their subsequent effects on QoL in patients with allergic rhinitis. AI's ability to process and analyze high-dimensional data enables the identification of subtle patterns and trends, thus facilitating a more detailed and personalized approach to managing AR [new-1].

Allergic rhinitis, a prevalent condition affecting millions globally, extends far beyond mere nasal discomfort. Its impact reverberates through various facets of life, significantly influencing the overall quality of life (QoL) of afflicted individuals [2.3]. As a pervasive allergic condition, its management not only involves addressing physical symptoms but also requires a holistic approach that acknowledges its multifaceted effects on daily life [4]. Understanding the nuances of allergic rhinitis reveals its profound implications on well-being. From disrupted sleep patterns to impaired cognitive function and diminished productivity, the burden extends beyond the confines of nasal congestion, sneezing and financial burden globally [5]. This investigation delves into the dynamic interplay between allergic rhinitis and QoL, shedding light on treatment strategies to alleviate its effects and enhance patient well-being. Effective management strategies include allergen avoidance, pharmacotherapy such as antihistamines and nasal corticosteroids, and in severe cases, allergen immunotherapy. By addressing symptoms and triggers, individuals with allergic rhinitis can improve their quality of life (QoL) and reduce the burden of the condition.

A retrospective analysis was conducted on a cohort of 15 patients presenting with allergic and respiratory symptoms. Data including patient demographics, symptoms, duration of symptoms, and smoking history were collected from medical records. Approval of the Institutional Ethics Committee was obtained and patient consent was obtained before the start of the study.  Patients were categorized into male and female groups for comparative analysis. The patients were recruited from among the population of Telangana (India) attending the ENT Clinics of Mahavir Hospital and Research Centre, Hyderabad. Individuals with history of allergic rhinitis (AR) as determined by the Health Professionals were selected for the study, based on inclusion and exclusion criteria as documented in our previous publication [5,6,7].

Figure 1: showing the Inflammation of the nasal cavity due to Rhinitis (Source: Google images)
The patients suffer from morbidity of nasal symptoms with impairment of the quality of life. A questionnaire was designed to collect the aetiology and Quality of life of the study group. these were followed up for a short period of time. Assessing the QoL involves evaluating various physical, emotional, and social parameters affected by the condition and severity of the disease. Some key parameters commonly used in assessing the QOL of allergic rhinitis patients include sneezing, nasal congestion, itching, and rhinorrhoea. Also assessing its impact on day-to-day activities, sleep quality and emotional well-being. Evaluating the side effects of medications used to manage allergic rhinitis are essential as they can affect QOL and treatment adherence. By evaluating these parameters, healthcare providers can tailor interventions to address specific QOL issues and improve outcomes for allergic rhinitis patients [8, 9].

The analysis revealed notable gender differences in symptom presentation among the patients. Male patients (Table-1) predominantly presented with symptoms such as sneezing, runny nose, and blocked nose, often with a longer duration of symptoms compared to females. In contrast, female patients (Table-2) exhibited a broader spectrum of symptoms, including nasal discharge, nasal congestion, headache, and wheezing. Smoking history varied among male patients, with some reporting occasional smoking, while females generally reported no smoking history.

Table 1: Male Patients: Effect of Smoking on Symptoms and duration of the disease

Table 2

These tables (Table-1 and Table-2) provide a breakdown of patient’s demographics, their reported symptoms, how long they have had the symptoms (duration), and their smoking history. This data is very useful for analysis related to the impact of symptoms and duration of the disease in male and female patients. It is also seen that none of the male and female patients were smokers. These tables compared the symptoms and duration of the disease between smokers and non-smokers in each gender group.

The impact of symptoms on QoL

Allergic rhinitis (AR) can significantly impact the quality of life of affected individuals due to the array of symptoms it presents (Table-1 and Table-2). Nasal stuffiness (congestion), sneezing, and runny nose: These symptoms can cause discomfort and annoyance, leading to difficulty breathing through the nose, disrupted sleep due to congestion, and embarrassment from frequent sneezing and runny nose episodes. It can also interfere with the ability to concentrate on tasks or enjoy activities. Itchiness can be quite bothersome and distracting. Constantly scratching or rubbing the nose, throat, or eyes can lead to irritation and potential complications like eye infections or throat irritation. Headaches, sinus pain, and dark circles under the eyes: Persistent headaches and sinus pain can be debilitating, affecting productivity, mood, and overall well-being. Dark circles under the eyes can contribute to a tired and unwell appearance, impacting self-esteem and confidence [10]. Increased mucus production can lead to throat irritation, frequent throat clearing, and a constant feeling of needing to clear the throat. This can be socially awkward and uncomfortable. Fatigue and malaise (general feeling of discomfort): Constant fatigue and malaise can affect energy levels, motivation, and the ability to engage in daily activities. It can lead to decreased productivity and enjoyment of life. Postnasal drip can cause a persistent sore throat, coughing, and throat irritation. It can also disrupt sleep and contribute to fatigue and irritability. Wheezing, coughing, and trouble breathing, these respiratory symptoms can be alarming and may indicate more severe complications such as asthma exacerbations. They can limit physical activity, disrupt sleep, and impact overall respiratory health and quality of life. Hives are itchy, raised welts on the skin that can appear suddenly and disappear quickly. They can be uncomfortable and unsightly, causing distress and affecting self-confidence, especially if they occur frequently or in visible areas.

Treatment strategies- and their impact on the quality of life (QoL) of AR patients

Treatment strategies and their implications in patients with Allergic Rhinitis are documented below these are a few of the generally used anti histamines given to the patients, which we obtained from their records The first-generation Antihistamines used were diphenhydramine (e.g., Benadryl), Chlorpheniramine (e.g., Chlor-Trimeton); Promethazine (e.g., Phenergan); Hydroxyzine (e.g., Atarax); Clemastine (e.g., Tavist); etc to name a few. The toxic effects of these medications are shown in Table-3.

Table 3: Toxic Side Effects of the medications affecting the Quality of life of AR patients and their Symptoms Description

These side effects highlight the limitations of first-generation antihistamines, and they underscore the importance of considering alternative, second-generation antihistamines in cases where sedation and cognitive impairment were significant concerns (Table-3).

Second-generation Antihistamines: included- Cetirizine (e.g., Zyrtec), Loratadine (e.g., Claritin); Fexofenadine (e.g., Allegra); Desloratadine (e.g., Clarinex); Levocetirizine (e.g., Xyzal) and few more. These were generally preferred for allergic rhinitis and other allergic conditions due to their reduced sedative effects and lower risk of central nervous system-related side effects compared to first-generation antihista-mines. Second-generation oral antihistamines and intranasal corticosteroids are the mainstay of treatment. Allergen immunotherapy is an effective immune-modulating treatment that is generally recommended if pharmacologic therapy for allergic rhinitis is not effective or is not tolerated, or if chosen by the patient. The best treatment strategies for allergic rhinitis aim to alleviate symptoms and improve the quality of life for affected individuals [11]. These strategies may include a combination of lifestyle modifications, pharmacotherapy, and, in some cases, immunotherapy, these therapies are presented in Table-4: The new approach to treat allergic rhinitis refers to Immunotherapy, which is recommended to start pre-seasonal in a series of 6 to 11 injections.

Table 4: Preventive Treatment strategies for AR patients

Life style Habits impacting the quality of life (QOL) of allergic rhinitis patients 

One of the primary domains where allergic rhinitis exerts its influence is sleep quality. Persistent nasal congestion and nocturnal symptoms frequently disrupt sleep patterns, leading to fatigue and impaired daytime functioning. Consequently, individuals may experience decreased productivity, impaired concentration, and heightened irritability, all of which impede their ability to engage fully in daily activities.Poor sleep due to symptoms like nasal congestion, itching, and difficulty breathing can significantly impair QOL. Evaluating sleep duration, latency, and disturbances can help assess this aspect. Furthermore, the emotional toll of allergic rhinitis should not be underestimated. Chronic symptoms often breed frustration, anxiety, and even depression, diminishing one's overall emotional well-being. The constant battle against allergens and the unpredictability of symptom onset can erode resilience, leaving individuals feeling emotionally drained and socially isolated [12, 13]. This study also involves evaluating various physical, emotional, and social parameters affected by the condition. The symptoms severity was varying according to age and gender. As we could determine percentage only. Many symptoms overlapped while some were exclusive to women.

Total Symptom Score (TSS): This score aggregates the severity of individual symptoms (e.g., sneezing, nasal congestion, or itchy nose, or runny nose) on a scale, usually from 0 (no symptoms) to 3 (severe symptoms), providing a cumulative measure of symptom burden. Each of these tools has its scoring system and interpretation guidelines, which can be used to compare the QoL impacts of allergic rhinitis among patients or in response to treatment. The most appropriate instrument based on the specific needs of the patient is generally selected, using the questionnaire.

Artificial intelligence (AI) has transformed various fields, including healthcare, with the potential to improve patient care and quality of life [14]. Allergic rhinitis (AR) is a prevalent chronic condition characterized by symptoms such as nasal congestion, sneezing, itching, and rhinorrhea, significantly impacting the quality of life (QoL) of affected individuals. Research has consistently demonstrated that AR manifests differently across genders, with variations in symptom severity, frequency, and QoL outcomes. Understanding these gender-specific differences is crucial for developing tailored therapeutic strategies. While there isn't a single, universally accepted score chart for comparing all parameters of Quality of Life (QoL) in allergic rhinitis patients directly, several validated instruments and scales are used to quantify and compare aspects of QoL among these patients. Here we opted for making a logical questionnaire to document the QoL of AR patients.  In clinical practice, a combination of these parameters, tailored to the individual patient's condition and circumstances, provided a comprehensive assessment of the impact of allergic rhinitis on their quality of life which determined their treatment strategies. The observed gender differences in symptom presentation may reflect underlying physiological and hormonal influences on allergic and respiratory conditions. Male predominance in certain symptoms such as sneezing and nasal congestion may be attributed to anatomical variations or genetic predispositions. Conversely, the broader symptom profile seen in female patients suggests potential interactions between hormonal fluctuations and immune responses.

The absence of a significant smoking history among female patients aligns with existing literature on gender disparities in smoking prevalence and its association with respiratory health. However, further studies with larger sample sizes are warranted to explore the complex interplay between gender, smoking behaviour, and allergic/respiratory symptoms. The symptoms of allergic rhinitis can have a profound impact on various aspects of life, including physical health, emotional well-being, social interactions, and productivity. Managing these symptoms effectively through medication, avoidance of triggers, and lifestyle modifications is crucial to improving the quality of life (QoL) for individuals with allergic rhinitis. Recent advancements in artificial intelligence (AI) have revolutionized medical research, offering powerful tools to enhance data analysis, pattern recognition, and predictive modeling. In this study, AI techniques have been employed to analyze clinical data more comprehensively and accurately than traditional methods. AI algorithms, particularly machine learning models, can handle vast datasets, identify complex relationships, and provide insights that might be overlooked by conventional statistical approaches.

The impact of allergic rhinitis on the quality of life of patients is multifaceted. Physically, the persistent symptoms can lead to fatigue, sleep disturbances, and decreased productivity. The nasal congestion and difficulty breathing can interfere with daily activities and may exacerbate other health issues such as asthma. Emotionally, allergic rhinitis caused frustration, irritability, and feelings of social isolation. The constant sneezing and runny nose were a kind of embarrassing in social situations, leading to avoidance of certain activities or settings. Allergic rhinitis symptoms affect interpersonal relationships with family, friends, and romantic partners. Assessing this aspect helps understand social support and adjustment issues [15]. Furthermore, the financial burden of managing allergic rhinitis were significant as described by the patients. Costs associated with medication, doctor's visits, and /or missed work or absent from school add up over time. However, amidst these challenges lie opportunities for intervention and support. Multimodal treatment approaches, encompassing pharmacological interventions, allergen avoidance strategies, and patient education, are instrumental in restoring balance and improving QoL. Pharmacotherapy, including antihistamines, intranasal corticosteroids, and immunotherapy, effectively alleviate symptoms and mitigate the inflammatory cascade underlying allergic rhinitis. Additionally, allergen avoidance measures, such as implementing air filtration systems and minimizing exposure to triggers, play a pivotal role in symptom management. Equally important is the role of AI inpatient education and empowerment in fostering self-management and resilience. Educating individuals about allergen triggers, symptom management techniques, and treatment options empowers them to take an active role in their care [16,17]. Furthermore, cultivating a supportive environment that acknowledges the psychosocial impact of allergic rhinitis can foster a sense of community and belonging, buffering against feelings of isolation and despair.

Allergic rhinitis is a chronic condition characterized by inflammation of the nasal passages due to an allergic reaction to certain allergens such as pollen, dust mites, or pet dander. The symptoms include sneezing, itching, nasal congestion, and a runny nose, which can range from mild to severe. This study highlights distinct gender differences in the presentation of allergic and respiratory symptoms among patients. Understanding these differences is crucial for tailored clinical management and emphasizes the importance of considering gender-specific factors in the assessment and treatment of allergic and respiratory conditions. Further research is needed to elucidate the underlying mechanisms driving these gender disparities and to optimize therapeutic approaches for both male and female patients. Allergic rhinitis not only affects the physical health of patients but also their emotional well-being and financial stability. Effective management strategies, including allergen avoidance, medication, and allergen immunotherapy, are essential in improving the quality of life for individuals living with allergic rhinitis.

In conclusion, allergic rhinitis transcends its physical manifestations to profoundly impact the QoL of affected individuals. By adopting a comprehensive approach that addresses both the physical and psychosocial dimensions of the condition, clinicians can optimize patient outcomes and restore a sense of normalcy to daily life. Through tailored interventions, patient education, and empathetic support, the journey towards managing allergic rhinitis becomes a collaborative effort aimed at enhancing overall well-being and reclaiming quality of life.

Acknowledgements

We thank the Chairman and the Research Director for their encouragement.

Financial support received

Nil

Ethics statement

Approval of the Institutional Ethics Committee was obtained for this study from the IEC of Mahavir Hospital and Research Centre.

Conflict of interest

The authors declare that they have no conflict of interests.