Asthma and allergic disease in Pakistan

Research Paper (postgraduate), 2016

15 Pages

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To identify the frequency and prevalence of allergic diseases and the causative factors in patients of all the four provinces of Pakistan.


Secondary data for the year 2012-2014 was observed. Skin prick was the method adopted for determining the response of the patients to allergies.


The results were considered and it was found that allergic rhinitis (44.62%) and urticaria (skin diseases) (53.04%) were the most common diseases. From given data it was observed that Allergic Rhinitis was the main Allergic infection of Islamabad, Khyber Pakhtunkhwa and Sindh. Likewise urticaria was the common allergic disease of Rawalpindi and Baluchistan. Mixed cases of different respiratory diseases were common in Punjab and Khyber Pakhtunkhwa. Pollen and dust were the main aerosolic allergens involved in triggering the disease, beside thresher and raw cotton allergens were detected manually through IgE mediated skin prick test.


It is observed that allergy has a wide variety of clinical manifestations, allergic Rhinitis was considered as the main disease but cases of bronchial asthma and mixed respiratory allergies were not under notice. Urticaria was the chief skin sickness. Aerosolic allergens were the main causative factor for respiratory tract infections.

Key words: Allergic Rhinitis, Bronchial Asthma, Immunoglobulin E, Skin Prick Test, Aerosolic Allergens.


Many allergens existing in the environment, prevalence studies show distinctions can activate allergic response. Generally, prevalence of asthma, allergic rhinitis and eczema are common at the country level. These studies also try to explain that some people are sensitive to more than one allergen.

The International Study of Asthma and Allergies from child to adulthood (ISAAC) and UK epidemiological Childhood, demonstrated that large data shows the inexorable rise and variations exist in the prevalence of asthma and other allergic diseases. Allergic rhino-conjunctivitis and eczema throughout Africa and some South East Asian countries the world besides this asthma is more prevalent in major determinants of the increase in prevalence in urban than in rural populations. However, in most and severity of these allergic diseases. From provided data there is evidence that both genetic and environmental factors play an important role in the etiology of allergic rhinitis.

Allergy and asthma are characterized by an overreaction of the human immune system to different allergens due to raised levels of IgE antibodies. Hypersensitive persons have occasional experiences of asthma attacks, wheezing, breathlessness, and chest tightness. These attacks bring about the blockage in airway and airway hyper-responsiveness, which then leads to the narrowing and blockage of airway passages due to the blockage and obstruction of airflow– a key feature of asthma [3,4].

Beyond the recent advances in the field of allergy medicine, the frequency of Rhinits and Asthma is increasing day by day throughout the world rapidly The reason would be the emergence of new risk factors or loss of protective traditional life style. In India the prevalence of allergic rhinitis is about 30% to 40% of the total population, of which 25% have acquired asthma. In 1999, a study conduct in Saudi Arabia showed the prevalence of allergic rhinitis cases to be 20% to 25% among school children, while the figure for eczema was so close to 12% to 13%. In Pakistan the prevalence of Hay Fever was reported to be 25.7% in 1998, while the prevalence of asthma was 61% and allergic rhinitis was 72%.During the 1997– 2002 years the emergence of new environmental risk factors and loss of protective factors of a traditional lifestyle may explain the increase or dissimilarities in the prevalence of allergic diseases

The allergic diseases are rising globally, and Pakistan is no exception for any studies, in the literature, showing prevalence of allergic diseases in Pakistan

This has prompted, although different and necessitated to undertake a retrospective study of the Allergic patients staying Allergy Centre NIH, Islamabad, from all four provinces of Pakistan including patients from the twin cities of Rawalpindi and Islamabad.

The purpose of this study was to examine the prevalence of allergic disorders in all four provinces of Pakistan, including twin cities of Rawalpindi and Islamabad.


This is a retrospective examination of patients who were estimated for allergies at Allergy Center NIH, Islamabad during a period of three years, 2012-2014. Inclusion criteria were as tracks; all new cases with clinical history of allergy, Patients age were five to sixty-five years and patients with positive response to skin prick test. Patients undergoing desensitization were omitted from the study. Skin prick test (SPT) specify an IgE mediated response. All patients had skin test to Aerosolic allergens (dust, pollens, paper mulberry, thresher and raw cotton) and food allergens (beef, mutton, chicken, egg, fish and rice). Standardized allergen extract equipped at NIH were used manually for allergy skin test.

The skin prick test was performed by placing drop of each allergen, and negative control on the volar surface of the forearm. Blood-less skin prick was made using sterile lancet and extra drops we re-adsorbed with an absorbent. Aerosolic allergens, response to each allergen were observed. In incident of food allergens, although different antigens were used, positive response to single or multiple allergen was taken as a whole, because the patients positive to any or all of the food extracts were desensitize with mixed protein vaccine, and not individual allergen. The results were presented in percentages.


The results of the patients suffering from rhinitis, asthma, urticaria, eczema and conjunctivitis along with their skin prick test were observed

1. All four Provinces including Twin Cities of Rawalpindi & Islamabad

During the year 2007, out of 41,213 patients, 27,283 (66.1%) were diagnosed with various allergic diseases. They were between ages 8 years to 55 years with 37 as median age. The male female patient ratio was 3:1 with 70% male and 30% female. A total of 2,019,911 skin prick tests were performed. Over all result of allergic diseases and skin prick test in percentages are shown.

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2. Results of allergic Diseases and Skin Prick Test Result

a. Islamabad

Out of 37,283 patients, 4459 patients (12%) came with different allergy symptoms and out of 1, 19,911 tests we performed, 10,507 (10.7%) were positive. The results for each allergic disease and skin prick tests are shown.

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b. Rawalpindi

Out of 37283 patients, 5439 (14.6%) has allergic symptoms. Total of 1,19,911 skin prick tests were performed, 15,819 (13.3%) showed positive results (wound size greater than 2mm).The results of allergic response and skin prick test result are shown

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c. Punjab

Out of 29,283 patients, 15,947 (53.1%) had various allergy symptoms. Whereas 69,088 (54.9%) skin prick tests out of 1, 19,911 showed positive results (swelling formation greater than 2mm). The results of both factors are shown.

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D. Khyber Pakhtunkhwa

For Khyber Pakhtunkhwa, 70385 patients (24.4%) out of 28,283 patients had different allergy symptoms. A total of 1, 19,911 tests were performed, 29,986 (26%) were positive (wheal formation greater than 2mm). The results are summarized

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e. Sindh:

Similarly, in Sindh out of 29,283 patients, 800 patients (4.8%) came for evaluation of altered allergies and out of 1,19,911 skin tests, 3493 (2\3.9%) showed positive results ( wheal formation greater than 2mm).The results for individual disease and allergen are mentioned

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f. Baluchistan

Out of 29,283 patients, 277 patients (2%) came for evaluation of different allergies, and out of 1,19,911 skin tests 1438 (2%) showed positive results (wheal formation of greater than 2mm).The results for individual disease and allergen are Shown.

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Allergy and Asthma is a global health problem and according to W.H.O, more than 180 million people undergo asthma. Allergic diseases are on increase and the specific cause is unknown but life style changes may have contributed to this increase asthma. Built on the percentages of allergic diseases and skin prick test, combine results (in the twin cities and four provinces of Pakistan) exhibited that allergic rhinitis (38.62%) was the most mutual allergic disease in this population. This is similar to epidemiological educations showing growth prevalence of this disease [12]

Urticaria (32.42%) was the second common disease, while bronchial asthma (18.32%) and mixed cases of allergic rhinitis and asthma (20.62%) ranked third and fourth respectively, with no clear difference between the percentages of these two respiratory tract disease. These results are not astonishing, as common of patients with asthma suffers from environmental allergies. The prevalence of eczema, in these inhabitants, was little (12.24%), as linked to other allergic diseases. Nevertheless, different studies have exposed increase incidence of eczema in children and adults. The cases of allergic conjunctivitis were only (8.2%).

Allergic rhinitis and asthma can either occur independently, or can coexist4. In atopic entities allergies of eyes, skin or other organs can arise. In some circumstances the patients can associate their skin disease symptoms to food, physical or environmental triggers. In some children the history of rash could often be traced back to infancy, and these children are at risk to develop asthma later in their life5. To examine the contributing factors for the symptoms, skin prick test registers of the patients showed positive responses to most of the aero allergens. However, the number of patients with positive responses to dust, pollen, and paper mulberry allergen was high, compared to thresher and raw cotton. The percentage of patients with positive reactions to food allergens, in urticaria and eczema cases were little (8.3%).Thus, in this group, aerosolic allergens were the most common causative factor

There is some controversy with respect to the role of allergy in eczema. Several studies have confirmed an increased rate of sensitization to both foods and aerosolic allergens in patients with eczema16. On average, 58% of children and 45%of adults with eczema are informed to common allergens. Two types of dermatologic expressions are believed to be associated with food allergies: urticaria and eczema. Food allergy can be estimated either by skin prick testing or in vitro testing for food-specific IgE. Although T-cell mediated reaction has thought to play a role in the pathogenesis of eczema, both IgE mediated and non-IgE mediated hypersensitivity mechanisms has been implicated in the exacerbations of eczema.

Double blind placebo control oral challenge test remain the gold standard for confirmation of food allergy. We normally perform SPT at our center for assessment of food hypersensitivity. The positive reaction to food allergens in our population indicates sensitivity but not certainly clinical reactivity to these allergens. Our data also support the idea that SPT alone, although help to classify some patient with food allergy but May underestimates the number of patients with food Induced eczema. APT is labor intensive, expensive, require patient to give reappearance in 48 hours for the reading, and would make it unfeasible for our patient population.

Skin prick testing (SPT) and serum food-specific IgE (sIgE) levels are extremely sensitive testing options, but positive test results to tolerated foods are not uncommon. Allergen component-resolved diagnostics (CRD) have the potential to provide a more accurate assessment in diagnosing food allergies. [4]

The gender ratio was 2:1 with 61% male and 29% female. The increase in the number of male patients might be due to experiences to outdoor environmental activates. The twin city data displayed that number of urticaria, allergic rhinitis and mixed cases of rhinitis and asthma were the earliest, second and third mutual diseases in Rawalpindi.

While in Islamabad it appeared to be opposite i.e. allergic rhinitis was the most common, urticaria was second and mixed cases of rhinitis and asthma was third public diseases. Overpopulation, pollution, dust and local vegetation seem to be supplementary possible factors in the causation of respiratory and other allergic disorders in Rawalpindi and Islamabad. The percentages of allergic eczema and allergic conjunctivitis were not high in either city. The skin test results showed positive response to aeroallergen in patients with respiratory, skin and ocular diseases. Patients with cutaneous symptoms also showed positive response to food allergens but it was not significant, supporting the role of aero allergens to be the primary triggers/causative factor in urticaria and eczema.

Looking at each province individually for the distribution of allergies, Punjab reported maximum number of cases (61.1%) excluding Rawalpindi. Khyber Pakhtunkhwa was second (29.24%). Fewer cases were reported in Sindh (27.8%) and Baluchistan (3.2%).

The few cases from Sindh and Baluchistan might be because of distance and costly traveling to reach the Allergy Centre Islamabad. Mixed cases of rhinitis and asthma (44.86%) and allergic rhinitis alone (34.01%) were the major allergic disorders in the province of Punjab. Again, in Khyber Pakhtunkhwa the mixed cases of rhinitis and asthma (26.29%) and bronchial asthma alone (28.6.19%) were the first and second most common allergic diseases. Allergic rhinitis was on top (44.92%) in Sindh province and bronchial asthma (32.33%) were second in number .In Baluchistan, urticaria (26.12%) was the main disorder while respiratory tract diseases; bronchial asthma, allergic rhinitis and mixed cases of allergic rhinitis and bronchial asthma (34.23%,2. 28.67% & 19.12.%) were second, third and fourth public diseases. Eczema and allergic conjunctivitis cases were stumpy in all the provinces. Positive skin test indicates the role of aerosolic allergens to be the main activator in respiratory, skin and eye diseases, in all the four provinces. So dust, pollution and local vegetation seem to be the main features in the patients of all the four provinces including the patients from the twin cities of Rawalpindi and Islamabad.


In this study majority of the patients underwent from respiratory tract allergies. The province of Punjab had the maximum incidence of allergies, making half part of the allergy patients. Khyber Pakhtunkhwa was second among allergies, while Sindh and Baluchistan Province had rarer cases of allergy patients. It was also detected that the patients have cutaneous and ocular allergies, such as urticaria, eczemas and allergic conjunctivitis correspondingly. In this study not only single respiratory tract diseases was realized but mixed pattern of respiratory diseases was also witnessed.

The atopic status of these patients was definite from their positive skin prick test results, which authorize the presence of specific IgE antibodies to the allergens. Results of this study recommend that Aerosolic or Aero allergens are the primary triggers (activators) not only for the respiratory tract diseases but also for the different cutaneous disease; urticaria and eczema, and different ocular symptoms.


A debt of gratitude is owed to my Professor Syeda Mehreen Hassan for his moral support, helps and directed us to get data from NIH, Islamabad, particularly the hospital laboratory staff for their support throughout the study period. We also special thank our teachers and the patients for accepting to participate in our study and also for their patience throughout the study.


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Asthma and allergic disease in Pakistan
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Muhammad Asim (Author)Hina Gul Qazi (Author)Syed Najeeb Ullah (Author), 2016, Asthma and allergic disease in Pakistan, Munich, GRIN Verlag,


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