Syntax Literate: Jurnal Ilmiah Indonesia p–ISSN: 2541-0849 e-ISSN: 2548-1398
Vol. 9, No. 11, November 2024
PREVALENCE
OF ALLERGIC RHINITIS ON CHILDREN WITH STUNTING USING ISAAC QUESTIONNAIRE
Venny Tiursani Sarumpaet1, Arif Dermawan2,
Lina Lasminingrum3
Universitas
Padjadjaran, Bandung, Indonesia1,2,3
Email: [email protected]1
Abstract
Stunting
is a chronic nutritional problem caused by many factors, including the
condition of nutritional intake in infants. Malnutrition reduces body immunity
so it is considered as a risk factor for inflammation in children. Allergic
rhinitis is an inflammatory disease of the nasal mucosa caused by allergic
reactions in patients. This study aims to determine the prevalence of allergic
rhinitis in stunting patients in Kabupaten Bandung.
This research is a descriptive study, data was taken by multistage cluster
randomized sampling based on inclusion and exclusion criteria, in Kabupaten Bandung from the October 2019 to December 2019.
The data obtained will be presented in the form of tables and diagrams. Result.
From a total of 436 children age 2 – 5 years old with stunting, there were 188
children (43.11%) with allergic rhinitis and 245 children (58.6%) who did not
suffer from allergic rhinitis. Most ages were in the range of 48-60 months as
many as 77 children (40.95%), with the most sex being male as many as 100
children (53.19%), the most reported comorbidities were tonsillitis as many as
74 children (39.36%). Of the total 188 respondents, only 19 children (8.5%) had
a history of atopy. In this study, the prevalence of allergic rhinitis in
stunting children was 43.11%.
Keywords:
Stunting, ISAAC Questionnaire, Allergic Rhinitis,
Introduction
Stunting is one of the most significant health
problems that should not be ignored in the realm of public health. Stunting is
a condition of failure to grow in children under five years old due to chronic
malnutrition which causes children to be shorter for their age. Malnutrition
can occur since the infant is still in the womb and in the early stages of life
after birth, but the symptoms only appears after the
child is 2 years old. According to WHO, stunting is defined as a condition in
which children have a height or length that is less than their age. This
condition is measured by a length or height that is more than minus two
standard deviations from the WHO median growth standard for children. Stunting
includes chronic nutritional problems caused by many factors such as
socioeconomic conditions, maternal nutrition during pregnancy, infant illness,
and lack of nutritional intake in infants. Children with stunting will have difficulty
achieving optimal physical and cognitive development in their future
WHO
shows as many as 87 million children with stunting are in Asia, 59 million in
Africa and as many as 6 million in Latin America. There are five subregions
that have a children with stunting rate that exceeds
30%, namely: West Africa (31.4%), Central Africa (32.5%), East Africa (36.7%),
South Asia (34.1%), and Oceania (38.3% covering Australia and New Zealand)
According
to data from the World Health Organization (WHO), the prevalence for children
under five with stunting, Indonesia is included in the third country with the
highest prevalence in the Southeast Asia / South-East Asia Region (SEAR). The
average prevalence of stunting under five in Indonesia in 2005-2017 is 36.4%.
This prevalence rate is still in the high category based on the threshold
prevalence of malnutrition as a public health problem established by WHO. Based
on data from the National Population and Family Planning Board (BKKBN), there
are 29.9% or 2.7 million children under five who are stunted in West Java
alone, especially in Kabupaten Bandung, where this
study was conducted, the prevalence of stunting children in Kabupaten
Bandung is 40.7%
Lack
of nutritional intake is one of the factors that influence the incidence of
stunting. The intake of these nutrients includes macronutrients such as
carbohydrates, proteins and fats as well as micronutrients such as
antioxidants, various vitamins and minerals. Macronutrient and micronutrient
deficiency can increase the risk of various diseases, especially allergic
diseases, one of which is allergic rhinitis
Allergic
rhinitis is an inflammatory disease of the nasal mucosa caused by an allergic
reaction in patients who have previously been sensitized to the same allergen
and released chemical mediators upon re-exposure to the allergen. Allergic
rhinitis is a disorder of the nose with symptoms of sneezing, rhinorrhea,
itching and congestion after being triggered by an allergen
One
of the methods to diagnose allergic rhinitis in children is scoring system from
the International Study of Asthma and Allergies in Childhood (ISAAC). One of
the strengths of the ISAAC questionnaire is that it can be used for research on
children in populations with different cultures. This questionnaire is a widely
used research instrument, because it is cheap, can be applied easily and has
high sensitivity and specificity. This questionnaire has been translated into
various languages
Given
that currently, there has not been any research on allergic rhinitis in
stunting children, researchers are interested in conducting a study on the
prevalence of allergic rhinitis in stunting patients in Kabupaten
Bandung. This study aims to determine the prevalence of allergic rhinitis in
stunting patients in Kabupaten Bandung.
Research
Method
This
study is part of a joint study on stunting children in Kabupaten
Bandung, but is specifically done to assess the incidence of allergic rhinitis.
This research is a crossectional descriptive study
conducted in a sub-district in Kabupaten Bandung from
October to December 2019. Using a multi-stage cluster random sampling method,
were then taken into 800 data.
The
study population was pediatric patients age 2-5 years old diagnosed with
stunting. Samples were taken with the inclusion criteria of children diagnosed
based on clinical signs and symptoms and the child's parents were willing to
provide written consent (informed consent). The exclusion criteria were
patients with autoimmun diseases and patients with
poor general conditions and 436 samples were obtained. The data was analyzed
using the SPSS statistical application.
The
data were collected using the ISAAC questionnaire which was translated into
Indonesian and then statistically analyzed and presented in tabular form.
Results
and Discussion
In
this study, all of the respondents who met the inclusion criteria were
interviewed using the ISAAC questionnaire. Data acquired from the completed
questionnaires were then analyzed. From a total of 427 children with stunting,
there were 184 children (43.1%) with allergic rhinitis and 243 children (56.9
%) without allergic rhinitis.
Table
1. Prevalence of Allergic Rhinitis in Children with Stunting
|
Allergic Rhinitis |
N |
% |
|
Yes |
184 |
43,1 |
|
No |
243 |
56.9 |
Table 2.
Characteristics of Allergic Rhinitis in Children with Stunting
|
No. |
Variable |
N(184) |
% |
|
1. |
Age |
|
|
|
|
24-35 months |
49 |
26.6 |
|
|
36-47 months |
60 |
32.6 |
|
|
48-60 months |
75 |
40.8 |
|
2. |
Sex |
|
|
|
|
Male |
99 |
53.8 |
|
|
Female |
85 |
46.2 |
|
3. |
Comorbidity |
|
|
|
|
Asthma |
21 |
11.4 |
|
|
Urticaria |
2 |
1.1 |
|
|
Tonsilitis |
74 |
40.2 |
|
|
Acute Otitis Media |
13 |
7.1 |
|
|
No comorbidity |
74 |
40.2 |
|
4. |
History of Atopy |
|
|
|
|
Yes |
17 |
9.2 |
|
|
No |
167 |
90.8 |
Age
of the respondents were mostly in the range of 48-60 months (as many as 75
children (40.8%)), the sex was mostly male (as many as 100 children (53.8%)),
and the comorbidity was mostly tonsillitis (as many as 74 children (40,2 %)).
Of the total 188 respondents, only 17 children (9.2%) had a history of atopy.
In this study, the prevalence of allergic rhinitis in children with stunting
was 43.1% (n = 184).
The
number of allergic rhinitis patients classified as mild persistent in this
study were 28 children (15.21%), 150 children (81%) were classified as mild
intermittent, 3 children (1.63%) were classified as moderate severe
intermittent, and only 4 children (2.16%) were classified as moderate severe
persistent.
Table 3.
Classification of Allergic Rhinitis in Children with Stunting
|
2001 ARIA Classification |
|
|
|
|
|
|
|
Mild Intermittent |
Mild Persistent |
Moderate Severe Intermittent |
Moderate Severe Persistent |
N |
|
Allergic Rhinitis |
150 (81%) |
28 (15.21%) |
3 (1.63%) |
4 (2.16%) |
184 |
Discussion
The ISAAC questionnaire used in this study
is a widely accepted questionnaire to assess the prevalence of allergic
rhinitis in children and adolescents. In a study conducted by Kim et al, the
validity of the ISAAC questionnaire for rhinitis could be assessed with higher
accuracy because it was carried out in the general population, with the
subjects of the study acquired from a variety of individuals from different
areas. The questions about symptoms had a moderate sensitivity and specificity
(57.5% and 58.4%). The specificity of the questionnaire increased as the age of
the subjects also increased, the specificity for children aged 5-7 years was
30%, and 50% for children aged 11-16 years
In this study, the prevalence of allergic
rhinitis in children with stunting was 43.1% (n = 184). These findings were
thought to be related with the theory that stated micronutrient deficiency is
one of the risk factors that influence the incidence of autoimmune diseases,
infections and the immune system. Micronutrients have a significant role in the
immune system and are closely related with allergic rhinitis, and in general
they regulate the activity of variety of cells involved in the immune system,
including monocytes, dendritic cells, T lymphocytes and B lymphocytes, and
epithelium
Micronutrients regulate cell mediated and
innate immunity, modulate cytokine expression, humoral antibody response and
play a crucial role in the differentiation and development of Th1 and Th2
lymphocyte subsets. Studies have established that micronutrients such as iron,
zinc, selenium, vitamin A, C, D, and E, and folic acid are essential for
efficient immune system functioning.
Apart from these, micronutrients like copper and chromium are significantly important in
immunomodulation. Animal models have shown that copper deficiency results in
reduced T cell proliferation thereby decreasing humoral, cell- mediated and
nonspecific immune response suggesting its role in maintenance in immune
competence. Chromium, on the other hand, alters immunostimulatory or
immunosuppressive processes thereby affecting immune response that causes
hypersensitivity reactions; it also has an influence on T and B lymphocytes;
and cytokine and macrophage production
In recent years, an increase in allergic
diseases in the world has been linked to low levels of vitamin D in the blood. Schauber et al in 2008 stated that the relationship between
low serum vitamin D levels in the blood and an increase in impaired immunity is
not a coincidence. Population growth causes people to spend more time indoors
leading to less sun exposure and less vitamin D production in the skin
Research by Mulligan (2011) and several
other researchers has proven that low vitamin D levels in the blood are
associated with a high number of dendritic cells compared with the control
group (groups with normal or high vitamin D levels through vitamin D
supplementation). Dendritic cells have an important role directly in the
process of differentiation of Th cells into Th1 or Th2 cell subsets, where
without vitamin D (or in conditions of low vitamin D levels in the blood) the
inflammatory response will be chaotic wherein the Th1 subset will become more
dominant which causes the occurrence of a chronic inflammatory process and a
person will become more sensitive to allergens through the formation of
immunoglobulin-E. Researchers also proved that low vitamin D levels will also
increase levels of inflammatory mediators (chemokines) such as IL-2, IL-5, and
leukotrienes. Increased Th1 activity, as well as inflammatory cytokines, will
increase the risk for a person with a history of atopy to develop complaints
such as allergic rhinitis
The results about sex characteristics of
allergic rhinitis in children with stunting showed that there were more male
subjects than female subjects in this study. This is consistent with the
statement of the literature that says boys tend to suffer higher numbers of
allergic diseases (such as asthma and urticaria) than girls
Several studies have tried to investigate
the genetic predisposition to the incidence of allergic rhinitis in childhood.
It was stated that the history of atopy in the parents was a factor associated
with the incidence of allergic rhinitis
One study in Korea by Byeon
states that the degradation of the immune system in the children can contribute
to the incidence of allergic diseases, and higher the risk of developing otitis
media in children. This is caused by the dysfunction of the eustachian tube due
to repeated inflammation of the lymphoid tissue, such as adenoids. Increased
number of eosinophils in adenoids and tonsils was found in patients with a
history of allergy
We found that most of the children in this
study were classified as mild intermittent. This is consistent with previous
study. Study in Latin America shows that those who have had symptoms of
allergic rhinitis in the past year, suffered from intermittent allergic
rhinitis (74.5%)
Although lack of miknoutrient
could compromised the immunological status on stunting childern.
We can not foresee the economical factor that might
contribute. Family with low income could result to lack of fresh and nutritious
food, this situation would lead to poor consumption of mikronutrient
and later become risk factory of various allergy
Conclusion
In
this study, it was found that the prevalence of allergic rhinitis in children
with stunting in Kabupaten Bandung was quite high.
This can be influenced by the role of macronutrient and micronutrient
deficiency in children with stunting. Lack of nutritional intake that occurs in
stunted children can lead to susceptibility to allergic disease in childhood. In
this study, we also found the comorbid factors associated with allergic
rhinitis in children with stunting, such as asthma, urticaria, tonsillitis, and
acute otitis media. However, the association of these comorbid factors with
allergic rhinitis in children with stunting should be investigated further.
BIBLIOGRAPHY
Annesi-Maesano, I., Didier, A., Klossek,
M., Chanal, I., Moreau, D., & Bousquet, J.
(2002). The score for allergic rhinitis (SFAR): A simple and valid assessment
method in population studies. Allergy: European Journal of Allergy and
Clinical Immunology, 57(2).
https://doi.org/10.1034/j.1398-9995.2002.1o3170.x
Arshi, S., Ghalehbaghi,
B., Kamrava, S.-K., & Aminlou,
M. (2012). Vitamin D serum levels in allergic rhinitis: any difference from
normal population? Asia Pacific Allergy, 2(1).
https://doi.org/10.5415/apallergy.2012.2.1.45
Bawekes, H. F., Simanjuntak,
A. M., & Christina Daat, S. (2018). Pengujian Teori Fraud Pentagon Terhadap Fraudulent Financial Reporting. Jurnal Akuntansi &
Keuangan Daerah, 13(1), 114–134.
Bonds, R. S., & Midoro-Horiuti,
T. (2013). Estrogen effects in allergy and asthma.
In Current Opinion in Allergy and Clinical Immunology (Vol. 13, Issue
1). https://doi.org/10.1097/ACI.0b013e32835a6dd6
Byeon, H. (2019). The association between allergic
rhinitis and otitis media: a national representative sample of in South Korean
children. Scientific Reports, 9(1), 1610.
Dewi, A. M. K., Suprihati,
S., & Dharmana, E. (2016). Hubungan
Antara Rinitis Alergi Dengan Infeksi Saluran Pernafasan Atas Akut Berulang Pada Anak. Media
Medika Muda, 1(2).
Frohlich, M., Pinart Gilberga, M., Keller, T., Reich, A., Cabieses,
B., Hohmann, C., Postma, D. S., Bousquet, J., Keil, T., & Roll, S. (2017).
Is there a sex-shift in prevalence of allergic rhinitis and comorbid asthma
from childhood to adulthood? A meta-analysis. Clinical and Translational
Allergy, 2017, Vol. 7, Num. 44.
Gombart, A. F., Pierre, A., & Maggini,
S. (2020). A review of micronutrients and the immune system–working in harmony
to reduce the risk of infection. Nutrients, 12(1).
https://doi.org/10.3390/nu12010236
Ji, Y., Liu, Y., & Yang, N. (2016). Pediatric rhinitis risk factors. Experimental and
Therapeutic Medicine, 12(4), 2383–2386.
Kim, D. H., Lim, D. H., Samra, M., Kim, E. H.,
& Kim, J. H. (2018). How accurate are the ISAAC questions for diagnosis of
allergic rhinitis in Korean children? International Journal of
Environmental Research and Public Health, 15(7).
https://doi.org/10.3390/ijerph15071527
Maggini, S., Pierre, A., & Calder, P. C. (2018).
Immune function and micronutrient requirements change over the life course. In
Nutrients (Vol. 10, Issue 10). https://doi.org/10.3390/nu10101531
Miranda-Machado, P., Bautista, D., &
Fabián, A. (2018). Prevalence of Clinical Diagnosis and Treatment of Allergic
Rhinitis According to the 2010 Aria Guidelines 2010 in the School Population
of Cartagena City, Colombia. J Allergy Ther, 9(282),
2.
Mostafa, W. Z., & Hegazy,
R. A. (2013). Vitamin D and the skin: Focus on a complex relationship: A
review. In Journal of Advanced Research (Vol. 6, Issue 6).
https://doi.org/10.1016/j.jare.2014.01.011
Mulligan, J. K., Bleier, B. S., O’Connell, B.,
Mulligan, R. M., Wagner, C., & Schlosser, R. J. (2011). Vitamin D3
correlates inversely with systemic dendritic cell numbers and bone erosion in
chronic rhinosinusitis with nasal polyps and allergic fungal rhinosinusitis. Clinical
and Experimental Immunology, 164(3).
https://doi.org/10.1111/j.1365-2249.2011.04325.x
Organization, W. H. (2018). Reducing
stunting in children: equity considerations for achieving the Global Nutrition
Targets 2025.
Pai, U. A., Chandrasekhar, P., Carvalho, R. S.,
& Kumar, S. (2018). The role of nutrition in immunity in infants and
toddlers: An expert panel opinion. Clinical Epidemiology and Global Health,
6(4). https://doi.org/10.1016/j.cegh.2017.11.004
Schauber, J., & Gallo, R. L. (2008). Vitamin D
deficiency and asthma: Not a strong link-yet. In Journal of Allergy and
Clinical Immunology (Vol. 121, Issue 3).
https://doi.org/10.1016/j.jaci.2007.12.1170
Sudiro, M., Lestari, B. W., Madiadipoera,
T., Setiabudiawan, B., & Boesoirie,
T. S. (2017). Vitamin D deficiency is correlated with severity of allergic
rhinitis. Open Access Library Journal, 4(8), 1–9.
Van Neerven, R. J.
J., & Savelkoul, H. (2017). Nutrition and allergic diseases. Nutrients,
9(7), 762.
|
Copyright
holder: Venny Tiursani Sarumpaet, Arif
Dermawan, Lina Lasminingrum (2024) |
|
First
publication right: Syntax
Literate:
Jurnal Ilmiah Indonesia |
|
This
article is licensed under:
|
