Study of vitamin C therapy in allergic rhinitis

INTRODUCTION

Individuals with allergic rhinitis present with rhinorhea, sneezing, nasal obstruction, anosmia and sometimes with associated, middle ear effusion, pharyngitis, laryngitis, irritation in the eyes, headache, asthma and gastrointestinal upset.¹

Antioxidants like vitamin C, tocopherols and carotenoids have a protective effect in allergic rhinitis and allergic sensitisationm. Individuals with increased intake of vitamin C have fewer symptoms of allergic rhinitis. Dietary intakes of citrus fruit too have been shown to reduce the episode of shortness of breath. Moreover vitamin C supplementation enhances the resistance to post exertional upper respiratory tract infections in athletes and reduces the severity in sedentary individuals.

Aim of the study

To study the effect of vitamin C on plasma ascorbic acid and features of allergic rhinitis.

METHODS

40 subjects of allergic rhinitis were selected from the allergy clinic of Dayanand medical college and hospital in a period of one and a half years (June 2009 to December 2010).

Study design

The present study was a prospective controlled study with the experimental group and the control group. The experimental group was divided into; group I: case group (20 subjects) and group II: placebo group (20 subjects).

Vitamin C was administered orally in the dose of 1 gm/day for 7 days and plasma levels were estimated after supplementation. Simultaneously their symptoms and signs were recorded and compared to previous findings. A sugar tablet was administered by oral route, twice a day for 7 days and the plasma levels were estimated and clinical manifestations compared.

Due care was taken that the subjects did not take any vitamin C supplementation, antihistamines or decongestants prior to plasma level estimation. Plasma levels of ascorbic acid was estimated by 2,6-dichlorophenol indophenols titration. Healthy 20 subjects without any complaints were included in the control group, for measuring levels of plasma ascorbic acid.

An inclusive criterion was patients with allergic rhinitis. Exclusive criteria were patients with fungal rhino-sinusitis and patients on long duration steroid oral or nasal sprays.

Statistical analysis

All statistical calculations were done using statistical package of social sciences (SPSS) 17 version statistical program for Microsoft windows (SPSS Inc. 2008. version 17.0, Chicago).

RESULTS

The mean duration of illness in the patients with allergic rhinitis was 10.15±3.4 years, with 25 patients having duration of less than 10 years, 10 patients of illness between 10 to 20 years and 5 were having duration more than 20 years (Table 1).

The most common complaint in patients with allergic was of nasal obstruction (57.5%), the next in order of frequency was of rhinorrhea (47. 5%), sneezing (37 5%) and postnasal dripping (27. 5%) (Table 2).

Patients with allergic rhinitis showed overall relief with vitamin C treatment, with all patients having complaints of sneezing, lacrimation, itching and malaise getting moderate to complete relief with the treatment (Table 3).

DISCUSSION

In present study the most common complaint in the patients with allergic rhinitis was nasal obstruction (57.5%). The next presentation in order of frequency was rhinorrhea (47.5%), sneezing (37.5%), post nasal dripping (27.5%), lacrimation, itching and malaise (25% each). Thacker analyzed 170 patients of allergic rhinitis and found that 27% had asthma, 8% had GIT symptoms, 13% had ear symptoms, 7% had hoarseness, 10% had pharyngitis, 23% headache, 7 % had anosomia, and 7% had eye syndromes.¹ Wilson et al in their study of 26 patients, out of which 11 were atopic patients, found that nasal obstruction was the commonest symptom. Rhinorrhea and sneezing were more common in atopic patients.² Smith stated that four of five patients with allergic rhinitis have predominantly nasal symptoms.³ Symptoms of patients suffering from allergic rhinitis in the present study were compared with a study on nasal allergy by Craddock (Table 4).⁴

Analysis with reference to effect on clinical features of allergic rhinitis

The most common findings in patients with allergic rhinitis in our study was deviation in nasal septum (47.5%). Various other clinical features were excess mucus production (35%), hypertrophy of turbinate(s) (30%), pale blue mucosa (22.5%), mulberry cushion (20%) and polypi (5%). 25% of the patients had essentially normal examination. Thacker as early as 1946 found that 53% of patients had pale, boggy turbinates, 3% had hypertrophic rhinitis.¹ Craddock found that the patients presenting with nasal allergy most commonly had normal nasal examination (38.755). Other features in order to frequency were excess mucus production (36.25%), pale mucosa (27.5%), and hypertrophy (13.75%), polypi (10%).⁴ Smith documented that 60% of the patients with allergic rhinitis had classically pale blue tone of nasal mucosa.³ Clinical findings in 40 patients of allergic rhinitis observed in this study were compared with a previous study (Table 5).

Analysis with reference to effect on plasma ascorbic acid levels

The mean plasma ascorbic acid level in control group was 20.45±3.58 mg/L. The mean plasma ascorbic acid level in pre vitamin C case group was 15.45±3.59 mg/L and in post vitamin C treatment it was 23.20±5.55 mg/L. The placebo group had mean plasma ascorbic acid level as 13.85±2.92 mg/L before placebo treatment and this level was 15.15±3.67 after placebo treatment. The mean levels of plasma ascorbic acid as estimated in this study is analysed in (Table 6).

Effect of treatment (vitamin C and placebo)

In our study patients with allergic rhinitis showed overall relief with vitamin C treatment, with all patients having complaints of sneezing, lacrimation, itching and malaise getting moderate to complete relief with the treatment. But with the placebo treatment there was no overall improvement in the symptoms of the patients.

Out of the 20 patients with allergic rhinitis in the case group, 17 (85%) improved with vitamin C treatment and 3 (15%) showed no improvement. But in placebo group 85% of the patients had no overall relief.

All the patients who had improvement with the respective treatment showed increase in the level of plasma ascorbic acid after the said treatment vis-à-vis- pre-treatment level. Thus, all the patients who showed improvement has increase in plasma ascorbic after the respective treatment but not all the patients showing increase in plasma ascorbic acid post-treatment showed improvement.

Mahindra et al found that the patients who were given vitamin C supplementation of 500 mg 1 BDx1 week had shown rise in plasma ascorbic acid and this coincided with subjective and objective improvement in allergic rhinitis.⁵

Wilson et al studied the effect of daily administration of vitamin C on symptom association and on the incidence, duration, severity and total intensity of the symptom in common cold. They found that the vitamin C reduces symptom association and alters the frequency of toxic and catarrhal complexes. The severity of symptoms of cold were reflected more accurately by changes in plasma ascorbic acid concentrations.⁶ Baird et al study of 362 healthy subjects found that there was a 14 to 21 % reduction in total symptoms due to common cold that were supplemented with vitamin C. Ascorbic acid also increased the number of “episode-free” subjects.

Munjal et al recorded that in allergic rhinitis there is unsaturated state of body ascorbic acid, which is confirmed by increased utilization of ascorbic acid after supplementation. This unsaturated state of body was more in acute stage of disease.⁸ Iris Kompauer et al study found a negative association between plasma total carotenoids and the prevalence of allergic rhinitis, with odds ratio other single carotenoids, tocopherols and vitamin C were unrelated to allergic rhinitis. Allergic sensitisation was negatively associated with plasma γ-tocopherol, no other antioxidant was significantly related to allergic sensitisation.⁹

Peters EM study provides evidence that vitamin C supplementation may enhance resistance to the post-race upper respiratory tract infections that occur commonly in competitive ultra-marathon runners and may reduce the severity of such infections in those who are sedentary.¹⁰ Vitamin C in mega doses administered before or after the appearance of cold and flu symptoms relieved and prevented the symptoms in the test population compared with the control group.¹¹

In the present study, patients with allergic rhinitis showed overall relief with vitamin C supplementation, with all subjects with complaints of sneezing, lacrimation, itching and malaise getting moderate to complete relief with the treatment. But with the placebo treatment there was no overall improvement in the symptoms of the patients. All the patients who showed improvement in their manifestations of allergic rhinitis had increase in the plasma ascorbic acid after the respective treatment.

CONCLUSION

Vitamin C ameliorates the signs and symptoms of allergic rhinitis, by raising the plasma ascorbic acid levels.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

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