Allergic illnesses commonly arise at different stages of life and contribute substantially to healthcare costs, school absenteeism, and reduced work productivity, ultimately affecting the quality of life of both patients and caregivers.¹ Allergies result from complex interactions between genetic predisposition and environmental exposures, presenting in various forms such as asthma, allergic rhinitis (AR), rhinoconjunctivitis, and eczema. Allergic rhinitis, a chronic IgE-mediated inflammatory disorder of the nasal mucosa triggered by allergen exposure, is characterized by sneezing, rhinorrhea, nasal blockage, and itching of the nose, eyes, or palate². These symptoms often lead to mouth breathing, snoring, postnasal drip, irritability, and the characteristic “allergic salute.” AR affects nearly 20–30% of children worldwide and is frequently associated with conjunctivitis, sinusitis, otitis media, enlarged tonsils and adenoids, and eczema; affected children are almost three times more likely to develop asthma later in life. Over the past five decades, the prevalence of AR has increased globally, reaching up to 40% in some regions³. While genetic factors play a role, environmental, dietary, and microbiome-related shifts are believed to drive this rise⁴. Symptoms may begin in infancy, but diagnosis is usually confirmed around six years of age, with the highest burden in late childhood. Risk factors include family history of allergies and serum IgE levels above 100 IU/mL before age six. Early-life exposures, such as tobacco smoke and high indoor allergen levels, significantly increase susceptibility, whereas cesarean delivery—especially in genetically predisposed children—may elevate risk due to limited exposure to maternal microbiota⁵. Elevated IgE responses to cockroach or mouse allergens in early childhood also predict later development of AR and wheezing. Interestingly, early exposure to pets, extended breastfeeding, and early introduction of common foods like cereals, eggs, and fish appear protective, while reduced gut microbiota diversity in infancy is linked to higher rates of allergic diseases.⁶ Globally, nearly 500 million individuals experience AR, making it a major public health issue affecting both industrialized and developing nations. The International Study of Asthma and Allergies in Childhood (ISAAC) provided standardized global data, documenting AR prevalence ranging from 0.8% to 14.9% among 6–7-year-olds and 1.4% to 39.7% among 13–14-year-olds, with increasing trends observed in Phase III. In India, ISAAC Phase III reported AR prevalence of 11.3% in younger children and 24.4% in adolescents⁷. Despite its widespread impact on sleep, school performance, and psychosocial functioning, AR is often underestimated, particularly in low- and middle-income countries like India, where it remains underdiagnosed and undertreated. Limited regional data, especially from central Rajasthan, underscores the need for localized research.⁸

 AIM

To estimate the prevalence of allergic rhinitis among school going children in Ajmer aged 6 to 18 years using an ISAAC (The International Study of Asthma and Allergies in Childhood) questionnaire. 

This study was planned to assess the prevalence of allergic rhinitis among school-going children aged 6–18 years in the central part of Rajasthan using the standardized and validated ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire. It was conducted in various schools of Ajmer under the Department of Paediatrics, JLN Medical College, Ajmer, Rajasthan, following approval from the Institutional Ethical Committee. The study design was a school-based cross-sectional study. Data collection was carried out according to the aims and objectives over a period of 12 months, from September 2023 to August 2024, followed by six months dedicated to data analysis. The study included children within the specified age range who were present and willing to participate at the time of survey administration. Exclusion criteria were clearly defined and included children younger than 6 years or older than 18 years, as well as those whose parents did not provide informed consent.

Table 1-Sociodemographic profile of children

In our study, the highest proportion of participants belonged to the 10–12 years age group (19.8%), followed by 13–14 years (18.1%), 15–16 years (17.5%), and 17–18 years (16.5%), while the 8–9 years and 6–7 years groups accounted for 15% and 13.1% of participants, respectively.

Table 2 - Family History of Allergies and Associated Conditions Among Study Participants

In the current study, asthma history was more commonly reported in mothers (10.4%), compared to fathersin 7.5% and siblings in 4.6% participants. In our study, the majority (95.0%) reported no other allergies. Asthma was reported by 2.8%, atopic dermatitis by 1.5%, and other allergies by 0.7% of participants.  In the current study, Snoring was reported by 11.0% in families, followed by skin allergy (7.7%), drug allergy (1.2%), and food allergy (0.2%) in families of participants.

Table 3-History of Sneezing or Runny Nose Without Cold or Flu (Ever) ,Incidence of Nasal Symptoms Without Cold or Flu and association with Itchy or Watery Eyes in the Past 12 Months

In our study, 22.4% of participants reported sneezing or a runny nose without cold or flu, and among the 224 with past symptoms, 79.5% experienced them within the last 12 months. Of the 178 participants with recent nasal symptoms, 62.9% also had itchy or watery eyes, while 37.1% did not.

Table 4-Impact of Nasal Problems on Daily Activities in the Past 12 Months

Among affected participants (178), 45.5% (81/178) reported a little interference, 37.6% (67/178) reported no interference, 11.2% (20/178) reported moderate interference, and 5.6% (10/178) reported significant interference in daily life.

Table 5- Association of history of allergies in children with presence of allergic rhinitis

In the present study, allergic rhinitis was markedly more common in children with pre-existing allergic conditions, with 65.5% of those with asthma and 50% of those with atopic dermatitis being affected, compared to 25% among children with other allergies. In contrast, the prevalence was significantly lower (12.3%) in children with no prior history of allergies, highlighting a strong association between past allergic history and current allergic rhinitis.

The age distribution of the study participants showed a fairly even spread across the different age groups. Children aged 10–12 years formed the largest proportion at 19.8%, followed closely by those aged 13–14 years (18.1%) and 15–16 years (17.5%). The 17–18 years age group accounted for 16.5% of the sample, while 8–9-year-olds made up 15%. Participants aged 6–7 years represented 13.1% of the study population, forming the smallest group. Overall, the data indicate that mid-adolescent children constituted a major share of the respondents, with relatively balanced representation across all age brackets.

The study findings showed that a family history of asthma was more commonly reported in mothers (10.4%) compared to fathers (7.5%) and siblings (4.6%). Most children (95%) had no history of allergies other than rhinitis, though small proportions reported asthma (2.9%), atopic dermatitis (1.6%), or other allergies (0.8%). In terms of family allergy history, skin allergies were the most frequent (7.7%), followed by drug allergies (1.2%) and food allergies (0.2%). Additionally, 11% of participants reported a history of snoring, suggesting possible airway-related concerns. Overall, the data highlight a low but notable presence of allergic and atopic disorders within families.When comparing our findings with other studies, Saini A et al⁹ reported nasal obstruction as the most common symptom (48.6%), followed by runny nose (33.0%), sneezing (24.1%), and nasal itching (20.3%). Their study also showed that about 64.3% of affected children had persistent rhinitis, which may indicate more severe or long-standing cases compared to our population, where more children reported intermittent or recent symptoms. Similarly, Sheikh S et al¹⁰ reported higher symptom frequencies among school children: sneezing (67.2%), watery rhinorrhea (65.5%), nasal obstruction (79.3%), nasal itching (46.2%), and itchy eyes (59.5%). These higher rates may be attributed to differences in geographic, climatic, or environmental exposures, or possibly to increased awareness and reporting in their study setting.

In the present study, 22.4% of children reported having sneezing or a runny nose even without a cold or flu, indicating symptoms suggestive of allergic rhinitis, while the majority (77.6%) did not experience such episodes. Among the 224 children who had these symptoms, 79.5% reported that the problem had occurred within the past 12 months, reflecting recent or ongoing nasal complaints. Additionally, 62.9% of those with recent nasal symptoms also experienced itchy or watery eyes, a common feature of allergic reactions. In contrast, 37.1% did not report associated eye symptoms. These findings highlight a considerable burden of allergic-type nasal problems among children, with many experiencing persistent or recurrent symptoms.

In the present study, among the 178 children who experienced nasal symptoms in the past 12 months, 37.6% reported that the problem did not interfere with their daily activities. However, 45.5% stated that it caused a little interference, indicating a mild but noticeable impact on routine functioning. A smaller proportion, 11.2%, experienced a moderate level of disruption, while 5.6% reported that their symptoms interfered a lot with daily activities. Overall, these findings show that while most children had mild limitations, a significant number faced moderate to severe impairment due to nasal problems.

In the present study, a clear association was observed between a child’s allergy history and the presence of allergic rhinitis. Among children with asthma, 65.5% were found to have allergic rhinitis, indicating a strong overlap between the two conditions. Half of the children with atopic dermatitis (50%) also had allergic rhinitis, reflecting the atopic tendency seen in such individuals. In those with other allergies, only 25% were affected, suggesting comparatively lower linkage. Notably, among children with no available history of allergies, only 12.3% had allergic rhinitis, while 87.7% did not. Overall, the findings highlight that children with pre-existing allergic conditions are more likely to develop allergic rhinitis, demonstrating the interconnected nature of atopic disorders.The findings in our study align with those of García-Almaraz R et al¹¹, who reported that asthma and allergic rhinitis co-existed in 25% of patients, and that asthma at least doubled the risk of allergic rhinitis in children and adolescents. Similarly, Sheik IA et al¹² noted that the prevalence of allergic rhinitis was 2.3 times that of asthma in their study population. This is supported by broader research indicating that both genetic and environmental factors interact in the development of allergic rhinitis

In conclusion, the study highlights a substantial burden of allergic rhinitis and related symptoms among children, with mid-adolescent age groups being most represented. A notable presence of familial and individual atopic conditions was observed, particularly maternal asthma and skin allergies. Many children experienced persistent nasal symptoms, with a considerable proportion reporting associated eye complaints and interference with daily activities. The strong association between allergic rhinitis and other atopic disorders—especially asthma and atopic dermatitis—reinforces the interconnected nature of atopy. Overall, the findings emphasize the need for early identification, targeted education, and improved management strategies to reduce the impact of allergic conditions in children.

• Skoner DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol. (2001) 108:S2–8.
• Kliegman RM, Behrman RE, Jenson HB, Stanton BM. Nelson textbook of pediatrics e-book. Elsevier Health Sciences; 2007 Aug 15, page 1379
• Pawankar R, Canonica GW, Holgate S, Lockey R, Blaiss M, eds. WAO White Book on Allergy. Update. Milwaukee: World Allergy Organization; 2013.
• Chandrika D. Allergic rhinitis in India: An overview Int J Otorhinolaryngol Head Neck Surg. 2017;3:1–6
• Skoner DP. Complications of allergic rhinitis. Journal of allergy and clinical immunology. 2000 Jun 1;105(6):S605-9.
• Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008. Allergy. 2008 Apr;63:8160.
• Wheatley LM, Togias A. Clinical practice. Allergic rhinitis. N Engl J Med. (2015) 372:456–63.
• Tan HT, Sugita K, Akdis CA. Novel biologicals for the treatment of allergic diseases and asthma. Current allergy and asthma reports. 2016 Oct;16:1-4.
• Saini A, Gupta M, Sharma BS, Kakkar M, Chaturvedy G, Gupta M. Rhinitis, sinusitis and ocular disease–2085. Prevalence of allergic rhinitis in urban school children, Jaipur City, India. World Allergy Organization Journal. 2013 Apr;6(Suppl 1):P164.
• Sheikh S, Bajaj A, Dar FA, Ahmad R, Dar SA. Prevalence of allergic rhinitis in schoolgoing children in Kashmir. Int J Otorhinolaryngol Head Neck Surg. 2018 Sep;4(5):1240-5.
• García-Almaraz R, Reyes-Noriega N, Del-Río-Navarro BE, Berber A, NavarreteRodríguez EM, Ellwood P, et al; GAN Phase I group. Prevalence and risk factors associated with allergic rhinitis in Mexican school children: Global Asthma Network Phase I. World Allergy Organ J. 2020 Dec 5;14(1):100492.
• Sheik IA, Moleyar VS. Prevalence of allergic rhinitis among students in the age group of 16-20 years in a south Indian city. J Adv Lung Health 2022;2:13-21.