The Clinical Efficacy of Vitamin D Supplementation for Allergic Rhinitis
A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.70552/pjaai.24.1.9919Keywords:
Vitamin D, supplementation, adjunct, allergic rhinitisAbstract
Objective: To conduct a systematic review and meta-analysis of all controlled studies of vitamin D for treating allergic rhinitis to determine the efficacy of vitamin D supplementation to patients with allergic rhinitis.
Methodology: A systematic search was conducted using PubMed, Cochrane, CENTRAL databases, and Google Scholar for articles published in journals from 2010 to February 2023. The change from baseline in the Total Nasal Symptom Score (TNSS) was the main outcome. A random-effects model was used to pool the results of the included studies. Separate subgroup analyses were performed for studies using TNSS-12 and TNSS-15.
Results: Eight studies were included, including seven randomized controlled trials and one prospective analytical observational study. The combined sample size across all studies was 635 participants, including adults and children. Studies utilizing the TNSS-12 and TNSS-15 scales consistently demonstrated that the group receiving vitamin D supplementation had lower severity scores than the control group. The standardized mean difference (SMD) showed a statistically significant improvement in TNSS compared to the baseline, with an average SMD of 6.27 (95% CI, 3.96 to 8.59).
Conclusion: Vitamin D supplementation significantly improves nasal symptom scores of allergic rhinitis. It can be considered an adjunctive therapy in the management of allergic rhinitis. However, larger-scale studies are needed to confirm this conclusion.
References
1. Abong JM, Kwong SL, Alava HD, Castor MA, De Leon JC. Prevalence of allergic rhinitis in Filipino adults based on the National Nutrition and Health Survey 2008. Asia Pac Allergy. 2012;2(2):129-35. https://pubmed.ncbi.nlm.nih.gov/22701863 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3345326 ttps://doi.org/10.5415/apallergy.2012.2.2.129
2. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(Suppl 86):8-160. https://pubmed.ncbi.nlm.nih.gov/18331513 https://doi.org/10.1111/j.1398-9995.2007.01620.x
3. Pawankar R, Canonica GW, Holgate ST, Lockey RF, eds. WAO white book on allergy: update 2013. World Allergy Organization; 2013. https://www.forskasverige.se/wp-content/uploads/WAO-WhiteBook-2013.pdf
4. Osguthorpe JD. Pathophysiology of and potential new therapies for allergic rhinitis. Int Forum Allergy Rhinol. 2013;3(5):384-92. https://pubmed.ncbi.nlm.nih.gov/23193028 https://doi.org/10.1002/alr.21120
5. Angeles-Agdeppa I, Tanda KV. Vitamin D status and usual nutrient intake of Filipino children aged 6-12 years in selected areas in the Philippines: a 2018 National Nutrition Survey. J Nutr Metab. 2021;2021(1). https://doi.org/10.1155/2021/8515607
6. Tian HQ, Cheng L. The role of vitamin D in allergic rhinitis. Asia Pac Allergy. 2017;7(2):65-73. https://pubmed.ncbi.nlm.nih.gov/28487837 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410413 https://doi.org/10.5415/apallergy.2017.7.2.65
7. Dogru M, Suleyman A. Serum 25-hydroxyvitamin D3 levels in children with allergic or nonallergic rhinitis. Int J Pediatr Otorhinolaryngol. 2016;80:39–42. https://pubmed.ncbi.nlm.nih.gov/26746610 https://doi.org/10.1016/j.ijporl.2015.11.013
8. Arshi S, Ghalehbaghi B, Kamrava SK, Aminlou M. Vitamin D serum levels in allergic rhinitis: any difference from normal population? Asia Pac Allergy. 2012;2(1):45-8. https://pubmed.ncbi.nlm.nih.gov/22348206 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3269601 https://doi.org/10.5415/apallergy.2012.2.1.45
9. Hyppönen E, Sovio U, Wjst M,e et al. Infant vitamin D supplementation and allergic conditions in adulthood: northern Finland birth cohort 1966. Ann N Y Acad Sci. 2004;1037:84–95. https://pubmed.ncbi.nlm.nih.gov/15699498 https://doi.org/10.1196/annals.1337.013
10. Wjst M, Hyppönen E. Vitamin D serum levels and allergic rhinitis. Allergy. 2007;62(9):1085–6. https://pubmed.ncbi.nlm.nih.gov/17686112 https://doi.org/10.1111/j.1398-9995.2007.01437.x
11. Maslova E, Hansen S, Jensen CB, Thorne-Lyman AL, Strøm M, Olsen SF. Vitamin D intake in mid-pregnancy and child allergic disease: a prospective study in 44,825 Danish mother-child pairs. BMC Pregnancy Childbirth. 2013;13:199. https://pubmed.ncbi.nlm.nih.gov/24176134 PMCID: PMC3871013 https://doi.org/10.1186/1471-2393-13-199
12. Cheng HM, Kim S, Park GH, et al. Low vitamin D levels are associated with atopic dermatitis, but not allergic rhinitis, asthma, or IgE sensitization, in the adult Korean population. J Allergy Clin Immunol. 2014;133(4):1048–55. https://pubmed.ncbi.nlm.nih.gov/24388009 https://doi.org/0.1016/j.jaci.2013.10.055
13. Kim YH, Kim KW, Kim MJ, et al. Vitamin D levels in allergic rhinitis: a systematic review and meta-analysis. Pediatr Allergy Immunol. 2016;27(6):580-90. https://pubmed.ncbi.nlm.nih.gov/27188226 https://doi.org/10.1111/pai.12599
14. Kemp AS, Ponsonby AL, Pezic A, Cochrane JA, Dwyer T, Jones G. The influence of sun exposure in childhood and adolescence on atopic disease at adolescence. Pediatr Allergy Immunol. 2013;24(5):493–500. https://pubmed.ncbi.nlm.nih.gov/23725559 https://doi.org/10.1111/pai.12085
15. Webb AR. Who, what, where and when influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol.2006:92(1):17–25. https://pubmed.ncbi.nlm.nih.gov/16766240 https://doi.org/0.1016/j.pbiomolbio.2006.02.004
16. Skversky AL, Kumar J, Abramowitz MK, Kaskel FJ, Melamed ML. Association of glucocorticoid use and low 25-hydroxyvitamin D levels: results from the National Health and Nutrition Examination Survey (NHANES): 2001-2006. J Clin Endocrinol Metab. 2011: 96(12):3838–45. https://pubmed.ncbi.nlm.nih.gov/21956424 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232615 https://doi.org/10.1210/jc.2011-1600
17. Searing DA, Zhang Y, Murphy JR, Hauk PJ, Goleva E, Leung DY. Decreased serum vitamin D levels in children with asthma are associated with increased corticosteroid use. J Allergy Clin Immunol. 2010:125(5): 995–1000. https://pubmed.ncbi.nlm.nih.gov/20381849 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866800 https://doi.org/10.1016/j.jaci.2010.03.008
18. Çoban K, Öz I, Topçu DI, Aydın E. The impact of serum 25-hydroxyvitamin 3 levels on allergic rhinitis. Ear, Nose, Throat J. 2021;100(5):NP236-41. https://pubmed.ncbi.nlm.nih.gov/31569970 https://doi.org/10.1177/0145561319874310
19. Kumar V, Kumar A, Tuli IP, Rai AK. Therapeutic significance of Vitamin D in allergic rhinitis. Astrocyte. 2015;2:8-11.
20. Bhardwaj, B., Singh, J. Efficacy of vitamin D supplementation in allergic rhinitis. Indian J Otolaryngol Head Neck Surg. 2021;73(2):152–9. https://pubmed.ncbi.nlm.nih.gov/34150589 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8163896 https://doi.org/10.1007/s12070-020-01907-9
21. Liu X, Liu X, Ren Y, Yang H, Sun X, Huang H. Clinical efficacy of vitamin D3 adjuvant therapy in allergic rhinitis: a randomized controlled trial. Iran J Immunol. 2020; 17(4):283-91. https://pubmed.ncbi.nlm.nih.gov/33382385 https://doi.org/10.22034/iji.2020.84336.1652
22. Velankar HK, Dabholkar YG, Deshmukh P et.al. The role of vitamin D deficiency and its supplementation in the treatment of allergic rhinitis. Int J Health Sci Res. 2019; 9(8):82-88
23. Rabi Hembrom, Souvik Gh, Swarnali P, Ramnarayan M, Sekhar M, Subhayan D, Bina T. Role of vitamin D3 supplementation in allergic rhinitis: an outpatient department based prospective analytical observational study. Int J Basic Clin Pharmacol. 2019 Nov;8(11):2498-2501
24. Menon B, Kaur C, Vardhan H, Dar MY. Placebo-controlled trial of vitamin D supplementation in allergic rhinitis. Indian J Otolaryngol Head Neck Surg. 2021;73(1):92-7. https://doi.org/10.13070/rs.en.3.1501
25. Upadhyay P, Jain R. The effect of vitamin D supplementation on children with allergic rhinitis. Pediatric Oncall J. 2017;14(3):56-9. https://doi.org/10.7199/ped.oncall.2017.49
26. Bakhshaee M, Sharifian M, Esmatinia F, Rasoulian B, Mohebbi M. Therapeutic effect of vitamin D supplementation on allergic rhinitis. Eur Arch Otorhinolaryngol. 2019;276(10):2797-801. https://pubmed.ncbi.nlm.nih.gov/31332549 https://doi.org/10.1007/s00405-019-05546-x
27. Samir Maher Hassan, Mohamed M. Abd Elmageed and Mohamed Galal El Senosy. 2016. Vitamin D Intervention in Children with Allergic rhinitis: A Pilot Randomized Controlled Trial. Int J Curr Microbiol App Sci. 5(12): 544-50.
28. Majak P, Olszowiec-Chlebna M, Smejda K, Stelmach I, Podlecka D. Vitamin D supplementation in children may prevent asthma exacerbation triggered by acute respiratory infection. J Allergy Clin Immunol. 2016;127(5):1294-6.
29. Gupta A, Bush A, Hawrylowicz C, Saglani S. Vitamin D and asthma in children. Paediatr Respir Rev. 2012;13(4):236-43. https://pubmed.ncbi.nlm.nih.gov/23069123 https://doi.org/10.1016/j.prrv.2011.07.003
30. Kumar J, Kumar P, Goyal JP, et al. Vitamin D supplementation in childhood asthma: a systematic review and meta-analysis of randomised controlled trials. ERJ Open Res. 2021;8(1):00662-2021. https://pubmed.ncbi.nlm.nih.gov/35141325 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8819253 https://doi.org/10.1183/23120541.00662-2021
31. Li Q, Zhou Q, Zhang G, et al. Vitamin D supplementation and allergic diseases during childhood: a systematic review and meta-analysis. Nutrients. 2022;14(19):3947. https://pubmed.ncbi.nlm.nih.gov/36235600 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9571357 https://doi.org/10.3390/nu14193947
32. Moradzadeh K, Larijan B, Keshtkar AA, et al. Normative values of vitamin D among Iranian population: a population based study. Int J Osteoporos Metab Disord. 2008;1:8-15. https://doi.org/10.3923/ijom.2008.8.15
33. Restimulia L, Pawarti DR, Ekorini HM. The relationship between serum vitamin D levels with allergic rhinitis incidence and total nasal symptom score in allergic rhinitis patients. Open Access Maced J Med Sci. 2018;6(8):1405-9. https://pubmed.ncbi.nlm.nih.gov/30159065 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108797 https://doi.org/10.3889/oamjms.2018.247
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