The preponderance of allergic rhinitis ( AR ) is steadily rising in the Thai population, causing a major shock on the quality of animation ( QoL ). Enhancing cognition on park aeroallergens in the local anesthetic mount helps in the allow prevention and management of AR. In this study, the demographic characteristics, clinical data, aeroallergen sensitizing model, allergic symptoms, ocular analogue scale ( VAS ) score, and QoL are described. We evaluated the association between VAS, QoL, and severity of symptoms, except the aeroallergen sensitization radiation pattern. We retrospectively reviewed the medical records of adult AR patients with a cocksure skin prick up test ( SPT ) for at least one aeroallergen from January 2018 to May 2020. Standard descriptive and inferential statistics were used for analysis. A full of 366 patients were enrolled. Indoor aeroallergen sensitization and outdoor aeroallergen sensitizing were observed in 32 % and 7.9 % of patients, respectively. Mono-sensitization was noted in 16.9 % of patients, while poly-sensitization was noted in 83.1 % of patients. Mites ( 65 % ) and sedge ( 39.3 % ) were the most common indoor and outdoor allergens. Nasal obstruction ( 74.6 % ), fluid nose ( 63.7 % ), and nasal itch ( 61.5 % ) were the primary symptoms affecting the QoL. The association between VAS and symptom scores showed a tendency of association with AR asperity ( Allergic Rhinitis and its impact on Asthma [ ARIA ] classification ) and VAS. AR has a significant effect on QoL in all domains of the validate generic ( short-form-36, SF-36 ) and specific ( rhino-conjunctivitis QoL questionnaire, Rcq-36 ) questionnaires. Mite and sedge remain the most common indoor and outdoor aeroallergens. The form of sensitization and number of aeroallergens were not associated with AR based on the ARIA guidelines. interim, symptoms of patients affected the QoL and VAS scores, which can be used as a promptly and reliable cock for monitor and stepping up or stepping down the treatment according to the next-generation guidelines. AR has a significant affect on the QoL of pornographic Thai patients .

Introduction

Allergic rhinitis ( AR ) is an immunoglobulin ( Ig ) E-mediated inflammation of the nasal mucous membrane induced after allergen exposure and has three cardinal symptoms : sneeze, nasal consonant obstruction, and rhinorrhoea ( 1 ). AR may besides be frequently associated with asthma, as emphasized by the Allergic Rhinitis and its affect on Asthma ( ARIA ) document ( 2 ). The skin prickle test ( SPT ) is considered a standard diagnostic method because of its accuracy, reproducibility, and affordability ; internationally, it remains the most satisfactory and cost-efficient means of diagnosing AR ( 3, 4 ). The effective management of AR requires a precise diagnosis, which includes the identification of IgE-mediated inflammation ( 4 ). The optimum management includes adequate control of symptoms through the provision of patient education, environmental master, and the practice of pharmaceutical therapies and immunotherapy ( 5 ) .
Allergic rhinitis represents a ball-shaped health trouble, affecting 10–20 % of the population. The preponderance of AR is steadily rising in Thailand, with no signs of abating. According to a former study, the prevalence of AR increased from 37.9 to 50.6 % ( 6 ). AR has a major impingement on the forcible, mental, and social serve of Thai patients. AR mar make, sleep, and emotional health. With its increasing incidence and the inadequate control of symptoms, AR causes a socioeconomic burden ( 6 ). The pattern of aeroallergen sensitization varies according to the geographic area due to differences in climate, urbanization, and life style. however, the sensitizing pattern constantly changes with the changes in economic conditions, grade of industrialization, and life style, due to the alterations in the prevailing circulating aeroallergens. Knowledge of the up-to-date data regarding the offending aeroallergen in a local jell at a particular prison term is important for the effective management of AR ( 3, 7 ) .
According to recently published 19-year ( 1998–2017 ) datum from an ENT allergy clinic, Faculty of Medicine Siriraj Hospital, the mite Dermatophagoides pteronyssinus ( Dp ) remains the most park indoor aeroallergen, while sedge remains the most common outdoor aeroallergen among the Thai population ( 4 ). This study aimed to analyse the radiation pattern of aeroallergen sensitization and describe the demographic and clinical data related to AR. It besides aimed to describe the quality of life ( QoL ) and determine the association between QoL and the badness of AR symptoms. The short-form-36 ( SF-36 ) and rhino-conjunctivitis QoL questionnaire ( Rcq-36 ) questionnaires are generic and disease-specific QoL questionnaires, which have been translated and validated to be used in the Thai population ( 8, 9 ). frankincense, the present study assessed the impact of AR in Thai patients using the SF-36 and Rcq-36 questionnaires.

Materials and Methods

This study was a retrospective chart revue of adult patients diagnosed with AR by a positive SPT for at least one aeroallergen, conducted at the Rhinology and Allergy Unit, Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, between January 2018 and May 2020. Patients who were unable to completely fill out the case read forms or QoL questionnaires were excluded from our analysis. The take after demographic and clinical data were obtained : historic period, gender, presenting symptoms, duration of symptoms, SPT results for respective aeroallergens, the score of each sphere in SF-36 ( generic QoL questionnaire ), the score of each world in the Rcq-36 ( specific questionnaire ), and categorization and badness of AR based on the ARIA guidelines. The patients were asked to discontinue taking oral antihistamines for 7 days anterior to the test day. The ocular analogue scale ( VAS ) was used to determine the severity of AR symptoms ( 0–10 curium ), and a diary card was provided to record the affected role ‘s symptoms for the last 7 days anterior to the SPT .
The SPT was performed on the adaxial aspect of the forearm by placing one drop of each allergenic extract 3-cm apart ; then, the skin was pricked with a 26-gauge separate disposable needle in the center of each allergen spend, using light pressure. The consequence was considered positive if the bicycle diameter was larger than 3 millimeter and had an accompanying flare. Siriraj Allergen Vaccine ( SAV ), which contains exchangeable allergen extracts and has proven allergenic potency, was used ( 4, 10 ). Allergen extracts from touch Dp, American cockroach ( Periplaneta americana ), cats, dogs, molds ( Aspergillus spp., Penicillium spp., and Cladosporium spp. ), Bermuda grass ( Cynodon dactylon ), para eatage ( Brachiaria mutica ), sedge ( Cyperaceae ), careless weed ( Amaranthus palmeri ), and Kapok ( Ceiba pentandra ) were used in our center field. Histamine and convention saline were used as cocksure and minus controls, respectively ( 4 ). All SPTs were performed by qualify technicians .
Validated Thai versions of the SF-36 ( 8 ) and Rcq-36 questionnaires ( 9, 11 ) were used in this study. The AR patients in our center were instructed to draw a hybrid on the horizontal note of the VAS at the specific detail that most accurately indicated their symptom austereness ( from 0 to 10 centimeter ). The symptom diary card is a form that contains a list of AR-related symptoms. Patients were asked to recollect the badness of the given symptom and provide a score accordingly. The list of symptoms provided by the study patients included an itchy nuzzle, sneezing, adenoidal obstruction, fluid nose, post-nasal drip, passing of smell, itchy eyes, and others. Each symptom was scored from 0 to 3 : 0 = none, 1 = mild, 2 = moderate, or 3 = hard. The total rhinal symptom score ( TNSS ) is the total of scores for nasal consonant congestion, sneezing, rhinal itch, and rhinorrhoea at each time point. TNSS was calculated by adding the score for each symptom, with a total score of 12 points ( 12 ) .
Data march and analysis were performed using PASW Statistics ( SPSS Inc., Chicago, IL, USA ). The data were expressed as frequency and percentage for categoric data or mean ± SD for continuous data. normally distributed continuous data were evaluated using the one-sample Kolmogorov-Smirnov test. The data were classified according to the ARIA guidelines. The differences in the type of aeroallergen and type of sensitizing among the AR badness groups ( ARIA categorization ) were determined by chi-square tests. The association between TNSS, VAS, and QoL scores in the SF-36 and Rcq-36 questionnaires and type of aeroallergen, pattern of sensitization, or ARIA categorization was analyzed using the Kruskal-Wallis test ; interim, the association of TNSS, VAS, and model of sensitizing was determined using the Mann-Whitney U -test for non-normally distributed data and using odd t -tests and ANOVA for normally distributed data. clinical symptoms and the practice of sensitization were evaluated for association with austereness and QoL. The factors associated with the blueprint of sensitizing and ARIA classification with a p-value < 0.05 using univariate analysis by bit-by-bit method acting and multivariate analysis are shown as p -value and odds ratio ( OR ) with 95 % CI. A p value < 0.05 was considered significant . This study was approved by the Siriraj Hospital Institutional Review Board ( approval number : Si 296/2019 ) .

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Results

The patient demographic and clinical characteristics are shown in table 1. A total of 366 patients who fulfilled the inclusion criteria were included in our cogitation. Among them, 236 ( 64.5 % ) were women and 130 ( 34.5 % ) were men. The mean old age of the female participants was 35.7 ± 12.4 years, while that of the male participants was 33.2 ± 12.6 years. The mean duration of symptoms was 9.7 ± 10.1 years in women and 9.0 ± 7.8 years in men. The mean ages of onset of AR were 25.5 ± 13.6 years in women and 23.3 ± 13.4 years in men .

table 1

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Table 1. Demographic and clinical characteristics of patients ( n = 366 ) .

Poly-sensitization was observed in 304 ( 83.1 % ) patients, while mono-sensitization was observed in 62 ( 16.9 % ) patients. Sensitization to indoor aeroallergens was noted in 117 ( 32 % ) patients, while sensitizing to outdoor allergens was noted in 29 ( 7.9 % ) patients. sensitization to both the aeroallergens was observed in 220 ( 60.1 % ) patients. Nasal obstruction ( 74.6 % ), fluid scent ( 63.7 % ), and nasal consonant itch ( 61.5 % ) were the most common symptoms observed in AR patients in this study. These symptoms were frequently observed in patients with moderate-to-severe intermittent and persistent AR. Based on the ARIA classification, a majority of the patients had moderate-to-severe haunting AR ( 54 % ), followed by moderate-to-severe intermittent AR ( 22 % ), balmy intermittent AR ( 14 % ), and mild persistent AR ( 10 % ) ( table 2 ) .

mesa 2

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Table 2. type of aeroallergen, type of sensitization, symptom score, and VAS score classified based on the ARIA guideline ( n = 366 ) .

The frequency of sensitization to versatile aeroallergens, from January 2018 to May 2020, is shown in Figure 1. The indoor aeroallergen was most frequently sensitized against the mite Dp ( 65 % ) followed by family dust ( 60.1 % ), cockroach ( 41.2 % ), cad ( 35.4 % ), and computerized tomography ( 24 % ). meanwhile, the outdoor aeroallergen was most frequently sensitized against sedge ( 39.3 % ) followed by para grass ( 31.4 % ), Bermuda denounce ( 31 % ), careless weed ( 25.4 % ), Kapok ( 23.4 % ), Typha ( 16.9 % ), Cladosporium ( 11.1 % ), Penicillium ( 7.5 % ), and Aspergillus ( 6.4 % ) ( table 2 ) .

FIGURE 1

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Figure 1. Pattern of aeroallergen sensitizing ( n = 366 ). Abbreviations : MDp, mite/ Dermatophagoides pteronyssinus ; HD, house scatter ; CR, cockroach ; Sed, sedge ; PG, belem grass ; BG, bermuda grass ; CW, careless weed ; Kap, Kapok ; Typ, Typha ; CS, Cladosporium ; PNC, Penicillium ; ASG, Aspergillum .

Regarding the determinants of AR austereness, a chi-square test revealed no significant relationship between the type of aeroallergen ( p = 0.54 ) and the type of sensitization ( p = 0.49 ) ( board 2 ). however, a significant deviation was observed between the symptom mark, VAS score, and ARIA classification using the independent-sample Kruskal-Wallis test ( p < 0.05 ). TNSS is importantly associated with the character of sensitizing ( Figure 2 ). An increased VAS grudge was associated with symptom badness and ARIA classification. In contrast, no meaning affiliation was found between the type of aeroallergen, sensitization, and the SF-36 and Rcq-36 domains ( Tables 3, 4 ). Factors associated with the convention of sensitizing and ARIA classification are shown in table 5. There was no association between the design of sensitization and affected role ‘s characteristics and symptoms. however, there was association between ARIA categorization, symptom asperity ( TNSS and VAS ), and QoL ( Table 6 ). Figures 3, 4 show a comparison of the types of aeroallergens and sensitizing among the SF-36 and Rcq-36 domains. furthermore, when each sphere of the generic SF-36 questionnaire was compared with the ARIA classification using ANOVA, a significant deviation was observed ( p < 0.05 ). The QoL in all domains was hapless as the asperity of AR increases. Bodily trouble, general health, and life force were the most badly affected domains. The disease-specific QoL questionnaire ( Rcq-36 ) besides yielded hapless QoL in all domains, specially for rhinitis symptoms ( 54.5 % ), sleep ( 65.5 % ), and emotions ( 57.5 % ), with ANOVA yielding significant results ( p < 0.05 ; Figure 5 ) . FIGURE 2 www.frontiersin.org
Figure 2. Association among TNSS, VAS score, ARIA classification, and type of sensitizing and aeroallergen. TNSS, the sum nasal symptom score ; VAS, ocular analogue scale ; ARAI, Allergic Rhinitis and its affect on Asthma. * p < 0.05 . table 3 www.frontiersin.org
Table 3. type of aeroallergen and each domain of the SF-36 and Rcq-36 questionnaires ( n = 366 ) .

table 4

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Table 4. type of sensitization and each world of the SF-36 and Rcq-36 questionnaires ( n = 366 ) .

mesa 5

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Table 5. Factors associated with the radiation pattern of sensitization and ARIA classification .

table 6

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Table 6. Independent gamble ration of univariable and multivariable analysis by polynomial logistic arrested development .

FIGURE 3

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Figure 3. Comparison of QoL, SF-36, and Rcq-36 scores among types of aeroallergens. QoL, quality of biography ; SF, social officiate ; Rcq, rhino-conjunctivitis QoL questionnaire ; RS, rhinitis symptoms ; ES, center symptoms ; OS, other symptoms ; PF, physical operation ; SP, sleep ; E, emotion. ( p < 0.05 : significant remainder between the type of aeroallergen and each domain of the SF-36 and Rcq-36 questionnaires using odd t -test ) .

FIGURE 4

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Figure 4. Comparison of QoL, SF-36, and Rcq-36 scores among the different types of sensitizations. QoL, quality of life ; SF, social serve ; Rcq, rhino-conjunctivitis. ( p < 0.05 : significant deviation between the character of sensitizing and each sphere of the SF-36 and Rcq-36 questionnaires using analysis of variance ) . FIGURE 5 www.frontiersin.org
Figure 5. Comparison of QoL between the ARIA classifications ( 36 ). QoL, choice of life sentence ; ARIA, Allergic Rhinitis and its impact on Asthma. ( * p < 0.05, * * p < 0.001 : significant difference among the ARIA classifications using analysis of discrepancy ) .

Discussion

The Mite was the most common sensitize indoor aeroallergen ( 65 % ), while sedge remained the most park sensitize outdoor aeroallergen ( 39.3 % ) reported in our study, which was conducted from January 2018 to May 2020. When compared to the 19-year ( 1998–2017 ) datum from the lapp center field ( 4 ), no significant changes in the distribution of sensitization patterns were observed. however, the share of sensitization against mites increased from 54.8 to 65 %, while that of sensitizing against cockroaches increased from 36 to 41.2 %. There was no significant change in the percentage sensitization model in the outdoor aeroallergen group. Sedge, para grass, and Bermuda grass were the top three outdoor aeroallergens that caused sensitization in our discipline ; this discover is similar to those of a previous study conducted in the lapp kernel. This result indicates that both indoor and outdoor allergens remain the campaign of AR among Thai patients. A sketch from another tertiary care hospital in Bangkok reported a touch Dp sensitization rate of 50.1 % within a 12-year period ( from January 2004 to December 2015 ) ( 13 ), which establishes the fact that there is an up tendency in mite sensitization in adult Thai AR patients .
House dust mite is the most common sensitize aeroallergen worldwide and causes sensitization in up to 90 % of asian atopic patients ( 7, 14 ). The mite sensitization rates were 57.5 % in South coast China ( 15 ), 97.4 % in the Philippines ( 7 ), 68.5 % in Singapore ( 16 ), 21.4 % in South Korea ( 17 ), and 63 % in Hong Kong ( 3 ). The aeroallergen sensitizing model in Thai adults is consistent with the findings from asian countries with the similar climatic conditions. The hot and humid and tropical climate of Thailand, throughout the year, is friendly for the touch, allowing it to thrive .
The worsening air out pollution in Bangkok and adjacent areas over the years may have impacts on allergens, along with changes in atmospheric variables, such as CO2 assiduity, temperature, rain, humidity, and wind accelerate and direction ( 18, 19 ). A previous study in Thailand reported that pollen is present in the air throughout the year, and pot and weed pollen, for example, Bermuda grass ( Cynodon dactylon ), parity grass ( Panicum purpurascens ), sedge ( Carex species ), and careless weed ( Amaranthus hybridus ), is more normally found in Bangkok than tree pollen ( 6 ). These findings might explain the upwards drift in mite sensitization and perseverance in the sensitization pattern for grasses ( Bermuda eatage, sedge, and para eatage ) over the last two decades, despite the fact that Bangkok is an urban center and has relatively less greenery.

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Lombardi et alabama. ( 20 ) reported that AR patients frequently self-managed with nonprescription medications, with a physician-based diagnosis made in lone 60 % of patients. The next-generation ARIA wish pathway stresses self-care and self-medication with certain nonprescription drugs, enabling the doctor to increase or decrease the treatment based on the VAS score ( 21 ). Nasal obstruction ( 74.6 % ), fluid scent ( 63.7 % ), and rhinal itch ( 61.5 % ) were the three primary symptoms salute in our AR patients. Based on our findings, the majority of these symptoms are portray in patients with moderate-to-severe AR, regardless of whether it is intermittent or persistent. These findings suggest that symptom badness matters more than the symptom longevity for moderate-to-severe disease and reiterates the importance of self-care and the self-medicate care nerve pathway .
Supporting the concept of “ one airway-one disease ”, 26 % of AR patients in our study had cough, which re-emphasizes the fact that 40 % of AR patients will besides have coincident bronchial asthma ( 22 ). In addition, 13.9 % of moderate-to-severe persistent AR patients had cough, while entirely 6 % of moderate-to-severe intermittent AR patients had cough .
Among the total phone number of patients recruited in our study ( n = 366 ), 64.5 % were women, while only 35.5 % were men. however, no significant gender discrepancies were observed in terms of intend long time, average duration of symptoms, and base senesce of onset of AR. The female predominance might be attributed to the better health awareness among women, as suggested in a previous study ( 4 ) .
ocular analogue scale is a dim-witted and quantitative method acting that can be used for the quantitative evaluation of the asperity of AR and for monitoring the efficacy of remedy interventions ( 23 ). The next-generation ARIA guideline uses an algorithm based on the VAS scores for the excerpt of pharmacotherapy for AR patients and to determine whether the discussion should be stepped up or stepped down depending on the condition of disease control ( 24 ). In fact, the phase 3 ARIA enterprise is based on Mobile Airways Sentinel Network, which aimed to initiate digitally enabled, integrated, person-centered caution for rhinitis and asthma multi-morbidity using real-world evidence ( 25 ). The real-life-integrated care nerve pathway has been adapted into the german healthcare system. An algorithm suitable for the German healthcare system using the VAS was devised and digitalised to increase or decrease AR treatment ( 21 ). In Thailand, no previous analyze has reported the association between VAS scores and AR asperity. Our cogitation revealed a significant association between VAS scores and AR severity, which means that VAS can be used as a usher in the treatment and follow-up of our AR patients. The findings from our report are an important footfall toward the execution of the real-world-integrated care pathway in the Thai population for the management of AR. however, in the stage study, we did not assess the changes in VAS scores after initiation of treatment. Hence, far research is needed to support our findings .
A previous study in Thailand using the Thai interpretation of the SF-36 questionnaire reported that AR patients had importantly impaired QoL scores compared with goodly individuals in all aspects, except the social officiate property. The same study besides reported that the Rcq-36 questionnaire showed a higher correlation with the symptom scores compared with the SF-36 questionnaire, additionally including information on sleep and productiveness ( 6 ). In our study, the analysis of both SF-36 and Rcq-36 questionnaires to assess the QoL showed the affect on all domains of health. The comparison of each domain of health with diverse categories of AR revealed that the QoL grudge became poorer as the asperity of AR increased, which was significant ( p > 0.05 ). Bodily pain, general health, and vitality were the most affect domains in the SF-36 questionnaire. interim, rhinitis symptoms, sleep, and emotions were the most affect domains in the analysis of the disease-specific questionnaire ( Rcq-36 ). The findings from our study reaffirm that AR continues to be significantly affecting the QoL of the Thai population. Adapting and advocating the next-generation ARIA road map with the use of real-world attest and an integrated care nerve pathway in the Thai population may fill the break and adequately address the needs of AR patients .
Ciprandi and Cirillo ( 2 ) reported that the asperity of symptoms was higher in poly-sensitized patients than in mono-sensitized patients. A previous study conducted in the italian population suggested that mono-sensitization and poly-sensitization constitute two different phenotypes of AR. A alike sketch conducted in Malaysia demonstrated that sensitization to two or more aeroallergens was importantly associated with moderate-to-severe haunting AR ( 26 ). previous studies from Thailand reported that all of the clinical parameters significantly affected the QoL of patients ( 9, 22 ), but did not mention the consequence of sensitization status. A holocene analyze reported that sensitization condition did not show a meaning association with QoL ( 4 ), but this discipline did not mention the effect of the number of sensitization on disease asperity or QoL. In our study, 83.1 % of the AR patients exhibited poly-sensitization, while only 16.9 % exhibited mono-sensitization. The chi-square trial between ARIA categorization of AR and number of sensitizations showed no significant association ( p = 0.49 ). There may be several factors that can have an impression on the clinical asperity of AR ascribable to the count of sensitizing aeroallergens. This should be addressed in future research. similarly, our analyze besides revealed that the type of aeroallergen and number of sensitizations had no association with VAS grudge and TNSS .
Our cogitation has some limitations. It was retrospective in nature and only used a 2-year dataset. Our findings would have been good supported if we had assessed the meaning of the changes in VAS scores and QoL after the initiation of discussion. In addition, due to the prevailing coronavirus disease 2019 pandemic, merely a few SPTs were performed from March to May 2020 .

Conclusion

Mite and sedge remain the most common sensitizing indoor and outdoor aeroallergens in adult Thai patients with AR. The VAS scores are significantly associated with AR asperity. VAS can be used as a quick and dependable tool in adult Thai patients with AR to monitor and increase or decrease treatment. AR has a significant impact on the QoL of adult Thai patients, and the severity of AR is not associated with the number and type of aeroallergen .

Data Availability Statement

The original contributions presented in the discipline are included in the article/supplementary fabric, further inquiries can be directed to the represent authors .

Ethics Statement

The studies involving human participants were reviewed and approved by Siriraj Institutional Review Board. Certificate of Approval No. Si 296/2019. Written informed consent for participation was not required for this study in accord with the national legislation and the institutional requirements .

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Author Contributions

PK : data collection, methodology, formal psychoanalysis, undertaking government, designed and wrote the beginning draft of the manuscript, and writing—review and edit. BP : data curation, statistical analysis, visual image, and writing—review and edit. KT : data solicitation and curation. platinum : conceptualization, methodology, stick out administration, supervision, and editing. All authors contributed to the article and approved the submitted interpretation .

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or fiscal relationships that could be construed as a electric potential conflict of interest .

Publisher’s Note

All claims expressed in this article are entirely those of the authors and do not inevitably represent those of their consort organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher .

Acknowledgments

We would like to thank Miss Khemajira Karaketklang and Dr. Orawan Supapueng for the invaluable remark and Mr. Thitiphol Chomsook for providing aid in the data collection summons. especial allusion goes to the staffs, nurses, and technicians at the Allergy and Rhinology Unit, Department of Otorhinolaryngology, Siriraj Hospital, who immediately or indirectly helped in the integral project. We would like to thank Editage ( www.editage.com ) for english speech editing .

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