Introduction

Allergic rhinitis (AR) is an IgE-mediated inflammatory disease characterized by sneezing, rhinorrhea, nasal obstruction, and nasal itching. Emerging evidence suggests a relationship between iron deficiency and atopic diseases. Iron deficiency may promote Th2-mediated immune responses, which contribute to allergic inflammation. Serum ferritin is an early and reliable marker of iron deficiency. This study explored whether serum ferritin levels are associated with the presence and severity of allergic rhinitis.

Aim

To determine serum ferritin levels in patients with AR and compare them with healthy controls and to evaluate the relationship between serum ferritin levels and the severity of AR.

Method

Study Design

Treatment Strategy

• A total of 40 patients with clinically diagnosed AR and 40 age- and sex-matched healthy controls were enrolled in the study
• Among the AR patients, 29 (72.5%) were female and 11 (27.5%) were male, with a mean age of 35.1 years
• Based on the ARIA classification, 27 patients (67.5%) had mild AR, while 13 patients (32.5%) had moderate-to-severe AR
• The cohort underwent clinical evaluation and hematological assessments such as complete blood count, serum ferritin estimation
• The severity of AR was classified using ARIA guideline

Endpoints

Primary Endpoint

Secondary Endpoints

• Association between serum ferritin levels and AR severity
• Relationship between serum IgE levels and AR severity

Results

• The study demonstrated a significantly higher prevalence of iron deficiency among patients with AR compared with healthy controls
• Mean serum ferritin levels were markedly lower in patients with AR than in healthy controls, and this difference was highly statistically significant (p < 0.0001) as seen in Figure 1.

Figure 1. Comparison of serum ferritin level 

• Furthermore, serum ferritin levels decreased with increasing disease severity
• Patients with mild AR had a mean ferritin level of 28.4 ng/mL, whereas those with moderate-to-severe AR had a mean ferritin level of 13.7 ng/mL (p = 0.043)
• Serum IgE levels also correlated with disease severity
• Patients with mild AR had a mean serum IgE level of 262.2 ± 64.6 IU/mL, while those with moderate-to-severe AR had significantly higher levels of 385.6 ± 84.3 IU/mL (p = 0.012)
• These findings indicate that lower serum ferritin levels and higher serum IgE levels are associated with greater severity of AR

Conclusion

• Patients with allergic rhinitis have a significantly higher prevalence of iron deficiency, reflected by lower serum ferritin levels, compared with healthy individuals. 
• Lower serum ferritin levels are associated with greater disease severity. 
• Serum ferritin may serve as a useful biomarker for assessing the severity of allergic rhinitis and could potentially aid in developing future preventive and therapeutic strategies.

Indian J Allergy, Asthma and Immunol 39(1):p 16-19, Jan-Jun 2025. DOI: 10.4103/ijaai.ijaai_53_24.