Pathophysiology Of Allergic Rhinitis Research Articles

Genetic associations between gut microbiota and allergic rhinitis: an LDSC and MR analysis

BackgroundSeveral studies have suggested a potential link between allergic rhinitis (AR) and gut microbiota. In response, we conducted a meta-analysis of Linkage Disequilibrium Score Regression (LDSC) and Mendelian randomization (MR) to detect their genetic associations.MethodsSummary statistics for 211 gut microbiota taxa were gathered from the MiBioGen study, while data for AR were sourced from the Pan-UKB, the FinnGen, and the Genetic Epidemiology Research on Aging (GERA). The genetic correlation between gut microbiota and AR was assessed using LDSC. The principal estimate of causality was determined using the Inverse-Variance Weighted (IVW) method. To assess the robustness of these findings, sensitivity analyses were conducted employing methods such as the weighted median, MR-Egger, and MR-PRESSO. The summary effect estimates of LDSC, forward MR and reverse MR were combined using meta-analysis for AR from different data resources.ResultsOur study indicated a significant genetic correlation between genus Sellimonas (Rg = −0.64, p = 3.64 × 10−5, Adjust_P = 3.64 × 10−5) and AR, and a suggestive genetic correlation between seven bacterial taxa and AR. Moreover, the forward MR analysis identified genus Gordonibacter, genus Coprococcus2, genus LachnospiraceaeUCG010, genus Methanobrevibacter, and family Victivallaceae as being suggestively associated with an increased risk of AR. The reverse MR analysis indicated that AR was suggestively linked to an increased risk for genus Coprococcus2 and genus RuminococcaceaeUCG011.ConclusionOur findings indicate a causal relationship between specific gut microbiomes and AR. This enhances our understanding of the gut microbiota’s contribution to the pathophysiology of AR and lays the groundwork for innovative approaches and theoretical models for future prevention and treatment strategies in this patient population.

Pattern and Severity of Allergic Rhinitis Correlated with Patient Characteristics: A Rural Hospital-Based Cross-Sectional Study.

Allergic Rhinitis (AR) is rising in incidence in both developed and developing countries. Genetics and epigenetics have a potential role to play. The pattern and severity of AR have implications with regard to choice of treatment, which itself could be related to patient specific genetic and epigenetic factors. Hence, the present study was undertaken to correlate the patient characteristics with AR pattern and severity, in order to understand the pathophysiology of AR. The study also aimed to find out the allergen sensitivity pattern among patients attending a tertiary care centre of rural central India, where climatic variations make it a high prevalence zone. Prospective Observational study on 90 patients with clinically diagnosed Allergic Rhinitis confirmed by Skin Prick Tests. Patient characteristics like demographic data, data relevant to allergen exposure, occupation, family history of atopy and gender; and Disease characteristics like severity (mild, mod-severe), pattern (continuous/ intermittent), type of disease (seasonal/perennial) were noted, analysed and correlation studied. Majority of the patients with AR were in the age group of 15-40 years. Medical students (52%) suffered from moderate to severe type of Allergic Rhinitis, with Persistent disease in approximately 80%. Similarly, 70.59% of farmers had moderate to severe type of the disease, with persistent disease in 70%. In the present study, in clinically diagnosed allergic rhinitis patients, Mite was the commonest allergen found on Skin Prick Test overall and in Medical students, whereas Pollen sensitivity was more common among farmers. 56.66% of the patients had negative family history of atopy. Severity and type of AR depend on allergen exposure. In farmers and medical professionals, persistent and moderate to severe type of disease was more common, as they were persistently exposed to different type of allergens, mites in case of medical professionals and pollens in farmers. Hence, the Disease characteristics, as defined by ARIA guidelines, should not be taken in isolation and management should consider the Patient characteristics for deciding and devising protocols. In the present study, more than 50% patients were without family history of atopy. Hence, the role of various environmental factors, leading to epigenetic changes could be a major contributor in the increase in incidence of allergic rhinitis in recent times. Occurrence of perennial moderate to severe form of disease, in majority of farmers, defies the phenomenon of "Hygiene Hypothesis", focusing on the role of epigenetic changes and various outdoor allergens in the development of allergic rhinitis in them.

Efficacy and Safety of Oral Probiotics in Children with Allergic Rhinitis: A Review

The prevalence of allergic rhinitis is rising, and it is impacting children’s growth and quality of life. To uncover unconventional treatment modalities, research was carried out to clarify the significance of novel components in the pathophysiology of allergic rhinitis. One of these elements was gut microbiota, which plays a crucial role in the development and evolution of allergic disorders. Specifically, dysbiosis, defined as impaired microbiota composition, characterizes allergic disorders. In light of this concept, probiotics (beneficial bacteria) may restore gut dysbiosis, rebalance the immune response, and indirectly influence the clinical course of allergic diseases. In this article, we discussed the role of the gut–lung axis in children and reported on new findings. We also reviewed the most relevant studies about probiotics in patients with allergic rhinitis.

Multimorbidities in Allergic Rhinitis-Current Evidence from Epidemiological Studies, Treatment Trials, and Molecular Data.

Given that allergic rhinitis (AR) commonly coexists with other diseases, the present narrative review attempts a brief presentation of current theories on multimorbidities in relation to phenotypes, genotypes, age, and treatment responses with the term "multimorbidities" indicating the uncertainty regarding the primary defect, organ, or pathophysiologic mechanism involved. Though age-related manifestations allow for the generation of several hypotheses on AR's specific mechanisms, the various theories regarding the initiation or the aggravation of atopic disorders have yet to be proved. Multimorbid AR seems to have a different genetic basis from "stand-alone" AR as well a more severe phenotype. Most studies on the treatment of AR and its multimorbidities focus on allergen immunotherapy, which improves the atopic symptoms and may play a preventive role in the onset of new allergen sensitizations. The use of biological factors may also have a beneficial effect, even though it has currently been approved only for some comorbidities of AR, such as asthma. Employing the use of phenotypes and genotypes concerning multimorbidity broadens current knowledge, but further research is needed to develop diagnostic, stratificational, and predictive algorithms for single and multimorbid allergic diseases (Fig.1). The real-time data obtained by mobile apps and the new insights on the pathophysiology of AR and its comorbidities will permit both timed preventive measures and better individualized and effective antiallergic treatment. Fig. 1 Current concepts and future trends in diagnosis and management of multimorbid allergic rhinitis.

Exacerbation of allergic rhinitis by the commensal bacterium Streptococcus salivarius.

Allergic rhinitis (AR)-commonly called hay fever-is a widespread condition that affects the quality of life of millions of people. The pathophysiology of AR remains incompletely understood. In particular, it is unclear whether members of the colonizing nasal microbiota contribute to AR. Here, using 16S ribosomal RNA sequencing, we show that the nasal microbiome of patients with AR (n = 55) shows distinct differences compared with that from healthy individuals (n = 105), including decreased heterogeneity and the increased abundance of one species, Streptococcus salivarius. Using ex vivo and in vivo models of AR, we demonstrate that this commensal bacterium contributes to AR development, promoting inflammatory cytokine release and morphological changes in the nasal epithelium that are characteristic of AR. Our data indicate that this is due to the ability of S. salivarius to adhere to the nasal epithelium under AR conditions. Our study indicates the potential of targeted antibacterial approaches for AR therapy.

Pathophysiology of Allergic Rhinitis with Future Therapeutic Targets- An Update

Rhinitis is defined by a combination of two or more nasal symptoms (running, blocking, itching, and sneezing). Allergic Rhinitis (AR) occurs when these symptoms are due to Immunoglobulin E (IgE)-mediated inflammation following exposure to the allergen. The current review article has attempted to revisit the pathophysiologic basis of this disease in order to understand the likely therapeutic targets. Controlling histone acetylation with histone deacetylase inhibitors, Deoxyribonucleic acid (DNA) hypermethylation with DNA methyl transferase inhibitors and post-transcriptional gene expression with micro Ribonucleic Acid (miRNA) mimetics which target epigenetic changes, may aid in the treatment of AR. The allergen-induced nasal hypersecretion in allergic patients can also be definitively blocked by vidian neurectomy. Probiotics are non pathogenic microorganisms that are assumed to exert a positive influence on host health and physiology which may aid in the treatment of AR. Reversing or targeting the epigenetic changes in susceptible individuals can help prevent sensitisation of the individual and better treatment outcome in patients with AR, help cure the symptoms and lack of drug dependance.

Effect of Temperature and Humidity on the Allegro-inflammatory Factors and Allergic Rhinitis-related Behavior.

Allergic rhinitis (AR) is an allergic disease induced by the T helper 2 (TH2) lymphocyte immune response, where its mediators are the primary cause of clinical symptoms. Environmental factors are the primary determinants of the allergic response in genetically susceptible individuals. This study investigates the effects of climate conditions (warm, cold, humid, and dry) on allergic rhinitis. AR models were created in mice under 4 different conditions. We investigated AR-related behavior (sneezing and nose rubbing), as well as total immunoglobulin E (IgE), histamine, interleukin-4 (IL-4), leukotriene (LT) B4 and LTC4 levels, and gene expression of CysLT1R, HRH1, and MUC5a. Nose rubbing, histamine levels, and the expression of MUC5a and HRH1 were increased in AR models in cold conditions, and sneezing was increased in AR models kept in dry conditions. LTB4 and LTC4 levels and the expression of CysLT1R in AR models kept in a wet environment also significantly increased compared with the control group. The levels of total IgE and IL-4 showed no significant changes. Air temperature and humidity affect AR pathophysiology, and weather conditions can be essential in controlling AR.

Immunotherapy in the Treatment of Allergic Rhinitis in Children.

Allergic rhinitis (AR)is an inflammation of the nasal membranes characterized by multiple allergic symptoms. It is a widespread health problem that affects patients' ability to engage in social and physical activity, which lowers their quality of life. The pathophysiology of AR is complex and requires sensitization and the development of a specific immune response to the allergen. Allergen-specific immunotherapy (AIT) is a therapeutic method that induces specific immune tolerance to allergens. The objectives of this review are to demonstrate the mechanismof action of immunotherapy,explain how it alleviates clinical symptoms of allergic rhinitis,list the indications and contraindicationsof immunotherapy in the treatment of allergic rhinitis, andidentify different modalities of allergen immunotherapy, their disease-modifying effects, as well as their potential risks and benefits. The review of the literature highlights that T-cell and B-cell responses to inhaled allergens are altered by AIT, which decreases both early and late reactions to allergen exposure. To induce clinical and immunologic tolerance, especially in the pediatric age, escalating dosages of the causing allergen are administered subcutaneously or sublingually. AIT is indicated for severe persistent AR when avoidancemeasures and medications are inadequate to control the symptoms. To conclude, AIT is a disease-modifying therapy that is safe and effective for the treatment of allergic rhinitis. It is indicated when the symptoms are uncontrolled or when there are undesirable effects from pharmacotherapy.

Allergic Rhinitis: Pathophysiology and Treatment Focusing on Mast Cells.

Allergic rhinitis (AR) is a common rhinopathy that affects up to 30% of the adult population. It is defined as an inflammation of the nasal mucosa, develops in allergic individuals, and is detected mostly by a positive skin-prick test. AR is characterized by a triad of nasal congestion, rhinorrhea, and sneezing. Mast cells (MCs) are innate immune system effector cells that play a pivotal role in innate immunity and modulating adaptive immunity, rendering them as key cells of allergic inflammation and thus of allergic diseases. MCs are typically located in body surfaces exposed to the external environment such as the nasal mucosa. Due to their location in the nasal mucosa, they are in the first line of defense against inhaled substances such as allergens. IgE-dependent activation of MCs in the nasal mucosa following exposure to allergens in a sensitized individual is a cardinal mechanism in the pathophysiology of AR. This review is a comprehensive summary of MCs’ involvement in the development of AR symptoms and how classical AR medications, as well as emerging AR therapies, modulate MCs and MC-derived mediators involved in the development of AR.

Chemokines and chemokine receptors in allergic rhinitis: from mediators to potential therapeutic targets.

Allergic rhinitis (AR) is an immune-mediated inflammatory condition characterized by immune cell infiltration of the nasal mucosa, with symptoms of rhinorrhea, sneezing, nasal obstruction, and itchiness. Currently, common medication for AR is anti-inflammatory treatment including intranasal steroids, oral, or intranasal anti-histamines, and immunotherapy. These strategies are effective to the majority of patients with AR, but some patients under medication cannot achieve symptom relieve and suffer from bothersome side effects, indicating a demand for novel anti-inflammatory treatment as alternatives. Chemokines, a complex superfamily of small, secreted proteins, were initially recognized for their chemotactic effects on various immune cells. Chemokines constitute both physiological and inflammatory cell positioning systems and mediate cell localization to certain sites via interaction with their receptors, which are expressed on responding cells. Chemokines and their receptors participate in the sensitization, early phase response, and late phase response of AR by promoting inflammatory cell recruitment, differentiation, and allergic mediator release. In this review, we first systemically summarize chemokines and chemokine receptors that are important in AR pathophysiology and then discuss potential strategies targeting chemokines and their receptors for AR therapy.

The Role of Small Extracellular Vesicles and MicroRNAs in the Diagnosis and Treatment of Allergic Rhinitis and Nasal Polyps.

Allergic rhinitis and nasal polyps are common otorhinolaryngological diseases. Small extracellular vesicles and microRNAs have recently become major research topics of interest due to their key regulatory roles in cancer, inflammation, and various diseases. Although very detailed and in-depth studies on the pathogenesis and pathophysiology of allergic rhinitis and nasal polyps have been conducted, few studies have assessed the regulatory effects of exosomes and microRNAs on allergic rhinitis and nasal polyps. This paper reviews the studies on small extracellular vesicles and microRNAs in allergic rhinitis and nasal polyps conducted in recent years and focuses on the regulation of small extracellular vesicles and microRNAs in allergic rhinitis and nasal polyps with the aim of providing insights for the future diagnosis and treatment of allergic rhinitis and nasal polyps.

Allergic Rhinitis: A Clinical and Pathophysiological Overview.

Allergic rhinitis (AR) represents a global health concern where it affects approximately 400 million people worldwide. The prevalence of AR has increased over the years along with increased urbanization and environmental pollutants thought to be some of the leading causes of the disease. Understanding the pathophysiology of AR is crucial in the development of novel therapies to treat this incurable disease that often comorbids with other airway diseases. Hence in this mini review, we summarize the well-established yet vital aspects of AR. These include the epidemiology, clinical and laboratory diagnostic criteria, AR in pediatrics, pathophysiology of AR, Th2 responses in the disease, as well as pharmacological and immunomodulating therapies for AR patients.

Trace Elements (Zn and Cu) and Oxidative Stress in Pediatric Patients with Persistent Allergic Rhinitis.

To investigate the relationship between complaints and serum trace elements and oxidative stress levels in pediatric patients with allergic rhinitis (AR). Descriptive study. Department of Otolaryngorhinology, Medicine Faculty, Alanya Alaaddin Keykubat University, between May and September 2020. Thirty-five patients diagnosed with AR in the pediatric age group and 35 healthy control groups were examined. The patients were evaluated according to the ARIA (Allergic rhinitis and its ımpact on asthma) guidelines. Blood samples were taken during the attack to measure serum Zn and Cu levels and oxidative stress levels from patients diagnosed with AR. Measurements of serum Zinc and Copper levels, and recently developed new generation oxidant-antioxidant balance markers were performed spectrophotometrically using a commercial kit.] Results: The mean ages of the study patients and healthy controls were 10.9 ± 4.7 and 10.5 ± 4.9 years, respectively. Female/Male ratio was 20 (57.1%)/15 (42.9%) in both groups. Zn level was lower in the patient group (p <0.05). Total thiol and native thiol values were higher in the control group (p <0.05). Statistically significant high disulfide values were found in allergic patients (p <0.05). Oxidative stress plays a role in the pathophysiology of allergic rhinitis, and thiol-disulfide hemostasis may be an indicator in allergic rhinitis. Key Words: Oxidative stress, Allergic rhinitis, Thiol, Disulfide, Cu, Zn.

Adult allergic rhinitis sufferers have unique nasal mucosal and peripheral blood immune gene expression profiles: A case-control study.

BackgroundAllergic rhinitis (AR) is a complex disease involving both mucosal and systemic immune compartments. Greater understanding of the immune networks underpinning AR pathophysiology may assist with further refining disease‐specific biomarkers.ObjectiveTo compare immune gene expression profiles in nasal mucosa and peripheral blood samples between adults with AR and controls without AR.MethodsThis cross‐sectional study included 45 adults with moderate‐severe and persistent AR (37.6 ± 12.8 years; mean ± SD) and 24 adults without AR (36.6 ± 10.2). Gene expression analysis was performed using the NanoString nCounter PanCancer Immune profiling panel (n = 730 immune genes) in combination with the panel plus probe set (n = 30 allergy‐related genes) with purified RNA from peripheral blood and cell lysates prepared from combined nasal lavage and nasal brushing.ResultsOne hundred and thirteen genes were significantly differentially expressed in peripheral blood samples between groups (p < .05). In contrast, 14 genes were differentially expressed in nasal lysate samples between groups (p < .05). Upregulation of allergy‐related genes in nasal mucosa samples in the AR group was observed. Namely, chemokines CCL17 and CCL26 are involved in the chemotaxis of key effector cells and TPSAB1 encodes tryptase, an inflammatory mediator released from activated mast cells and basophils. Six differentially expressed genes (DEGs) were in common between the nasal mucosa and blood samples. In addition, counts of specific DEGs in nasal mucosa samples were positively correlated with eosinophil and dust mite‐specific immunoglobulin E (IgE) counts in blood.Conclusions and Clinical RelevanceDistinct gene expression profiles in blood and nasal mucosa samples were observed between AR sufferers and controls. The results of this study also provide evidence for a close interaction between the local site and systemic immunity. The genes identified in this study contribute to the current knowledge of AR pathophysiology and may serve as biomarkers to evaluate the effectiveness of treatment regimens, or as targets for drug discovery.

Neuroimmunomodulation in allergic rhinitis

The role of neuroimmunomodulation in allergic diseases is a research hotspot in recent years. Allergic rhinitis（AR） is caused by overactive immune response to a foreign antigen in nasal mucosa. Immune cells release inflammatory mediators（including histamine, cytokines and neurotrophins）, which directly activate peripheral neurons to mediate nasal congestion, itching, sneezing, and other hyperresponsive symptoms. Upon activation, these peripheral neurons release neurotransmitters （including acetylcholine and norepinephrine） and neuropeptides（including calcitonin gene-related peptide, substance P and vasoactive intestinal peptide） that directly act on immune cells to drive allergic inflammation. Neuro-immune signaling may play a significant role in the pathophysiology of AR. Therefore, a better understanding of these cellular and molecular neuro-immune interactions may inspire the discovery of new targets and novel therapies.

Comparing the nasal allergen challenge and environmental exposure unit models of allergic rhinitis

Allergic rhinitis (AR) is an immunoglobulin E–mediated hypersensitivity reaction triggered by allergen exposure that causes inflammation of the nasal cavity. Allergens can be seasonal, such as pollens and grasses, or perennial, including house dust mite and animal dander. Historically, evaluations of novel AR therapies have been conducted using outpatient studies in which participants, having received a certain medication, go about their day-to-day routines during the expected pollen season. Though clinically relevant, real-world field studies are inherently limited by the heterogeneity of allergen exposure across different geographic locations and varying daily routines of participants. Field studies can also be associated with irregular compliance of medication and recording of daily symptom scores. Experimental models have been developed to counter these limitations, namely the environmental exposure unit (EEU) and nasal allergen challenge (NAC). The EEU is a controlled allergen challenge facility that allows for exposure of aerosolized whole allergen to a group of participants, whereas the NAC involves direct nasal delivery of a personalized dose of allergen extract. It is unclear how these models compare in replicating natural allergen exposure; hence, this article recommends the preferential use of the NAC for modeling natural allergen exposure, especially of seasonal allergens, and studying AR pathophysiology and therapies.

Relationship between allergic rhinitis and diamine oxidase activity: A preliminary report.

Aim: To analyze the diamine oxidase (DAO), the main catabolic enzyme of histamine, degradation activity and its relation with symptoms of persistent allergic rhinitis. Methods: In this descriptive and analytical observational study, we collected DAO activity levels and the nasal peak inspiratory flow. Results: Enzymatic activity deficit in 108 patients was 46.3% (95% CI, 0.44 – 0.63), 33.33% in mild and 47.92% in moderate/severe rhinitis (p = 0.376). The nasal peak inspiratory flow in patients with a deficit in DAO activity was 76.30 ± 28.40 L/min compared to 93.62 ± 37.50 L/min in patients with normal enzymatic activity (p = 0.010). Conclusions: It seems that the lower the catabolic activity of DAO, the lower the nasal peak inspiratory flow observed. Although DAO activity levels could be a severity biomarker in allergic rhinitis, a cause-effect association cannot be concluded. The enzyme could be another actor in the pathophysiology of allergic rhinitis.

Serum Periostin as a Biomarker for Predicting Clinical Response to House Dust Mite Sublingual Immunotherapy in Allergic Rhinitis

House dust mite (HDM) sublingual immunotherapy (SLIT) has proven to be effective for allergic rhinitis (AR), but its efficacy varies among patients. No candidate biomarkers for prediction of response to SLIT are available. Periostin, a matricellular protein, is involved in pathophysiology of AR, and its serum levels reflect airway allergic inflammation. To evaluate the relationship between serum periostin levels and current rhinitis control before and after standardized quality (SQ)-HDM SLIT, and to investigate the role of periostin in predicting clinical response. One hundred eleven subjects with HDM-induced AR were randomized to receive either SLIT plus pharmacotherapy or pharmacotherapy alone, for 48 weeks. At enrollment and the end of study, clinical characteristics and biomarkers that included serum periostin, serum HDM-specific IgE (s-IgE), total IgE, blood eosinophil counts, and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) were measured. The association between clinical indices or biomarkers and clinical response to SLIT was analyzed. A response to SLIT was recorded in 64% (32 of 50) patients. High serum periostin levels (>30.2 ng/mL) were associated with an effective response to SLIT, and the magnitude of RQLQ improvement was correlated with the level of serum periostin. The sensitivity and specificity based on receiver operating characteristic analysis for periostin were higher than those of s-IgE. Multivariate regression analysis showed that serum periostin was an independent factor for SLIT responders. Serum periostin appears to be a useful biomarker for predicting the response to SQ-HDM SLIT in patients with AR.

IL-36α contributes to enhanced T helper 17 type responses in allergic rhinitis

BackgroundT helper 17 (Th17) cell subsets, belongs to CD4+ T cell lineage, are proved to be closely related to pathophysiology of AR recently. The interleukin-36 (IL-36) had been reported to promote the up-regulation of Th17 cytokines in psoriasis. We investigated the regulation of Th17 inflammation by IL-36 family cytokines in allergic rhinitis (AR). MethodsTwenty-one patients with AR and 20 healthy controls were enrolled. The expression of serum protein and mRNA of IL-36 family cytokines between AR and control group were detected and compared. Human peripheral blood mononuclear cells were purified and stimulated by IL-36 cytokines. The transcription factor and production of Th17 cytokines by Th17 cells were evaluated. Mouse model with AR was established to confirm the in vitro results. ResultsThe serum expression of IL-36 cytokines and Th17 cytokines (IL-17 and IL-23) of AR patients were up-regulated significantly compared with controls. The IL-36α promoted the differentiation and function of Th17 cells. The anti-IL-36α treatment could alleviate the Th17 response in AR mice, presented with alleviated symptoms, decreased infiltration of Th17 cells and down-regulated Th17 cytokines expression. ConclusionsIL-36α was involved in the regulation of Th17 responses in allergic rhinitis.

Vitamin D and Serum Immunoglobulin E Levels in Allergic Rhinitis: A Case-control Study from Pakistan.

IntroductionAllergic rhinitis (AR) is the most common non-infectious rhinitis and is associated with sneezing, cough, and flu-like symptoms. The exact pathophysiology of AR remains uncertain. The deficiency of vitamin D3 has been documented as a probable cause of allergic conditions due to its role in immunomodulation. The aim of this study was to evaluate the role of vitamin D3 deficiency in allergic rhinitis.MethodsThis case-control study was conducted with 50 patients of AR and 50 healthy individuals. Serum immunoglobulin (Ig) E and vitamin D3 levels were measured in all study participants. Data were analyzed using SPSS v. 21.0 (IBM Corp., Armonk, NY).ResultsMean serum IgE levels in the AR group were 553.5 ± 53.9 IU/L as compared to 219.4 ± 32.1 IU/L in the control group (p <0.0001). AR patients had mean serum vitamin D levels of 14.8 ± 7.4 ng/mL as compared to 19.1 ± 6.6 ng/mL in the control group (p=0.002). Only 10% of participants in the AR group had adequate serum vitamin D levels as compared to 26% in the controls (p=0.08).ConclusionVitamin D deficiency was present in both study groups. The AR group had significantly lower mean levels of serum vitamin D than the control group. However, upon stratification, the differences were insignificant.