ORIGINALARTICLE

AEROALLERGEN SENSITIZATION PATTERNS IN PATIENTS WITH ALLERGIC RESPIRATORY

DISEASES AT A SINGLE CENTER IN PESHAWAR, PAKISTAN: RETROSPECTIVE ANALYSIS

INCLUDING PATIENTS FROM NEIGHBORING AFGHANISTAN

Saima Alam¹, Wajeeha Qayyum², Nabeel Khan³, Suleman Ali Khan⁴

How to cite this article

ABSTRACT

OBJECTIVES

Alam S, Qayyum W, Khan N, Khan

SA. Aeroallergen Sensitization

Patterns in Patients with Allergic

Respiratory Diseases at A Single

Center in Peshawar, Pakistan:

Retrospective Analysis Including

Patients from Neighboring

Afghanistan. J Gandhara Med Dent

Sci. 2026;13(2):50-54

https://doi.org/10.37762/jgmds.13-2.796

To investigate the prevalence and patterns of aero -allergen sensitization in

patients assessed for allergic respiratory diseases, referred to a tertiary care

center in Peshawar, Pakistan, including patients from neighbouring

Afghanistan.

METHODOLOGY

This retrospective observational study reviewed the results of 452 skin prick

tests (SPTs) performed as part of routine assessment between January 2017

and December 2022 at the Rehman Medical Institute. The sensitization

response to 13 types of inhalant allergens (both seasonal and perennial) was

documented. Using a multivariate logistic regression model, associations

with age, gender, and region of origin were investigated, reporting the

adjusted odds ratio(OR) and 95% condence interval (CI).

RESULTS

Date of Submission: 02-10-2025

Date Revised:

10-03-2026

Date Acceptance: 15-03-2026

Four hundred and fty-two (452) patients were studied; 362 (80.1%) had at

least one positive skin prick test result and were therefore included in the

analysis. HDM was the most common allergen identied (62.7%), followed

by mouse (40.9%) and cockroach (40.3%). Mulberry (17.1%), silver birch

(16.0%), and grass mix (13.5%) were the leading seasonal allergens.

Polysensitisation was demonstrated in 66.6% of the patients studied.

Multivariate logistic regression analyses showed that age was inversely

related to sensitization to weeds (OR=0.97, CI 0.94-0.99, p=0.03), mixed

feather (OR=0.97, CI 0.95-1.00, p=0.04), and cockroach allergens

(OR=0.98, CI 0.97-0.99, p=0.038). No other associations with demographic

or regional factors reached statistical signicance.

²Assistant Professor, Department of

Medicine, Rehman Medical Institute,

Peshawar

³Medical Officer, Department of

Pulmonology, Rehman Medical

Institute, Peshawar

⁴Trainee Medical Ofcer, Department of

Pulmonology, Rehman Medical

Institute, Peshawar

Correspondence

¹Saima Alam, Associate Professor,

Department of Pulmonology, Rehman

Medical Institute, Peshawar

CONCLUSION

HDM is the major allergen causing sensitization among patients with allergic

respiratory disease in this clinical group, and has a high level of

Polysensitisation. The observed dierences in association with gender and

age highlight the need for region-specic diagnostic panels and caution when

interpreting statistically borderline associations.

+92-336-9616105

saima.alam@rmi.edu.pk

KEYWORDS: Allergic Respiratory Diseases, Aeroallergen Sensitization,

House Dust Mite, Skin Prick Test, Peshawar, Pakistan, Afghanistan,

Polysensitization

also highly prevalent in urban environments, due to

high exposure levels resulting from overcrowding and

INTRODUCTION

poor living conditions.^2,4,8In addition to HDM and

cockroach allergens, other aeroallergens of signicance

in Pakistan include pollen from grasses and weeds

(including Parthenium hysterophorus, Chenopodium

album, and Prosopis juliora), animal dander and

mould spores (Alternaria, Aspergillus).^{6,9,10,11,12,13}

Geographic variations in allergen sensitivity exist,

primarily due to dierences in climate, plant species,

and occupational exposure.^6,9,10Early and progressive

The increasing prevalence of allergic respiratory

diseases, especially allergic rhinitis and asthma,

represents a growing public health issue in South and

Southeast Asia. Rise in urbanization, environmental

pollution, climate change, and lifestyle changes are the

major

contributors to the increase

these

disorders.^1,2,3,4,5,6HDM is the most common allergen

responsible for sensitization, with rates reported at 50-

85%

among

allergic

individuals

Pakistan,

Bangladesh, and Iran.^7,8,9,10Cockroach allergens are Polysensitisation to HDM and cockroach allergens is

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Aeroallergen Sensitization Patterns in Patients with Allergic

common in pediatric populations and is associated with or documented lung function variability, was used to

more severe allergic phenotypes.^14,15Regardless of the support the diagnosis. Patients with atopic dermatitis

without concurrent respiratory allergic disease were

excluded. All patients were advised to discontinue

systemic antihistamines for at least seven days before

testing to reduce the likelihood of false-negative results.

Skin prick testing was done using standardized allergen

extracts from Stallergenes Greer (USA). These extracts

considerable burden of allergic respiratory diseases

across South and South East Asia, cross-border

epidemiological studies of allergens remain poorly

characterized, particularly for Afghanistan. Therefore,

the primary aim of this study was to identify patterns of

aeroallergen sensitization among patients assessed for

allergic respiratory diseases at a tertiary care center in

Peshawar, Pakistan, including those from neighbouring

Afghanistan, using standardized skin prick testing and

following ARIA guidelines for allergic rhinitis

diagnosis and GINA guidelines for asthma diagnosis.

Additionally, the study investigated demographic

associations, the proportion of patients demonstrating

monosensitization vs polysensitization, and seasonal vs

perennial allergen patterns to provide a regional

benchmark for clinical allergy practice.

are

produced

under

controlled

manufacturing

conditions with standardized allergenic protein

concentrations (typically 1:20 w/v or the highest

available

commercial

concentration),

ensuring

consistency and reproducibility. The SPTs were done

on the volar aspect of the forearm with a sterile single-

use lancet (30 gauge, Golden+, Batla Impex). Each SPT

included both a positive (histamine) and a negative

(saline) control to conrm skin responsiveness to the

testing extract and to rule out non-specic reactions.

The diameter of the wheal was determined 15-20

minutes later. A wheal diameter of ≥ 3mm, greater than

that of the negative control, indicated a positive

reaction. To ensure uniformity of procedure, all SPTs

were performed by trained personnel using a standard

protocol, and the reliability of the SPTs was conrmed

by repeating the testing in a random sample of patients.

The allergen panel included 13 inhalant aeroallergens,

categorized as seasonal and perennial. Seasonal

allergens included: a mixture of grass pollen, a mixture

of weed pollen, alder pollen, hazel pollen, white birch

METHODOLOGY

This is a retrospective observational study examining

skin prick test (SPT) results from 452 patients who

underwent SPTs to determine their allergen sensitivities

to environmental allergens for allergic respiratory

diseases between January 2017 and December 2022.

Data was collected from records at Rehman Medical

Institute (RMI) in Peshawar, Pakistan, where the skin

prick tests were conducted. Approval was granted by

the Institutional Review Board of Rehman Medical pollen, and mulberry pollen. Perennial allergens

included: house dust mites, cockroaches, rodent

epithelium, cat dander, dog epithelial cells, Aspergillus

fumigatus, and Alternaria. This panel of allergens was

chosen based on previously published studies of

allergen distribution in the region and the ready

availability of commercial extracts of these allergens.

Some common allergens found in Pakistan (Parthenium

hysterophorus, Chenopodium album, Prosopis juliora)

were not included in this panel because commercial

extracts of these allergens were unavailable during the

study. The study sample included all patients who

underwent SPT during the study period following an

outpatient department consultation. All patients who

met the inclusion criteria were enrolled using a

nonprobability, consecutive sampling technique. The

sample size of 452 patients provided adequate numbers

to estimate the prevalence of sensitization to specic

allergens with reasonable accuracy and to evaluate

associations with demographic characteristics. Data

were analyzed using IBM SPSS Statistics version 25.0

(Armonk, NY, USA).

Institute, Peshawar (Approval No. RCD-005-25-216).

Because this study involved a review of anonymized

clinical data, the need for individual informed consent

was waived. Patient demographics and clinical

information were obtained retrospectively from the

hospital's electronic medical record system and allergy

clinic registers using a standard data collection form.

Variables recorded included age, gender, location,

clinical diagnosis, and SPT results for each aeroallergen

tested. Before statistical analysis, all data were

anonymized to protect patient privacy. Patients were

included if they had a physician-conrmed diagnosis of

allergic rhinitis, asthma, or both. Allergic rhinitis was

diagnosed in accordance with the Allergic Rhinitis and

its Impact on Asthma (ARIA) guidelines, based on

characteristic symptoms such as nasal congestion,

rhinorrhea,

sneezing,

and

nasal

itching,

with

identifiable environmental triggers. Asthma was

diagnosed in accordance with the Global Initiative for

Asthma (GINA) guidelines, which include a history of

variable respiratory symptoms such as wheeze,

shortness of breath, chest tightness, and cough that vary

over time and intensity. The availability of objective

evidence of expiratory airow limitation, including

RESULTS

spirometry demonstrating reversible airow obstruction Of the 452 patients who underwent SPT, 362 (80.1%)

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Aeroallergen Sensitization Patterns in Patients with Allergic

were found to be sensitive to at least one allergen.

Ninety patients were excluded from the study because

their SPTs failed to detect any sensitivity to the tested

allergens. The patients were divided into four age

categories: 0-20, 21-40, 41-60, and >60 years, and into

five geographically distinct regional areas: Region 1-

Peshawar, Jamrud, Khyber Agency; Region 2- Kohat,

Bannu, Hangu, Lakki Marwat, Karak, Dera Ismail

Khan, Darra Adam Khel, Orakzai Agency; Region 3-

Charsadda, Mardan, Nowshehra; Region 4 - Swabi,

Attock, Swat, Dir, Malakand, Abbottabad; and Region

5 - Afghanistan. Among the 362 patients with positive

SPT results, 206 were male (57%), and 156 were

female (43%). The average age of the patients studied

was 29.8±13.1 years. When divided into age categories,

the largest number of patients were in the 21-40 year

category (n=193, 53.3%), followed by those 0-20 years

old (n=102, 28.2%), 41-60 years old (n=59, 16.3%),

and those >60 years old (n=8, 2.2%).

Figure 3: Prevalence of Sensitization to Tested Aeroallergens

Among 362 Patients with Positive Allergen Test Results.

Note: Horizontal bars represent the percentage of

patients sensitized to each allergen, including both

seasonal and perennial allergens.

Table 1: Prevalence of Selected Perennial Allergens and Their

Associations with Demographic Factors Among Patients Testing

Positive for at least one Allergen (n = 362).

Aller-

gens

Aller- Association

gen with age

Freque Chi P-

ncy square Value

Association

with Gender with Region

Association

Chi

P-

Chi

P-

square

Value square Value

House

62.70% 1.403 0.705 1.633 0.201 1.838 0.765

Dustmite

Mouse 40.90% 4.357 0.225 3.963 0.047 1.158 0.885

epithelia

Cat

13.30% 5.507 0.138 1.076 0.3

2.966 0.563

epithelia

Dog

epithelia

Mixed

feathers

6.60% 2.041 0.564 0.999 0.318 1.672 0.796

8.00% 2.05

0.562 3.092 0.079 0.612 0.962

Asper- 1.90% 6.005 0.111 0.575 0.448 2.342 0.673

gillus

Alter-

naria

Cock-

roach

Figure 1: Chi-Square Associations of Aeroallergen Sensitization

(n = 362 Patients with Positive Allergen Test Results) with

Demographic Factors.

8.30% 1.307 0.727 1.399 0.237 2.603 0.626

Note: Blue bars represent associations with gender,

orange bars represent associations with age groups, and

green bars represent associations with region.

40.30% 5.202 0.158 2.24 0.135 2.49 0.646

Table 2: Prevalence of Selected Seasonal Allergens and their

Associations with Demographic Factors among Patients Testing

Positive for at least One Allergen (n = 362)

Aller-

gens

Aller Association

-gen with Gender

Frequ Chi

P-

Association Association

with age with the region

Chi P- Chi P-

Type

ency square Value square Value square Value

Grass

pollen

mix

13.80 1.88

0.59

0.001

0.97 7.16

0.12

Weed

mix

6.90% 6.47

0.91

2.495

1.484

0.11 4.51

0.34

0.94

7.70% 1.51

Alder

tree

0.67

0.22 0.73

pollen

Hazel

tree

Figure 2: Chi-Square Associations of Aeroallergen Sensitization

with Demographic Factors Among 362 Patients with Positive

Allergen Test Results.

6.10% 3.29

0.34

2.391

0.751

0.586

0.12 5.37

0.25

Pollen

Silver

birch

Pollen

16.00 0.28

0.96

0.38 1.863 0.76

Note: Blue bars indicate associations with gender,

orange bars indicate associations with age groups, and

green bars indicate associations with region.

Mulberr 17.10 4.23

y Pollen

0.24

0.44 1.64

0.8

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Aeroallergen Sensitization Patterns in Patients with Allergic

Table 3: Logistic Regression Analysis of Demographic Factors

regression analysis identied that increasing age was

inversely associated with sensitization to weeds, mixed

feathers, and cockroach allergens, indicating age-

related variations in immune responsiveness or

exposure. No other signicant demographic or regional

associations were seen. The allergen panel included 13

inhalant allergens, chosen based on their availability as

commercially standardized extracts and clinical

relevance. Regionally important allergens (e.g.,

Parthenium, Chenopodium, Prosopis Pollen) were not

included due to a lack of commercially available

standardized extracts at the time of testing. Although

this may have underestimated the prevalence of

sensitization to these weeds, the allergen panel provides

a reliable representation of the most commonly used

diagnostic allergens in clinical practice during the study

period.

Associated with Allergen Sensitization among Patients Testing

Positive for at least One Allergen (n = 362)

Allergen

Age OR

P-Value Gender OR P-Value

(95% CI)

0.995

(<0.05) (95% CI)

(<0.05)

Grass Pollen

mix

Weed mix

0.677

0.033

0.807

0.366

0.663

0.454

0.352

0.140

0.319

0.694

0.049

0.157

0.422

0.038

0.998

0.995

(0.973-1.018)

0.970

(0.542-1.837)

0.516

0.153

0.222

0.145

0.405

0.477

0.226

0.060

0.270

0.335

0.107

0.406

0.219

0.177

(0.943-0.998)

1.004

(0.209-1.277)

0.598

Alder tree

pollen

Hazel tree

pollen

(0.974-1.034)

0.986

(0.263-1.364)

0.488

(0.955-1.017)

0.995

(0.186-1.280)

0.782

Silver birch

Pollen

(0.974-1.017)

0.992

(0.439-1.394)

0.816

Mulberry

Pollen

(0.972-1.013)

0.992

(0.465-1.430)

0.767

House Dust

Mite

(0.976-1.009)

1.013

(0.498-1.179)

1.505

Mouse

epithelia

Cat

(0.996-1.029)

0.989

(0.984-2.304)

1.411

epithelia

Dog

(0.967-1.011)

0.994

(0.766-2.600)

0.649

LIMITATIONS

epithelia

Mixed

(0.964-1.025)

0.974

(0.270-1.562)

0.498

As a single-center retrospective evaluation, selection

and referral bias may inuence generalizability.

Molecular data and longitudinal follow-up were not

available. Therefore, our understanding of the

mechanisms behind some of the results observed in the

current cohort of patients is limited. Cross-sectional

design and a limited allergen panel also limit the

assessment of all regionally relevant exposures.

However, the inclusion of patients from multiple

geographic clusters (including Afghanistan) enhances

the representativeness of the study. Future multicenter

feather

(0.948-1.000)

0.966

(0.213-1.163)

1.904

Aspergillus

(0.922-1.013)

0.989

(0.417-8.697)

1.603

Alternaria

Cockroach

(0.962-1.016)

0.983

(0.755-3.403)

0.743

(0.967-0.999)

(0.483-1.143)

Note: Odds ratios (ORs) and 95% condence intervals

(CIs) are presented by age group and gender to indicate

the strength and signicance of the associations.

studies

using

component-resolved

diagnostics,

DISCUSSION

environmental allergen monitoring, and longitudinal

follow-up are needed to clarify regional sensitization

This retrospective evaluation is one of the largest

assessments of aeroallergen sensitization among

patients with Allergic Respiratory Diseases within a

single center in Peshawar, Pakistan, including patients

from surrounding Afghanistan. The current evaluation

confirms the dominance of perennial indoor allergens

(i.e., HDM, Cockroach, and mouse) and identies

seasonal allergens (i.e., Grass, Mulberry, and silver

birch pollen). The prevalence of HDM sensitisation

(62.7%) is consistent with previous studies from

Pakistan (50-70%), India (55 - 75%), Bangladesh (67 -

74%), and Iran (up to 85%).^{7,8,9,10,16,17,18}In addition,

cockroach and mouse allergens were identied as

signicant sensitizers, reecting indoor exposures

common in densely populated urban and peri-urban

environments. The most common seasonal allergens in

our cohort, i.e., mulberry (17.1%), silver Birch (16.0%),

and grass mix (13.5%), were consistent with studies

patterns and support personalized

strategies.

management

CONCLUSIONS

HDM remains the dominant allergen causing sensitivity

among patients with allergic respiratory diseases within

this cohort. High rates of poly-sensitization and

demographic trends highlight the need for region-

specific diagnostic panels and careful interpretation of

results. The increased sensitivity to weed pollen, mixed

feathers, and cockroach in older patients may be

explained by age-related immunosenescence and

immune imbalance, making older individuals more

prone to allergic inammation. These ndings provide

foundation for improved allergy diagnostics,

avoidance strategies, and future multicenter research in

Pakistan and neighboring regions.

from

northern

Pakistan.¹⁸

our

cohort,

polysensitization was observed in 66.6% of patients.

The frequency of polysensitization increased with age,

CONFLICT OF INTEREST: None

reecting cumulative exposure to allergens. Logistic FUNDING SOURCES: None

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Aeroallergen Sensitization Patterns in Patients with Allergic

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