Severity of Allergic Rhinitis

The severity and duration of symptoms of AR varies in different patients. The classification of AR into mild and moderate/ severe is useful for therapeutic purposes. Severe persistent rhinitis sufferers are those patients whose symptoms are inadequately controlled despite adequate (i.e., effective, safe, and acceptable) pharmacologic treatment based on guidelines. 

Bousquet et al have reported that current treatment and allergy diagnosis have no effect on the patient’s assessment of rhinitis severity and that the severity, rather than the duration, had a greater impact on Visual Analogue Scale levels. Therefore, we should consider control of the disease as the main target of management. It is likely that a large proportion of this group of patients may benefit from allergen specific immunotherapy

The Burden of Allergic Rhinitis

AR has a significant socio-economic impact on the patient, the patient’s family and society. It affects multiple parameters including quality of life, physical, psychological and social functioning and has financial consequences.

Physical Symptoms: Allergies in America, a survey conducted by telephone involving 2,500 adults with AR, showed that the most common symptoms are congestion, rhinorrhea, nasal and ocular itching, tearing, sneezing, headache, facial and ear pain

Psychological effects: Fatigue, irritability, anxiety, depression, frustration, self-consciousness and lower energy, motivation, alertness, and ability to concentrate, are commonly present in patients with AR 

Decreased quality of life: Investigators have used health status questionnaires to assess the quality of life of patients with asthma or rhinitis. While physical functioning was slightly higher in patients with AR compared with patients with asthma, social functioning was lower in the AR group.

Sleep disturbances: Nasal congestion is often associated with sleep-disordered breathing. Up to 57% of adult patients and up to 88% of children with AR have sleep problems, including micro-arousals, leading to daytime fatigue and somnolence, and decreased cognitive functioning. These are accompanied by disorders of learning performance, behaviour and attention in children.

Interference with social interaction: Social isolation, activity limitations, limited visits to friends and family, and an inability to visit open spaces such as parks and closed spaces (restaurants, cinemas), are frequent consequences of AR. Patients are forced to carry handkerchiefs or tissues, and need to rub and blow the nose repeatedly

Use of medications: On average, patients with AR usually use two or more medicines to treat their AR. Self-medication with over the counter sedating antihistamines results in drowsiness and further impairment of cognitive and motor functions.

Financial burden: It has been demonstrated that patients with AR support two-fold increases in medication costs and 1.8 times the number of visits to health practitioners when compared with matched controls. Expenses for AR include direct and indirect costs 

In the United States of America, direct costs for AR increased from $ 2.7 billion in 1995 to $7.3 billion in 2002. Indirect costs in 2002 were estimated at $4.28 billion, with a total amount of $11.58 billion for that year. Additionally 3.5 million lost work days and 2 million lost school-days occur annually. On any given day, about ten thousand children are absent from school in the USA because of AR.