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.
