Allergy

Allergic rhinitis: burden of illness, quality of life, comorbidities and control

Meltzer EO. Immunol Allergy Clin North Am 2016; 36(2): 235–248

Allergic rhinitis is burdensome, highly prevalent and impairs quality of life

Allergic rhinitis (AR) is a common condition that can result in impaired quality of life.1 In a recent review article published in the journal Immunology and Allergy Clinics of North America, Eli Meltzer describes the burden of this highly prevalent disease, and how control of the disease can be measured. 1

The impact of AR

AR is costly and highly prevalent. 1

Each year, up to 60 million people in the US are affected by AR.1 Boys are more frequently affected by AR during childhood, whereas more women are affected as adults. 1

The morbidity of nasal symptoms contributes to the burden of the disease.1 AR has four main symptoms: nasal congestion, rhinorrhea, sneezing and nasal itch.1 Generally, nasal congestion is considered the most prevalent and bothersome of these in both adults and children with AR. 1

Meltzer noted that nasal allergies also have a substantial impact on multiple domains of quality of life, and on patient-perceived health status. 1

Patients with nasal allergies rate their overall health significantly lower than people without nasal allergies. 1

Meltzer highlighted a survey of the burden of AR in the US, Latin America and Asia-Pacific, in which 35–50% of people with AR reported that their nasal allergies had at least a moderate effect on daily life. 2

Negative effects on patients’ quality of life by AR can include: 1

• Impaired physical and social functioning
  
• Disturbed sleep
  
• Daytime somnolesence
  
• Irritability
  
• Depression
  
• Deficits in attention, memory and learning.

As well as its impact on quality of life, Meltzer discussed several comorbidities which can be associated with AR, including: 1

• Headaches
  
• Allergic conjunctivitis
  
• Otitis media
  
• Rhinosinusitis
  
• Cough sensitivity
  
• Asthma
  
• Gastroesophageal reflux
  
• Sexual dysfunction
  
• Skin rashes
  
• Sleep disturbances.

Assessing control of AR

A considerable economic and clinical burden is still associated with AR, despite the availability of effective therapies. 1

The author highlighted that many clinicians have not implemented or adhered to guidelines and recommendations, and consequently, poor disease control is common. 1For improvement strategies of AR management, accurate assessment of disease control is crucial. 1

The control of symptoms can be measured using the Total Nasal Symptom Score, based on patient-reported symptoms, whilst nasal peak flow meters or rhinomanometry can be used to directly measure nasal airflow. 1In addition, the Rhinoconjunctivitis Quality of Life Questionnaire can be used to assess the impact of AR on social, physical, mental and emotional domains of quality of life. 1Other measures which estimate the effects of AR on sleep disturbance, performance at school and work, functioning and emotional issues are also available. 1

Overall, the goal of AR therapy is the long-term control of symptoms. 1

Report on: Allergic rhinitis: burden of illness, quality of life, comorbidities, and control. Meltzer EO. Immunol Allergy Clin North Am 2016; 36(2): 235–248.

Reference list

1. Meltzer EO. Allergic rhinitis: burden of illness, quality of life, comorbidities, and control. Immunol Allergy Clin North Am 2016; 36(2): 235–248.
   
2. Meltzer EO, Blaiss MS, Naclerio RM, Stoloff SW, Derebery MJ, Nelson HS, et al. Burden of allergic rhinitis: allergies in America, Latin America, and Asia-Pacific adult surveys. Allergy Asthma Proc 2012; 33(Suppl 1): S113–S141.