Allergic rhinitis substantially impacts patient quality of life: Findings from the Nasal Allergy Survey Assessing Limitations

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Medical Education Library

Allergic rhinitis substantially impacts patient quality of life: Findings from the Nasal Allergy Survey Assessing Limitations

February 2012 · Vol. 61, No. 02 Suppl: S5-S10

By

Eli O. Meltzer, MD

Gary N. Gross, MD

Rohit Katial, MD

William W. Storms, MD

References

1. Asthma and Allergy Foundation of America. Allergy facts and figures. http://www.aafa.org/display.cfm?id=9&sub=30. Accessed December 2011.

2. National Academy on an Aging Society. Chronic conditions: a challenge for the 21st century. http://www.agingsociety.org/agingsociety/pdf/chronic.pdf. Published November 1999. Accessed December 2011.

3. Settipane RA. Complications of allergic rhinitis. Allergy Asthma Proc. 1999;20(4):209-213.

4. Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet. 2012;378(9809):2112-2122.

5. Leynaert B, Neukirch C, Liard R, Bousquet J, Neukirch F. Quality of life in allergic rhinitis and asthma. A population-based study of young adults. Am J Respir Crit Care Med. 2000;162(4 pt 1):1391-1396.

6. Hadley JA, Derebery J, Marple BF. Comorbidities and allergic rhinitis: not just a runny nose. J Fam Pract. 2012;61(suppl 1):S11-S15.

7. Malone DC, Lawson KA, Smith DH, Arrighi HM, Battista C. A cost of illness study of allergic rhinitis in the United States. J Allergy Clin Immunol. 1997;99(1 pt 1):22-27.

8. Kay GG. The effects of antihistamines on cognition and performance. J Allergy Clin Immunol. 2000;105(6 pt 2):S622-S627.

9. Schoenwetter WF, Dupclay L, Jr, Appajosyula S, Botteman MF, Pashos CL. Economic impact and quality-of-life burden of allergic rhinitis. Curr Med Res Opin. 2004;20(3):305-317.

10. Storms W, Yawn B, Fromer L. Therapeutic options for reducing sleep impairment in allergic rhinitis, rhinosinusitis, and nasal polyposis. Curr Med Res Opin. 2007;23(9):2135-2146.

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13. Brozek JL, Bousquet J, Baena-Cagnani CE. et al; Global Allergy and Asthma European Network; Grading of Recommendations Assessment, Development and Evaluation Working Group. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466-476.

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18. Craig TJ, Mende C, Hughes K, Kakumanu S, Lehman EB, Chinchilli V. The effect of topical nasal fluticasone on objective sleep testing and the symptoms of rhinitis, sleep, and daytime somnolence in perennial allergic rhinitis. Allergy Asthma Proc. 2003;24(1):53-58.

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Table of Contents

Introduction

Allergic rhinitis substantially impacts patient quality of life: Findings from the Nasal Allergy Survey Assessing Limitations

Comorbidities and allergic rhinitis: Not just a runny nose

Insights on allergic rhinitis from the patient perspective

Closing thoughts: Implications of the findings from the National Allergy Survey Assessing Limitations for the management of allergic rhinitis in America

Appendix

TAKE-HOME POINTS

People with allergic rhinitis (AR) rate their overall health significantly lower than individuals without nasal allergies.
Compared with the general population, more people with AR complain of difficulty getting to sleep, waking up during the night, lack of a good night’s sleep, or a combination of these, as a result of their nasal symptoms.
More than half of individuals with AR describe their symptoms as impacting daily life a lot or to a moderate degree.
More adults with AR report that their health limits them from doing well at work compared with adults without nasal allergies, and their estimated productivity drops by an average of 20% on days when their nasal symptoms are at their worst.

Introduction

Allergic rhinitis (AR) is a common chronic medical condition, affecting at least 40 million people in the United States (US).¹ The overall prevalence of AR has been increasing since the early 1980s across all age, sex, and racial groups and is one of the most common chronic diseases among all age groups in the US.² AR can often be a debilitating condition, which, if untreated, can result in considerable health-related and economic consequences. For example, numerous studies have demonstrated that poorly controlled symptoms of AR contribute to decreased health-related quality of life (HRQoL), reduced sleep quality, daytime fatigue, impaired learning, impaired cognitive functioning, and decreased long-term productivity.^3,4 One study evaluating the impact of AR and asthma on HRQoL found that people with AR were more likely to report problems with social activities, difficulties with daily activities, and decreased feelings of mental well-being than people without AR.⁵ Moreover, as discussed by Hadley et al⁶ later in this supplement, the presence of AR is directly linked to exacerbations of other inflammatory airway diseases, such as asthma, chronic otitis media, and rhinosinusitis and thus has additional important health implications.

Despite the fact that the symptoms of nasal congestion, sneezing, rhinorrhea, and nasal itch can be very troublesome to the patient, many people with AR do not to seek medical advice regarding treatment, choosing instead to self-treat with home remedies and over-the-counter medications.⁷ This may be because AR is perceived by both patients and the health care community as less important than other airway diseases such as asthma. However, nasal allergies are responsible for substantially more disability than is generally realized, and it has been estimated that AR results in significant absenteeism with 3.5 million lost workdays and 2 million missed school days each year.⁸ When other factors related to presenteeism (ie, performance deficits) are included, this rises to an estimated 28 million days of restricted activity or reduced productivity because of AR annually in the US.⁹ Thus, it is evident that the general population lacks an understanding of the symptom burden of AR, its associated risks for other respiratory complications, and its ability to compromise all aspects of an individual’s QoL.

The Nasal Allergy Survey Assessing Limitations (NASAL; www.nasalsurvey.com), a study sponsored by Teva Respiratory, LLC, was the first national survey to measure the burden of disease of AR in the US by comparing the health status of adults with current hay fever, AR, or nasal allergies (N = 400) with a national sample of adults without nasal allergies (N = 522). The objective of this aspect of the survey was to examine the impact of AR on patient-perceived health status, daily activities, and emotional status. Full details of the survey methods are provided elsewhere in this supplement.

Results of the Nasal Allergy survey Assessing limitations

Impact of Nasal Allergies on Patient-Perceived Health Status

Although the majority of people with AR reported a good overall health status (excellent 11%; very good 29%; good 34%), when compared with adults without nasal allergies it became clear that AR patients rated their overall health significantly lower. Nearly twice as many adults without nasal allergies rated their health as excellent (23%), compared with AR patients (11%), and at the other extreme, nearly twice as many AR patients rated their health as only fair/poor/ very poor (27%) compared with adults without nasal allergies (15%) (FIGURE 1).

FIGURE 1

Respondent-rated general health status: Nasal allergy vs nonallergy*

All respondents were asked: In general, would you say that your health is excellent, very good, good, fair, poor, or very poor?