Insights on allergic rhinitis from the patient perspective

Introduction

Allergic rhinitis (AR) is a growing challenge for primary care because most AR patients consult primary health care providers (HCPs) who generally make the diagnosis, initiate treatment, give the relevant information, and monitor the condition.1 It is already a very common disease, affecting up to 40% of the population in young adults, and its prevalence is ever increasing.2,3 The effective management of AR involves allergen avoidance, pharmacotherapy, immunotherapy, or a combination of these methods.4 Options for pharmacotherapy include intranasal corticosteroids, oral and intranasal antihistamines, intranasal chromones, oral and intranasal decongestants, oral and intranasal anticholinergic agents, and antileukotrienes. Of these choices, the Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines state, "intranasal glucocorticosteroids are recommended for the treatment of allergic rhinitis in adults and children. They are the most effective drugs for the treatment of allergic rhinitis."4 Although effective treatments have been available for many years, numerous studies show that the care offered to patients is often suboptimal, with significant problems of patient nonadherence to medication.5 Considering that AR is usually a long-term condition and that patient adherence to prophylactic therapy directly impacts long-term symptom control, it is vital that all efforts are made to improve medication adherence.

Medication nonadherence is a complex issue with many contributing factors.6 Reasons for nonadherence in patients with chronic illnesses include patient self-efficacy, social support, disease knowledge, costs, and side effects. In addition, it has been shown that physicians contribute to patients' poor adherence by prescribing complex regimens, failing to explain the benefits and side effects of a medication adequately, not giving consideration to the patient's lifestyle or the cost of the medications, and having poor therapeutic relationships with their patients.6 In many areas of medicine, there is often a significant mismatch between the way a patient and physician view the illness in question.7-10 It is therefore important that physicians treating AR understand the patient perspective and take this into account when planning long-term management of the patient's symptoms. The objective of this part of the National Allergy Survey Assessing Limitations (NASAL; www.nasalsurvey.com), a study sponsored by Teva Respiratory, LLC, was to examine patients' perspectives (N = 400) on their experiences with AR and its management, focusing in particular on the attributes of nasal allergy medications that contribute to patient satisfaction with therapy. To promote a better understanding of how the patient perspective matches the HCP perspective, data from the HCP survey (N = 250) are also included. The sample of HCPs included a national sample of 200 physicians in direct patient care in outpatient settings in the United States, including 100 in adult primary care specialties (family medicine and internal medicine), 100 specialists (allergy and otolaryngology), and 50 nurse practitioners (NPs) and physician assistants (PAs). Full details of the survey methodology have been provided elsewhere in this supplement.

Results of the National Allergy Survey Assessing Limitations

Allergy Triggers

Nasal allergy symptoms may be triggered by allergens, and different allergens may affect individuals in different ways. Hence, the first question asked of this national sample of adult nasal allergy sufferers was what things usually trigger or make their nasal allergy symptoms worse. Adults with nasal allergies most commonly volunteered pollen (63%) as the usual trigger or thing that worsens their symptoms; other common triggers were dust (34%); grass (32%); changes in weather (20%); animals (18%); mold (10%); perfume (7%); fumes or odors (6%); chemicals (6%); and tobacco smoke (4%) (FIGURE 1A). The survey further showed that these triggers often have a large effect on the severity of nasal allergy symptoms. More than half of adults with nasal allergies (54%) reported that these triggers made their allergy symptoms a lot worse, 32% reported that these triggers made their allergy symptoms moderately worse, and just 13% reported that the triggers made their symptoms only a little worse or not worse at all (FIGURE 1B).