The burden of allergic rhinitis (AR) in Canada: perspectives of physicians and patients
Allergic rhinitis (AR) is a common problem and we sought to examine the burden of disease and its management in Canada from the perspectives of patients and physicians.
Two parallel, Canadawide structured telephone interviews surveyed 1,001 AR patients and 160 physicians in July 2006.
44% of patients had experienced nasal symptoms unrelated to a cold and 20% had a physician diagnosis of AR. At screening 27% reported asthma, 15% chronic or recurrent sinusitis and 5% nasal polyps. With attacks nasal congestion and runny nose were the most bothersome symptoms. Other problems experienced were fatigue (46%), poor concentration (32%), and reduced productivity (23%). Most (77%) had not seen a physician in the past year. Physicians estimated they prescribed intranasal cortico steroids (INCS) to most AR patients (77%) consistent with guidelines but only 19% of patients had used one in the last month. Only 48% of patients were very satisfied with their current INCS. 41% of AR patients reported discontinuing their INCS with the most common reason being a perceived lack of long-lasting symptom relief (44%). 52% of patients felt that their current INCS lost effectiveness over 24 h. The most common INCS side effects included dripping down the throat, bad taste, and dryness. Most AR patients reported lifestyle limitations despite treatment (66%). 61% of patients felt that their symptoms were only somewhat controlled or poorly/not controlled during their worst month in the past year.
AR symptoms are common and many patients experience inadequate control. Physicians report they commonly prescribe intranasal corticosteroids, but patient’s perceived loss of efficacy and side effects lead to their discontinuation. Persistent relief of allergic rhinitis symptoms remains a major unmet need. Better treatments and education are required.
- Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al.: Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008,63(Suppl 86):8–160. CrossRef
- Pawankar R: Inflammatory mechanisms in allergic rhinitis. Curr Opin Allergy Clin Immunol 2007, 7:1–4. CrossRef
- Canadian Allergy, Asthma and Immunology Foundation [homepage on the internet]: Allergies and Asthma brochure. 2007. [cited 2007 Jul 18]; Available from: [http://www.allergyfoundation.ca/asthma_allergies_brochure.pdf]
- Beggs PJ: Impacts of climate change on aeroallergens: past and future. Clin Exp Allergy 2004, 34:1507–1513. CrossRef
- Rogers CA, Wayne PM, Macklin EA, Muilenberg ML, Wagner CJ, Epstein PR, et al.: Interaction of the onset of spring and elevated atmospheric CO2 on ragweed (Ambrosia artemisiifolia L.) pollen production. Environ Health Perspect 2006, 114:865–869. CrossRef
- Bahls C: In the clinic. Allergic rhinitis. Ann Intern Med 2007,146(ITC4):1–13.
- Price D, Bond C, Bouchard J, Costa R, Keenan J, Levy ML, et al.: International Primary Care Respiratory Group (IPCRG) Guidelines: management of allergic rhinitis. Prim Care Respir J 2006, 15:58–70. CrossRef
- Dykewicz MS, Fineman S: Executive Summary of Joint Task Force Practice Parameters on Diagnosis and Management of Rhinitis. Ann Allergy Asthma Immunol 1998, 81:463–468. CrossRef
- Weiner JM, Abramson MJ, Puy RM: Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ 1998, 317:1624–1629. CrossRef
- Agency for Healthcare Research and Quality [homepage on the internet]: Management of allergic and nonallergic rhinitis. Available from: http://www.aafa.org/display.cfm?id=7&sub=92&cont=529
- Asthma and Allergy Foundation of America [homepage on the internet]: New survey reveals patients may want more from their allergy medication. Available from: http://www.aafa.org/display.cfm?id=7&sub=92&cont=529
- Marple BF, Fornadley JA, Patel AA, Fineman SM, Fromer L, Krouse JH, et al.: Keys to successful management of patients with allergic rhinitis: focus on patient confidence, compliance, and satisfaction. Otolaryngol Head Neck Surg 2007,136(Suppl 6):S107-S124. CrossRef
- Nathan RA: The burden of allergic rhinitis. Allergy Asthma Proc 2007, 28:3–9. CrossRef
- Data on file. HealthSTAR Communications. Allergies in America: A Landmark Survey of Nasal Allergy Sufferers. Executive Summary. Altana Pharma US, Inc, Florham Park; 2006.
- Bousquet J, Van CP, Khaltaev N: Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001,108(Suppl 5):S147-S334. CrossRef
- Leith E, Bowen T, Butchey J, Fischer D, Kim H, Moote B, et al.: Consensus guidelines on practical issues of immunotherapy–Canadian Society of Allergy and Clinical Immunology. Allergy Asthma Clin Immunol 2006, 2:47–61.
- Keith PK, Luciuk G: Effectiveness of desloratadine 5 mg once daily in patients with symptoms of seasonal allergic rhinitis: results of a Canadian multicenter, open-label trial. Clin Ther 2007, 29:419–426. CrossRef
- Kremer B, Den Hartog HM, Jolles J: Relationship between allergic rhinitis, disturbed cognitive functions and psychological well-being. Clin Exp Allergy 2002, 32:1310–1315. CrossRef
- Leger D, nnesi-Maesano I, Carat F, Rugina M, Chanal I, Pribil C, et al.: Allergic rhinitis and its consequences on quality of sleep: An unexplored area. Arch Intern Med 2006, 166:1744–1748. CrossRef
- Szeinbach SL, Seoane-Vazquez EC, Beyer A, Williams PB: The impact of allergic rhinitis on work productivity. Prim Care Respir J 2007, 16:98–105. CrossRef
- Meltzer EO: Quality of life in adults and children with allergic rhinitis. J Allergy Clin Immunol 2001,108(Suppl 1):S45-S53. CrossRef
- Meltzer EO, Kunjibettu S, Hall N, Wingertzahn MA, Murcia C, Berger W, et al.: Efficacy and safety of ciclesonide, 200 microg once daily, for the treatment of perennial allergic rhinitis. Ann Allergy Asthma Immunol 2007, 98:175–181. CrossRef
- Bachert C, Vignola AM, Gevaert P, Leynaert B, van CP, Bousquet J: Allergic rhinitis, rhinosinusitis, and asthma: one airway disease. Immunol Allergy Clin North Am 2004, 24:19–43. CrossRef
- Canova CR, Downs SH, Knoblauch A, Andersson M, Tamm M, Leuppi JD: Increased prevalence of perennial allergic rhinitis in patients with obstructive sleep apnea. Respiration 2004, 71:138–143. CrossRef
- Corren J: The connection between allergic rhinitis and bronchial asthma. Curr Opin Pulm Med 2007, 13:13–18. CrossRef
- Keith PK, Conway M, Evans S, Wong DA, Jordana G, Pengelly D, et al.: Nasal polyps: effects of seasonal allergen exposure. J Allergy Clin Immunol 1994, 93:567–574. CrossRef
- Bousquet J, Lund VJ, van CP, Bremard-Oury C, Mounedji N, Stevens MT, et al.: Implementation of guidelines for seasonal allergic rhinitis: a randomized controlled trial. Allergy 2003, 58:733–741. CrossRef
- Juniper EF, Guyatt GH: Development and testing of a new measure of health status for clinical trials in rhinoconjunctivitis. Clin Exp Allergy 1991, 21:77–83. CrossRef
- Revicki DA, Leidy NK, Brennan-Diemer F, Thompson C, Togias A: Development and preliminary validation of the multiattribute Rhinitis Symptom Utility Index. Qual Life Res 1998, 7:693–702. CrossRef
- Santilli J, Nathan R, Glassheim J, Rockwell W, Gold K: Validation of the rhinitis outcomes questionnaire (ROQ). Ann Allergy Asthma Immunol 2001, 86:222–225. CrossRef
- The burden of allergic rhinitis (AR) in Canada: perspectives of physicians and patients
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Allergy, Asthma & Clinical Immunology
- Online Date
- June 2012
- Online ISSN
- BioMed Central
- Additional Links
- Rhinitis, Allergic
- Anti-allergic agents
- Administration, Intranasal
- Quality of life
- Author Affiliations
- 1. McMaster University, Hamilton, ON, Canada
- 2. Hôtel-Dieu de Montréal, Montreal, QC, Canada
- 3. Nycomed: A Takeda Company, Oakville, ON, Canada
- 4. Pacific Lung Health Centre, St. Paul’s Hospital, Vancouver, BC, Canada