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Clinical & Experimental Allergy

Specialist-based treatment reduces the severity of allergic rhinitis

Authors

  • J. Mullol,

    Corresponding author
    1. Immunoal.lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
    2. Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
    • Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
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  • J. Bartra,

    1. Unitat d'Al.lèrgia, Servei de Pneumologia i Al.lèrgia Respiratòria, Hospital Clínic, Barcelona, Catalonia, Spain
    2. Immunoal.lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
    3. Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
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  • A. del Cuvillo,

    1. Sección de Rinología, UGC ORL, Hospital de Jérez, Cádiz, Spain
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  • I. Izquierdo,

    1. Unidad de Desarrollo Clinico, J Uriach y Cía SA, Palau-Solità i Plegamans, Barcelona, Catalonia, Spain
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  • R. Muñoz-Cano,

    1. Unitat d'Al.lèrgia, Servei de Pneumologia i Al.lèrgia Respiratòria, Hospital Clínic, Barcelona, Catalonia, Spain
    2. Immunoal.lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
    3. Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
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  • A. Valero

    1. Unitat d'Al.lèrgia, Servei de Pneumologia i Al.lèrgia Respiratòria, Hospital Clínic, Barcelona, Catalonia, Spain
    2. Immunoal.lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
    3. Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
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Correspondence:

Joaquim Mullol, Rhinology Unit & Smell Clinic, Hospital Clínic, C/ Villarroel 170, 08036 Barcelona, Catalonia, Spain. E-mail: jmullol@clinic.ub.es

Summary

Background

Although the treatment of allergic rhinitis (AR) is now well established, its impact on severity has not yet been evaluated.

Objective

The aim was to analyse specialist-based treatment on AR severity, nasal symptoms and quality of life.

Methods

A longitudinal observational, prospective, multi-centre study with 4 weeks of follow-up was carried out by 141 allergologists and ENT specialists in Spain. Selection criteria were adult patients with AR, clinically diagnosed at least 2 years before, with a total nasal symptom score (TNSS) ≥5, not receiving either antihistamines within the previous week or nasal corticosteroids during the 2 previous weeks. Disease severity using both original Allergic Rhinitis and its Impact on Asthma (o-ARIA) and modified (m-ARIA) classifications, nasal symptoms, and Quality of Life (ESPRINT-15), were measured at baseline and after 4 weeks of treatment.

Results

Among the recruited AR patients (n = 707, 58% women), 39.3% were intermittent and 60.7% persistent, 40.2% had asthma and 61.4% conjunctivitis. Most patients were treated with second generation antihistamines in monotherapy (63.2%) or in combination with intranasal corticosteroids (31.5%). While using o-ARIA, 96.9% of patients had ‘moderate/severe’ AR, the m-ARIA discriminated between ‘moderate’ (55.4%) and severe (41.5%) AR, at baseline. After 4 weeks of treatment, improvement was found on disease severity (P < 0.0001), TNSS (8.2 ± 1.8 vs. 3.5 ± 2.3, P < 0.0001) and Quality of Life (ESPRINT-15 global score: 3.0 ± 1.2 vs. 1.1 ± 1.0, P < 0.0001).

Conclusions

Specialist-based treatment reduces AR severity, evaluated using the m-ARIA classification for the first time, in addition to the improvement of nasal symptoms and quality of life.

Clinical relevance

Specialist-based treatment improves AR severity, in addition to nasal symptoms and quality of life. However, no matter the treatment option some AR patients remain severe and need further follow-up.

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