Marlene M Speth1, Lloyd P Hoehle2,3, Katie M Phillips2,3, David S Caradonna2,4, Stacey T Gray2,3, Ahmad R Sedaghat5,6,7,8. 1. Klinik für Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Aarau, Switzerland. 2. Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. 3. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA. 4. Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA, USA. 5. Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. ahmad_sedaghat@meei.harvard.edu. 6. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA. ahmad_sedaghat@meei.harvard.edu. 7. Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA, USA. ahmad_sedaghat@meei.harvard.edu. 8. Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, MA, USA. ahmad_sedaghat@meei.harvard.edu.
Abstract
BACKGROUND: Recalcitrance of allergic rhinitis (AR) to medical management may be reflective of patient-specific impact of AR symptoms. AIMS: To understand the relationship between AR symptoms and general health-related quality of life (QOL) or AR control, based on treatment status. METHODS: Cross-sectional cohort study of 130 adult participants-65 using no allergy medications and 65 consistently using intranasal corticosteroid sprays (ICS) in the last 3 months-presenting with persistent AR. General health-related QOL was measured using the EuroQol 5-dimensional visual analog scale (EQ-5D VAS). Severity and control of AR symptoms were measured using the 22-item Sinonasal Outcome Test (SNOT-22) and the Rhinitis Control Assessment Test (RCAT), respectively. We compared associations between AR symptoms and general health-related QOL and AR control in patients presenting with persistent AR with and without ICS use. RESULTS: Severity of AR symptoms was similar between cohorts. In participants using no allergy medications, extranasal AR symptom severities were most dominantly associated with decreased EQ-5D VAS and RCAT score. In participants using ICS, only nasal symptom severities were associated with decreased EQ-5D VAS and RCAT scores. Consistently, only in participants on ICS was a deviated septum associated with decreased EQ-5D VAS (β = - 12.1, 95% CI - 21.1 to - 3.1, p = 0.011) and poorly controlled AR (OR = 4.27, 96% CI 1.27 to 14.33; p = 0.019). CONCLUSIONS: In persistent AR despite consistent ICS use, nasal symptoms may be the dominant drivers of AR-associated decreased general health-related QOL in contrast to persistent AR on no medication, when extranasal symptoms of AR are most significant. Longitudinal study is needed to investigate whether these results are predictive of responsiveness to ICS.
BACKGROUND: Recalcitrance of allergic rhinitis (AR) to medical management may be reflective of patient-specific impact of AR symptoms. AIMS: To understand the relationship between AR symptoms and general health-related quality of life (QOL) or AR control, based on treatment status. METHODS: Cross-sectional cohort study of 130 adult participants-65 using no allergy medications and 65 consistently using intranasal corticosteroid sprays (ICS) in the last 3 months-presenting with persistent AR. General health-related QOL was measured using the EuroQol 5-dimensional visual analog scale (EQ-5D VAS). Severity and control of AR symptoms were measured using the 22-item Sinonasal Outcome Test (SNOT-22) and the Rhinitis Control Assessment Test (RCAT), respectively. We compared associations between AR symptoms and general health-related QOL and AR control in patients presenting with persistent AR with and without ICS use. RESULTS: Severity of AR symptoms was similar between cohorts. In participants using no allergy medications, extranasal AR symptom severities were most dominantly associated with decreased EQ-5D VAS and RCAT score. In participants using ICS, only nasal symptom severities were associated with decreased EQ-5D VAS and RCAT scores. Consistently, only in participants on ICS was a deviated septum associated with decreased EQ-5D VAS (β = - 12.1, 95% CI - 21.1 to - 3.1, p = 0.011) and poorly controlled AR (OR = 4.27, 96% CI 1.27 to 14.33; p = 0.019). CONCLUSIONS: In persistent AR despite consistent ICS use, nasal symptoms may be the dominant drivers of AR-associated decreased general health-related QOL in contrast to persistent AR on no medication, when extranasal symptoms of AR are most significant. Longitudinal study is needed to investigate whether these results are predictive of responsiveness to ICS.
Entities:
Keywords:
Allergic rhinitis; Extranasal symptoms; General health-related quality of life; Intranasal corticosteroid spray; Nasal symptoms