Behavioural patterns in allergic rhinitis medication in Europe: A study using MASK‐air^® real‐world data

Abstract

Background: Co-medication is common among patients with allergic rhinitis (AR), but its dimension and patterns are unknown. This is particularly relevant since AR is understood differently across European countries, as reflected by rhinitis-related search patterns in Google Trends. This study aims to assess AR co-medication and its regional patterns in Europe, using real-world data. Methods:We analysed 2015-2020 MASK-air ® European data. We compared days under no medication, monotherapy and co-medication using the visual analogue scale (VAS) levels for overall allergic symptoms ('VAS Global Symptoms') and impact of AR on work. We assessed the monthly use of different medication schemes, performing separate analyses by region (defined geographically or by Google Trends patterns). We estimated the average number of different drugs reported per patient within 1 year. Results:We analysed 222,024 days (13,122 users), including 63,887 days (28.8%) under monotherapy and 38,315 (17.3%) under co-medication. The median 'VAS Global Symptoms' was 7 for no medication days, 14 for monotherapy and 21 for co-medication (p < .001). Medication use peaked during the spring, with similar patterns across different European regions (defined geographically or by Google Trends). Oral H 1 -antihistamines were the most common medication in single and co-medication. Each patient reported using an annual average of 2.7 drugs, with 80% reporting two or more.Conclusions: Allergic rhinitis medication patterns are similar across European regions.One third of treatment days involved co-medication. These findings suggest that patients treat themselves according to their symptoms (irrespective of how they understand AR) and that co-medication use is driven by symptom severity.

Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA‐MeDALL hypothesis

“…163 In MASK-air, a co-medication pattern was associated with a poorer rhinitis control than in monotherapy. 164,165 In the combined symptom-medication score, the distinction between rhinitis and A + R was clear, with large effect sizes (submitted).…”

“…Moreover, they more often reported a treatment with intranasal corticosteroids, and oral antihistamines were associated with poor control 163 . In MASK‐air, a co‐medication pattern was associated with a poorer rhinitis control than in monotherapy 164,165 . In the combined symptom‐medication score, the distinction between rhinitis and A + R was clear, with large effect sizes (submitted).…”

Immunomodulatory properties of mesenchymal stem cells: A potential therapeutic strategy for allergic rhinitis

“…Current therapeutic options for AR consist of patient education, irritant and allergen avoidance, pharmacotherapy, and allergen immunotherapy (AIT). 35,36 Pharmacotherapy, including nasal glucocorticoids, antihistamines, leukotriene receptor antagonists (LRAs), and mast cell membrane stabilizers, targets immune cells and important mediators involved in allergic inflammation to control symptoms (Figure 1). 37 The selection of pharmacotherapy depends on the symptom severity, efficacy and safety of treatment, current treatment, historic response to treatment, and effect on sleep and work productivity.…”

“…Current therapeutic options for AR consist of patient education, irritant and allergen avoidance, pharmacotherapy, and allergen immunotherapy (AIT) 35,36 . Pharmacotherapy, including nasal glucocorticoids, antihistamines, leukotriene receptor antagonists (LRAs), and mast cell membrane stabilizers, targets immune cells and important mediators involved in allergic inflammation to control symptoms (Figure 1).…”

Beyond ARIA: Will e‐diaries replace retrospective questionnaires in measuring the severity of allergic rhinitis in clinical research and daily practice?

“…33 When applying these compilation of an e-diary for a long period, so that the former may be preferred to achieve a severity classification only. On the other hand, the information given in the e-diary is more flexible, detailed, and complete than the ARIA questionnaire and, beyond disease severity, can be used to measure the AR overall burden, 43 time trends, 4 association with allergen exposure, 26 short-and long-term response to preventive or therapeutic intervention, 23,[44][45][46] and adherence to medication. 47 Both evaluations are therefore complementary to the clinical history.…”