Systematic review of measures of disease severity in rhinitis

Abstract

Background: Rhinologists often encounter a broad spectrum of allergic rhinitis (AR) and nonallergic rhinitis (NAR) patients, who can be variably classified based upon timing and severity of disease. Our understanding of the varied quality of life (QOL) impact in different classifications of rhinitis is limited. Thus a more comprehensive understanding of the impact of rhinitis upon our patients, as measured by both patient reported outcome measures (PROMs) and clinical physiologic measures, as well as unique factors associated with disease severity is needed. Methods: A systematic search of databases was performed to identify AR and NAR studies reporting Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), total nasal symptom score (TNSS), or visual analogue scale (VAS) scores, and physiologic measures including peak nasal inspiratory flow (PNIF) and nasal airflow. Relationships between PROMs, physiologic measures, and associated factors (e.g., allergic status, disease duration) were assessed by weighted correlations and meta-regressions. Results: A total of 171 studies reporting on 33,843 patients were included.Symptoms were more severe in AR than NAR on VAS (p < 0.001). Classification based upon Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines demonstrated differences in PROM severity. There was no significant correlation between PROMs and demographic factors, comorbidities, or physiologic measures. Meta-regression identified a correlation between worse RQLQ scores and shorter disease duration (r = −0.4, p < 0.001). Conclusion: Rhinitic patients have more severe impact upon QOL in the presence of allergy with variable impact upon specific symptom subdomains. PROMs do not correlate with common demographic factors, comorbidities, or physiologic measures of nasal airflow.

Allergic rhinitis in Chinese young adults from the Singapore/Malaysia cross-sectional genetics epidemiology study (SMCGES) cohort: Prevalence, patterns, and epidemiology of allergic rhinitis

“…The mTNSS of 4.32 in our study population was lower than that reported in the existing literature and summarized in a recent review (pooled mean TNSS = 6.06). 32 We attributed this discrepancy to the differences in study settings, wherein studies assessing TNSS were frequently against a clinical backdrop, resulting in study samples comprising patients perceiving their AR as sufficiently severe so as to warrant treatment and meriting a higher TNSS. 33 Indeed, one study which occurred in a non-clinical setting similar to ours reported lower mean TNSS in rhinitics.…”

Patient‐reported outcome measures in birch pollen allergic patients treated with sublingual immunotherapy reflect real life

“…The TOSS was less well correlated with RQLQ and VAS-RS. 5 Although ocular symptoms are bothersome and affect RQLQ, RQLQ may not be optimal at reflecting ocular symptoms. Furthermore, the TOSS scale displays some limitations, as it only assesses two items (eye itching and tearing), displaying a lower contribution to TSS.…”

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

“…High quality evidence evaluating the impact of AR on QOL continues to show AR patients suffer from decreased general and disease‐specific QOL due to impacts on physical and mental health 1042–1047 . These studies also show that treatment of AR with INCS, oral antihistamines, and AIT leads to improved QOL.…”