Current therapy does not provide sufficient control in many patients. A survey of 990 patients with allergic rhinitis recruited by 161 GPs in France found that the vast majority of treated patients remained symptomatic:6
Rhinorrhea
Sneezing
Congestion
Itching
Ocular symptoms
| Sneezing | Rhinorrhea | Nasal obstruction | Nasal itch | Eye symptoms | |
|---|---|---|---|---|---|
| H1-antihistamines | |||||
| Oral | ++ | ++ | + | +++ | ++ |
| Intranasal | ++ | ++ | + | ++ | 0 |
| Eye drops | 0 | 0 | 0 | 0 | +++ |
| Corticosteroids | |||||
| Intranasal | +++ | +++ | ++ | ++ | ++ |
| Chromones | |||||
| Intranasal | + | + | + | + | 0 |
| Eye drops | 0 | 0 | 0 | 0 | ++ |
| Decongestants | |||||
| Intranasal | 0 | 0 | ++++ | 0 | 0 |
| Oral | 0 | 0 | + | 0 | 0 |
| Anti-cholinergics | 0 | ++ | 0 | 0 | 0 |
| Anti-leukotrienes | 0 | + | ++ | 0 | ++ |
| Intranasal steroids and intranasal antihistamine (Dymista®) |
+++ | +++ | +++ | +++ | +++ |
Adapted from Scadding GK, et al. 2017.1
ALLERGIC RHINITIS AND CONCOMITANT CONDITIONS9
- 63% of people with allergic rhinitis have concomitant conditions, with the highest frequency occurring in people over 65 years of age.
Asthma
Eczema
Food allergy
Urticaria
Allergic rhinitis affects many aspects of people’s lives, including activities, sleep, and work or school, all of which contribute to a reduced quality of life (QoL).3
In a prospective, cross-sectional, international survey of 1482 allergic rhinitis patients and matched data from 415 primary care physicians and specialists, allergic rhinitis had at least some impact on the daily lives of approximately 80% of patients, and moderate or severe impact in 13%.3
- 71% of patients reported suffering from nasal and ocular symptoms currently or frequently, and one-third of patients described their current symptoms as moderate or severe.3
- More than 50% of all patients reported that their allergic rhinitis had some impact on their sleep patterns in the past month, which has been shown previously to result in daytime fatigue and decreased overall cognitive function.3
- Sleep is significantly more impaired in patients with severe rhinitis than in those with mild disease.3
- Allergic rhinitis had a significantly greater impact on health-related QoL in patients with moderate–severe or persistent disease, compared with mild or intermittent disease.3
Allergic rhinitis patients visit doctors on average three times a year:9
- Perennial allergic rhinitis patients visit their doctors 3.5 times per year, compared with 2.4 times per year for intermittent patients.
- 48% of the diagnoses are made by GPs, and 32% by allergy and ear, nose and throat specialists in secondary care.
- A total of 13.2% of patients (n=235) had attended their doctor five or more times in the current calendar year because of their AR.5
With the availability of combination treatment in a single device – Dymista®– the majority of allergic rhinitis symptoms can be treated in the primary care setting.10
Continued symptoms in some patients means that a proportion of sufferers will be seen in secondary care, which is much more costly than primary care.10
- Each GP consultation costs an average of £31 (NHS England).
- The cost of secondary care referrals can often vary, but typically start from approximately £136 for an ENT referral.
BSACI evidence-based, NICE-accredited, guidance provides a clear pathway for allergic rhinitis treatment in primary care.10 This includes the recommendation that AZ/FP (single device) are used as second-line intervention in primary care.10,11
Adherence to this care pathway has the potential to limit the management costs of allergic rhinitis by avoiding unnecessary treatments and investigations, and avoiding the need for time consuming and costly referrals to secondary care in the majority of cases.10 It also provides GPs with a well-tolerated effective AR treatment to give patients the control they desire.10
- Scadding GK, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2017; 47(7): 856-889.
- Scottish Medicine Consortium (SMC). Available at https://www.scottishmedicines.org.uk/medicines-advice/azelastine-hydrochloride-plus-fluticasone-propionate-dymista-abbreviatedsubmission-92113/. Last accessed: November 2018.
- Canonica GW, et al. A survey of the burden of allergic rhinitis in Europe. Allergy 2007; 62(Suppl. 85): 17-25.
- World Allergy Organization. Combined Allergic Rhinitis and Asthma Syndrome. 2015. Available at: http://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/combined-allergic-rhinitis-and-asthma-syndrome. Last accessed: November 2018.
- Klimek L, et al. Effectiveness of MP29-02 for the treatment of allergic rhinitis in real-life: results from a noninterventional study. Allergy Asthma Proc. 2015; 36(1): 40-47.
- Bousquet PJ, et al. Impact of allergic rhinitis symptoms on quality of life in primary care. Int Arch Allergy Immunol. 2013; 160(4): 393-400.
- Meltzer E, et al. Clinically relevant effect of a new intranasal therapy (MP29-02) in allergic rhinitis assessed by responder analysis. Int Arch Allergy Immunol. 2013; 161(4): 369-77.
- Price D, et al. The hidden burden of adult allergic rhinitis: UK healthcare resource utilisation survey. Clin Transl Allergy 2015; 5: 39.
- Valovirta E, et al. The voice of the patients: allergic rhinitis is not a trivial disease. Curr Opin Allergy Clin Immunol. 2008; 8(1): 1-9.
- Lipworth B, et al. An algorithm recommendation for the pharmacological management of allergic rhinitis in the UK: a consensus statement from an expert panel. NPJ Prim Care Respir Med. 2017; 27(1): 3.
- Scadding GK, et al. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clinical and Experimental Allergy 2008; 38(1): 19-42.
