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Larenas-Linnemann, Desiree, Dinger, Hanna, Shah-Hosseini, Kijawasch, Michels, Alexandra and Moesges, Ralph (2013). Over diagnosis of persistent allergic rhinitis in perennial allergic rhinitis patients: A nationwide study in Mexico. Am. J. Rhinol. Allergy, 27 (6). S. 495 - 502. THOUSAND OAKS: SAGE PUBLICATIONS INC. ISSN 1945-8932

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Abstract

Background: Allergic rhinitis (AR) symptom phenotypes have been described, and two different classifications exist. The former classification, seasonal versus perennial AR (SAR-PAR), and the Allergic Rhinitis and Its Impact on Asthma (ARIA) classifications, intermittent (INT) versus persistent (PER; >= 4 days/wk and >= 4 consecutive weeks) and mild versus moderate/severe. ARIA cataloging of INT-PER is based on the patient's description of the frequency of symptoms. This study was designed to (1) describe the epidemiology of these two AR classifications and relate them to one another and to a visual analog severity scale (VAS) and (2) describe how the cataloging of these classifications differs between patients and allergists. Methods: Skin-prick test-positive AR patients seen nationwide by Mexican allergists completed a validated questionnaire cataloging AR. They recorded demographic data and AR severity on a VAS. The patients' physicians were also asked to classify the AR phenotypes. Results: Of the patients, 56.5% had INT and 82.2% had PAR and moderate-severe (84.7%) AR. However, 57% of the INT-PAR patients were misdiagnosed as PER-PAR by their physicians. PER patients had more severe disease with a longer clinical history, more PAR, nose and eye symptoms, and a higher VAS score, and only 7% had mild symptoms. VAS values >= 7.45 relate to PER (sensitivity, 68%; specificity, 65%). VAS <= 6.2 indicated mild and >= 6.4 indicated moderate-severe AR. Similar to the adults, in the 2- to 11 year and 12-to 17-year age groups perennial, INT, and moderate-severe AR was the most frequent finding, but the children had more INT (p < 0.01) and mild (p < 0.03) symptoms, less SAR (p = 0.03), and more physician-diagnosed asthma (p < 0.05). Public health care (PHC) patients had more INT (p = 0.016). Conclusion: In the PAR group, the physicians' classification of INT-PER often goes astray. PER overdiagnoses might affect treatment decisions because PER is a more severe phenotype. VAS is useful to evaluate severity. In Mexican AR patients, rhinitis symptom phenotypes differ according to age and between private and PHC system patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Larenas-Linnemann, Desiree UNSPECIFIED UNSPECIFIED UNSPECIFIED Dinger, Hanna UNSPECIFIED UNSPECIFIED UNSPECIFIED Shah-Hosseini, Kijawasch UNSPECIFIED UNSPECIFIED UNSPECIFIED Michels, Alexandra UNSPECIFIED UNSPECIFIED UNSPECIFIED Moesges, Ralph UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-472415
DOI:	10.2500/ajra.2013.27.3957
Journal or Publication Title:	Am. J. Rhinol. Allergy
Volume:	27
Number:	6
Page Range:	S. 495 - 502
Date:	2013
Publisher:	SAGE PUBLICATIONS INC
Place of Publication:	THOUSAND OAKS
ISSN:	1945-8932
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language IMPACT; ASTHMA; SEVERITY; SYMPTOMS; POPULATION; PREVALENCE; CLASSIFICATION; VALIDATION; GUIDELINES; CHILDREN Multiple languages Otorhinolaryngology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/47241