Burden of allergic rhinitis: Results from the Pediatric Allergies in America survey

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Allergic rhinitis (AR), a chronic inflammatory disease of the upper airway, is one of the most common chronic diseases in the United States and is estimated to affect up to 60 million people. Pediatric Allergies in America is the largest and most comprehensive survey to date of pediatric patients and parents of patients with allergy, as well as health care providers (HCPs), regarding AR in children and its treatment. The goals of the survey were to determine the prevalence of AR in the US pediatric population and to collect information on what effect the condition has on patients in terms of symptom burden, quality of life, productivity, disease management, and pharmacologic treatment. This national survey screened 35,757 households to identify 500 children with HCP-diagnosed nasal allergies and 504 children without nasal allergies who were between the ages of 4 and 17 years. Parents of young children, as well as children 10 to 17 years of age, were questioned about the condition and its treatment. In parallel, 501 HCPs were interviewed. This survey has captured previously unavailable data on the prevalence of nasal allergies and their most common and most bothersome symptoms, on the effect of nasal allergies on the quality of life of children, and on medication use, including both over-the-counter and prescription medications, and has identified factors affecting satisfaction with treatment. The Pediatric Allergies in America survey also identifies distinct areas for improvement in the management of AR in children. In fact, based on the results of this survey, it appears that HCPs overestimate patients' and parents' satisfaction with disease management and the benefit of medications used for the treatment of nasal allergies in children. Findings from this national survey have identified important challenges to the management of AR, suggesting that its burden on children in the United States has been significantly underestimated.

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Survey design

Pediatric Allergies in America, a comprehensive national telephone screening of 35,757 households in the United States, was conducted to identify subjects with nasal allergy between 4 and 17 years of age. This national survey was designed to use a credible data-collection approach to determine the prevalence of AR in the US pediatric population. This survey interviewed the parents of children 4 through 9 years of age and both the parents and children 10 years of age and older and collected

Prevalence of pediatric allergic rhinitis

Although AR is currently estimated to affect approximately 60 million people in the United States and prevalence is increasing, it is still considered by many to be a nuisance condition of childhood rather than a serious disease.1, 2, 3 Many children become symptomatic and are given diagnoses of AR by age 6 years; 80% of all individuals with AR have symptoms before age 20 years.9 According to the Agency for Healthcare Research and Quality, the self-reported prevalence of AR in adults is

Symptoms of pediatric AR

AR is characterized by nasal congestion, rhinorrhea, repeated sneezing, and nasal itching, common symptoms brought on by the body's immunologic inflammatory response to allergen exposure.19, 20, 21, 22 Ocular symptoms, such as eye itching, tearing, redness, and lid puffiness, collectively referred to as allergic conjunctivitis, are also common symptoms of AR.23

Because the types of allergy symptoms experienced by children often vary in frequency, parents were asked which of 12 common allergy

Burden of pediatric AR

Traditionally, AR has been regarded as more of a nuisance than a substantive disease. However, in 2006, Allergies in America, a national survey of patients 18 years of age and older with nasal allergy, helped to describe the true burden of this disease on US adults.7, 8 In 2007, after this adult study, the Pediatric Allergies in America survey was conducted to qualify and quantify the effect of AR on the lives of children in the United States. It appears that in children, as well as in adults,

Need for treatment of AR symptoms

Through the combination of bothersome symptoms, compromised sleep, and effect on physical, mental, and emotional health, AR has a profound effect on the daily lives of children with the disease. When asked to estimate the effect of nasal allergy symptoms on their children, 1 in 4 parents felt that nasal allergies affected their child's life a lot (9%) or a moderate amount (17%) during the allergy season. Interestingly, compared with parents, HCPs reported that AR has a far greater effect on

Efficacy of current nasal allergy medications in pediatric patients with AR

Ideally, children experiencing uncontrolled rhinitis symptoms should be referred by their pediatrician to an allergy specialist for consultation and specific allergen testing. Once the determination that a specific allergen is responsible for the nasal symptoms, ocular symptoms, or both has been made, appropriate steps to remove the allergen or otherwise limit exposure to the allergen should be made. The benefit would be that identifying the causative allergen or allergens could dramatically

Pediatric patient satisfaction with prescription nasal sprays for AR

Because AR is a chronic inflammatory condition, regular prophylactic use of medication might be required to achieve effective long-term control of nasal allergy symptoms. Adherence to the prescribed AR regimen is needed to maintain reduction of inflammation and resultant nasal allergy symptoms. However, as many as 1 in 3 adults might be inconsistent in the regular use of their prescribed AR medications, and 40% to 80% of these patients might discontinue treatment within 6 weeks.64

Results of the

Discussion

The Pediatric Allergies in America survey has highlighted gaps in our understanding of AR and the profound effect AR has on children. During the times when allergy symptoms are at their worst, children experience nasal congestion, headache, postnasal drip, repeated sneezing, runny nose, and other symptoms on a near-daily basis. These symptoms were described as being moderately to extremely bothersome by most parents of children with nasal allergies. Because of the effect of these allergy

References (67)

  • T. Young et al.

    Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group

    J Allergy Clin Immunol

    (1997)
  • J.M. Klossek et al.

    [Epidemiology of seasonal spring-time allergic rhinitis in adults in France]

    Presse Med

    (2005)
  • B.A. Stuck et al.

    Changes in daytime sleepiness, quality of life, and objective sleep patterns in seasonal allergic rhinitis: a controlled clinical trial

    J Allergy Clin Immunol

    (2004)
  • D. Bresolin et al.

    Mouth breathing in allergic children: its relationship to dentofacial development

    Am J Orthod

    (1983)
  • R.G. Slavin

    Complications of allergic rhinitis: implications for sinusitis and asthma

    J Allergy Clin Immunol

    (1998)
  • J.M. Bernstein

    The role of IgE-mediated hypersensitivity in the development of otitis media with effusion

    Otolaryngol Clin North Am

    (1992)
  • T.B. Casale et al.

    Clinical implications of the allergic rhinitis-asthma link

    Am J Med Sci

    (2004)
  • N.A. Behbehani et al.

    Prevalence of asthma, allergic rhinitis, and eczema in 13- to 14-year-old children in Kuwait: an ISAAC study. International Study of Asthma and Allergies in Childhood

    Ann Allergy Asthma Immunol

    (2000)
  • J. Corren et al.

    Nasal beclomethasone prevents the seasonal increase in bronchial responsiveness in patients with allergic rhinitis and asthma

    J Allergy Clin Immunol

    (1992)
  • J. Crystal-Peters et al.

    Treating allergic rhinitis in patients with comorbid asthma: the risk of asthma-related hospitalizations and emergency department visits

    J Allergy Clin Immunol

    (2002)
  • A. Foresi et al.

    Once daily intranasal fluticasone propionate (200 micrograms) reduces nasal symptoms and inflammation but also attenuates the increase in bronchial responsiveness during the pollen season in allergic rhinitis

    J Allergy Clin Immunol

    (1996)
  • W.T. Watson et al.

    Treatment of allergic rhinitis with intranasal corticosteroids in patients with mild asthma: effect on lower airway responsiveness

    J Allergy Clin Immunol

    (1993)
  • P.W. Welsh et al.

    Efficacy of beclomethasone nasal solution, flunisolide, and cromolyn in relieving symptoms of ragweed allergy

    Mayo Clin Proc

    (1987)
  • P.A. Eggleston

    Improving indoor environments: reducing allergen exposures

    J Allergy Clin Immunol

    (2005)
  • B.J. Ferguson

    Environmental controls of allergies

    Otolaryngol Clin North Am

    (2008)
  • P.P. Belliveau

    Omalizumab: a monoclonal anti-IgE antibody

    MedGenMed

    (2005)
  • R. Bloebaum

    Managing allergic rhinitis: the role of pharmacotherapy; sound treatment can improve your patient's quality of life

    J Respir Dis

    (2002)
  • R.A. Nathan

    The burden of allergic rhinitis

    Allergy Asthma Proc

    (2007)
  • R.A. Settipane

    Rhinitis: a dose of epidemiological reality

    Allergy Asthma Proc

    (2003)
  • W.E. Berger

    Allergic rhinitis in children: diagnosis and management strategies

    Paediatr Drugs

    (2004)
  • D.C. McCrory et al.

    Management of allergic rhinitis in the working-age population

    Evid Rep Technol Assess (Summ)

    (2003)
  • A.L. Wright et al.

    Epidemiology of physician-diagnosed allergic rhinitis in childhood

    Pediatrics

    (1994)
  • HealthStar Communications, Inc, in partnership with Schulman, Ronca and Bucuvalas, Inc. Allergies in America: a landmark survey of nasal allergy sufferers. Executive summary

    (2006)
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    Supported by Nycomed US. Support for editorial assistance was provided by Nycomed US, and Sepracor Inc.

    Disclosure of potential conflict of interest: E. O. Meltzer received grant support from Alcon, Amgen, Antigen, Apotex, AstraZeneca, Boehringer Ingelheim, Capnia, Clay-Park, Critical Therapeutics, Genentech, GlaxoSmithKline, Hoffmann-LaRoche, MAP Pharmaceuticals, Medicinova, Meda, Merck, Naryx, Novartis, Nycomed US, Pharmaxis, Rigel, Sanofi-Aventis, Schering-Plough, Skye Pharma, Teva, Vocel, and Wyeth; is a consultant for Abbott, Alcon, Allux, Amgen, AstraZeneca, Capnia, Critical Therapeutics, Dey, Evolutec, Genentech, GlaxoSmithKline, Greer, Inspire, Meda, Merck, Novartis, Nycomed US, Pfizer, Rigel, Sanofi-Aventis, Schering-Plough, Sepracor, Shionogi, VentiRx, and Wyeth; is a speaker for AstraZeneca, Alcon, Genentech, GlaxoSmithKline, Meda, Merck, Pfizer, Sanofi-Aventis, Schering-Plough, and Sepracor; has provided expert witness testimony on allergic rhinitis and asthma. M. S. Blaiss is a consultant and speaker for Sepracor, Nycomed, GlaxoSmithKline, Schering Plough, Alcon, AstraZeneca, Genentech, Teva, Merck, Sanofi-Aventis, UCB, Proctor and Gamble; receives grant support from UCB and GlaxoSmithKline, and has provided legal consultation/expert witness testimony in cases related to asthma. M. J. Derebery is a speaker for Sepracor, GlaxoSmithKline, Schering Plough, Meda, and Alcon; is an advisor for SRxA; and received grant support from Alcon. T. A. Mahr is on the speakers' bureau for Alcon, AstraZeneca, Genentech, GlaxoSmithKline, Merck, Novartis, Sanofi-Aventis, Schering-Plough, and UCB; receives grant support from Alcon, AstraZeneca, Genentech, and GlaxoSmithKline, serves on the committees for the American College of Allergy, Asthma & Immunology, the American Academy of Allergy, Asthma & Immunology, and for the American Academy of Pediatrics; is on the board for American Lung Association-Wisconsin; and is on the executive committee for the Wisconsin Asthma Coalition. B. R. Gordon has provided legal consultation/expert witness testimony in cases related to anaphylaxis, and is a consultant and/or speaker for ALK-Abello, Merck, Sanofi-Aventis, and Schering-Plough. Previously published research (not including this research), has been funded by the University of Singapore and by the American Academy of Otolaryngic Allergy Foundation. Dr Gordon has no relevant business, patent, or stock ownership issues. None of these relationships represent any material or significant conflict of interest to his participation in the Pediatric Allergies in America study. K. K. Sheth is a consultant for Alcon, GlaxoSmithKline, Nycomed, is a member of the speakers bureau for Sanofi-Aventis and GlaxoSmithKline, and serves on a committee for the American College of Allergy, Asthma & Immunology. A. L. Simmons is an advisory board consultant for Nycomed, and is an advisory board consultant on the speakers' bureau for GlaxoSmithKline. M. A. Wingertzahn is employed by Nycomed. J. M. Boyle is Executive Vice President of Abt SRBI, which conducted the survey under a contract from HealthStar Communications. Abt SRBI also had a contract from ProEd Communications for additional analyses after the HealthStar contract was completed.

    Disclosure of sponsor involvement: In any sponsored investigation the issue of bias is invariably of concern for the pharmaceutical company and the authors, as well as for the journal's reviewers and readers. During the conduct of this study, much effort was made to mitigate potential bias, and safeguards were put in place to limit the sponsor's participation. The Pediatric Allergies in America survey was designed by a panel of experts within the allergy and ear, nose, and throat specialties. The sponsor had negligible input during these meetings, except for stating that it had hoped the project would study the current magnitude of the prevalence and burden of nasal allergies. This limited sponsor involvement was not an attempt to shape or otherwise influence the direction or outcome of the survey. The survey questions, in concert with the expert panel, were written by and administered through Abt SRBI, a respected global strategy, public policy, and opinion polling organization that has as clients multiple Fortune 500 companies; federal, state, and local governments; foundations; and universities. Data from the survey were not revealed to the sponsor before a follow-up meeting that was held with the clinician advisory committee, thus further minimizing any risk of sponsor bias of the data. Finally, the authorship includes only 1 person from the sponsoring company, Dr Wingertzahn, a PhD within their clinical development department. Dr Wingertzahn has a solid foundation in ethical research and has authored numerous manuscripts in peer-reviewed journals within the area of allergy. He was not a member of the core writing committee but was a reviewer of the supplement. We believe that pharmaceutical companies, no less than clinicians, are appropriately interested in learning as much as possible about the needs of their market and patients.

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