title: Seasonal and perennial allergic rhinitis: is this classification adherent to real life?
abstract: BACKGROUND
  Allergic rhinitis is traditionally subdivided into seasonal (SAR) and perennial (PAR), although the new definitions of persistent and intermittent were recently proposed. We assessed the validity of the traditional classification in a large group of subjects suffering from allergic rhinitis alone.
  
  
  METHODS
  Young males referred to a Navy Military Hospital for routine fitness visit, and reporting symptoms of rhinitis alone were selected. According to the sensitization they were subdivided into (i) sensitized to pollens only (seasonal, SAR), (ii) to perennial allergens only (perennial, PAR) and (iii) to both (mixed, MAR). Spirometry, methacholine challenge, severity and characteristics of symptoms were assessed in all participants.
  
  
  RESULTS
  Of 19 325 subjects, 2347 had allergic rhinitis. Seventy-two percent of the subjects had MAR, 17% SAR and 11% PAR. Ocular involvement and irritative symptoms were more frequent in SAR (P < 0.03), whereas obstruction was predominant in PAR (P < 0.01). Nasal symptoms varied according to the period of the year in SAR (P < 0.01) and PAR (P < 0.03). An overt bronchial obstruction was detected in 12% of PAR patients, in 7.8% of MAR, and in 4.2% of SAR. forced expiratory volume/1 s was significantly lower during season in SAR patients only (P < 0.05). The FEF25-75 was impaired in 22.5% MAR patients, 21% PAR, and 14% SAR, with a seasonal change in SAR (P < 0.05) and PAR (P < 0.001). Bronchial hyperreactivity was present in 82.2% of PAR, 73.6% of MAR, and 53.5% of SAR, with a seasonal change in SAR (P < 0.001) and MAR (P < 0.05).
  
  
  CONCLUSIONS
  This study provides evidence that up to 80% of allergic rhinitics have a mixed form, and SAR and PAR definitions are poorly adherent to real life. Lung involvement is frequent in patients reporting nose symptoms alone.
authors.affiliation: Head-Neck Department, S. Martino Hospital, Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ciprandi
authors.forename: I
authors.initials: I
authors.lastname: Cirillo
authors.forename: A
authors.initials: A
authors.lastname: Vizzaccaro
authors.forename: M
authors.initials: M
authors.lastname: Tosca
authors.forename: G
authors.initials: G
authors.lastname: Passalacqua
authors.forename: E
authors.initials: E
authors.lastname: Pallestrini
authors.forename: G W
authors.initials: GW
authors.lastname: Canonica
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000276:immunology; D008297:Male; D011058:Pollen / Q000009:adverse effects*; D012129:Respiratory Function Tests; D012221:Rhinitis, Allergic, Perennial / Q000145:classification* / Q000150:complications / Q000276:immunology; D006255:Rhinitis, Allergic, Seasonal / Q000145:classification* / Q000150:complications / Q000276:immunology
chemical_list: D000485:Allergens