title: A new criterion by which to discriminate between patients with moderate allergic rhinitis and patients with severe allergic rhinitis based on the Allergic Rhinitis and its Impact on Asthma severity items.
abstract: BACKGROUND
  Allergic Rhinitis and its Impact on Asthma (ARIA) differentiates mild from moderate/severe patients on the basis of 4 severity items. The high prevalence of moderate/severe patients suggests the need to differentiate between them.
  
  
  OBJECTIVE
  To identify the categorization that maximizes discrimination between moderate and severe allergic rhinitis (AR) by using ARIA guidelines.
  
  
  METHODS
  Observational, cross-sectional study. Clinical characteristics, nasal symptoms (Total Symptom Score 4), and health-related quality of life (HRQL; Rhinoconjunctivitis Quality of Life Questionnaire and Short Form 12) were assessed. The association of severity items (sleep, daily activities/sport, work/school, and troublesome symptoms) with symptoms and HRQL was analyzed using linear regression models. ANOVA and effect sizes were used to assess differences in symptoms and HRQL among groups defined by the number of affected ARIA items.
  
  
  RESULTS
  Nontreated patients (N = 141) with moderate/severe AR were studied. All severity items showed a similar independent association with symptoms and HRQL scores, and there were no interaction effects, indicating that categorization of patients into moderate and severe could be based only on the number of items affected. Effect sizes were highest between patients with 4 affected ARIA items and those with 3, 2, or 1 affected item (effect sizes greater than 0.8 in all comparisons using Rhinoconjunctivitis Quality of Life Questionnaire and Short Form 12 Physical Composite Summary, and greater than 0.5 using the Total Symptom Score 4; P < .001).
  
  
  CONCLUSIONS
  Using ARIA severity items, the criterion that best discriminates AR severity is considering moderate those with 1 to 3 affected items and severe those with 4.
  
  
  CONCLUSIONS
  Discrimination between patients with moderate and severe AR should help to obtain homogeneous populations for both research and clinical purposes.
authors.affiliation: Unidad de Alergia, Servicio de Neumología y Alergia Respiratoria, Hospital Clínic, Barcelona, Spain. Valero@clinic.ub.es
authors.forename: Antonio
authors.initials: A
authors.lastname: Valero
authors.forename: Montse
authors.initials: M
authors.lastname: Ferrer
authors.forename: Joaquín
authors.initials: J
authors.lastname: Sastre
authors.forename: Ana M
authors.initials: AM
authors.lastname: Navarro
authors.forename: Laura
authors.initials: L
authors.lastname: Monclús
authors.forename: Enrique
authors.initials: E
authors.lastname: Martí-Guadaño
authors.forename: Michael
authors.initials: M
authors.lastname: Herdman
authors.forename: Ignacio
authors.initials: I
authors.lastname: Dávila
authors.forename: Alfonso
authors.initials: A
authors.lastname: Del Cuvillo
authors.forename: Carlos
authors.initials: C
authors.lastname: Colás
authors.forename: Eva
authors.initials: E
authors.lastname: Baró
authors.forename: Ignacio
authors.initials: I
authors.lastname: Antépara
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.forename: Joaquim
authors.initials: J
authors.lastname: Mullol
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001249:Asthma / Q000209:etiology* / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D006967:Hypersensitivity / Q000150:complications*; D016014:Linear Models; D008297:Male; D011788:Quality of Life; D012220:Rhinitis / Q000145:classification / Q000150:complications / Q000209:etiology* / Q000503:physiopathology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires