title: Difference in symptom severity between early and late grass pollen season in patients with seasonal allergic rhinitis.
abstract: BACKGROUND
  For the development of forecasts for seasonal allergic rhinitis symptoms, it is essential to understand the relationship between grass pollen concentrations and the symptoms of grass pollen allergic patients.
  
  
  OBJECTIVE
  The aim of this study was to delineate this relationship between seasonal allergic rhinitis symptoms and grass pollen concentrations in the Netherlands.
  
  
  METHODS
  Grass pollen allergic patients (n = 80 [2007] - 84 [2008]) were enrolled into the study. They were asked to enter their seasonal allergic rhinitis symptoms (runny nose, sneezing, blocked nose, post nasal drip, and eye symptoms) daily on a scale from 0 to 3 to the study centre either by short message service (SMS) or by internet from May-July 2007 and April-July 2008. Daily pollen counts were used to define the early and the late grass pollen season as the period 'before and during' respectively 'after' the first grass pollen peak (more than 150 pollen/m3).
  
  
  RESULTS
  At similar grass pollen concentrations, the daily mean of the individual maximum symptom scores reported in the early season were higher as compared to that reported in the late season [differences of -0.41 (2007) and -0.30 (2008)]. This difference could not be explained by medication use by the patients nor by co-sensitization to birch.
  
  
  CONCLUSIONS
  We conclude that seasonal allergic rhinitis symptoms at similar grass pollen concentrations are more severe in the early flowering season as compared to those in the late flowering season. This finding is not only relevant for development of forecasts for seasonal allergic rhinitis symptoms but also for understanding symptom development and planning and analysis of clinical studies.
authors.affiliation: Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands. l.a.de_weger@lumc.nl.
authors.forename: Letty A
authors.initials: LA
authors.lastname: de Weger
authors.forename: Thijs
authors.initials: T
authors.lastname: Beerthuizen
authors.forename: Jeannette M
authors.initials: JM
authors.lastname: Gast-Strookman
authors.forename: Dirk T
authors.initials: DT
authors.lastname: van der Plas
authors.forename: Ingrid
authors.initials: I
authors.lastname: Terreehorst
authors.forename: Pieter S
authors.initials: PS
authors.lastname: Hiemstra
authors.forename: Jacob K
authors.initials: JK
authors.lastname: Sont