title: Validating childhood symptoms with physician-diagnosed allergic rhinitis.
abstract: BACKGROUND
  Multiple population-based and high-risk cohort studies use parental questionnaire responses to define allergic rhinitis (AR) in children. Individual questionnaire items have not been validated by comparison with physician-diagnosed AR (PDAR).
  
  
  OBJECTIVE
  To identify routine clinical questions that best agree with a physician diagnosis of AR and can be used for early case identification.
  
  
  METHODS
  Children participating in a longitudinal birth cohort study were evaluated at ages 1 through 4 and at age 7 (n = 531) using questionnaires, physical examinations, and skin prick tests (SPT) with 15 aeroallergens (AG). Parents answered 3 stem questions pertaining to their child, including presence of nasal symptoms absent a cold/flu (ISAAC-validated question), presence of hayfever, and ocular itch. Substem questions were answered with details regarding seasonality, nasal triggers, and ocular seasonality. A global assessment of allergic diseases, including AR, was performed by a specialty-trained clinician. Percent agreement, sensitivity, specificity, and positive predictive values were assessed for individual stem and substem questions.
  
  
  RESULTS
  Positive response to having hayfever and presence of ocular symptoms had the highest specificity (84% and 69%, respectively) and the highest percent agreement (74% and 68%) with PDAR. Identification of triggers for nasal and ocular symptoms had the highest sensitivity (89%). Positive predictive values ranged from 31 to 39%. Combining 2 responses with highest agreement increased specificity for PDAR to 91%.
  
  
  CONCLUSIONS
  Responses to hayfever and ocular symptoms had better specificity and percent agreement with PDAR than the ISAAC-validated questionnaire item. Combining 2 rhinitis questions sharply increases specificity and may improve diagnostic accuracy of clinical questions.
authors.affiliation: Department of Internal Medicine, Division of Immunology, Allergy, and Rheumatology, University of Cincinnati, Ohio, USA. hkim3@hfhs.org
authors.forename: Haejin
authors.initials: H
authors.lastname: Kim
authors.forename: Linda
authors.initials: L
authors.lastname: Levin
authors.forename: Grace K
authors.initials: GK
authors.lastname: LeMasters
authors.forename: Manuel
authors.initials: M
authors.lastname: Villareal
authors.forename: Sherry
authors.initials: S
authors.lastname: Evans
authors.forename: James E
authors.initials: JE
authors.lastname: Lockey
authors.forename: Gurjit K
authors.initials: GK
authors.lastname: Khurana Hershey
authors.forename: David I
authors.initials: DI
authors.lastname: Bernstein
mesh_terms: D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D004781:Environmental Exposure / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005104:Expert Testimony; D006801:Humans; D007223:Infant; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012221:Rhinitis, Allergic, Perennial / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D011795:Surveys and Questionnaires; D014481:United States