title: Nasal allergies in the Middle Eastern population: results from the "Allergies in Middle East Survey".
abstract: BACKGROUND
  Chronic respiratory diseases such as asthma and allergic rhinitis (AR) are a major public health problem in developing countries including those in the Middle East. However, to date, there is a paucity of information related to physician-diagnosed AR in this region.  The Allergies in Middle East Survey was undertaken to help clarify and broaden the understanding of physician-diagnosed AR across Egypt, Iran, Lebanon, Saudi Arabia, and the United Arab Emirates. The survey explores the frequency of physician-diagnosed AR, prevalence and types of associated  symptoms, the impact on quality of life (QOL), current treatment practices, and therapy expectations.
  
  
  METHODS
  In total, 7411 households in five countries (Egypt, Lebanon, Saudi Arabia, Iran and the United Arab Emirates) were screened to identify individuals that were ≥4  years old with a physician diagnosis of AR and either symptoms and/or treatment in the past 12 months. A total of 501 respondents from the five countries completed the survey. Standardized questionnaires were used to make comparisons across the regions; however, the data collection procedures  were tailored for each country. The sample was probability based to ensure valid statistical inference to the population.
  
  
  RESULTS
  Ten percent of the Middle East population surveyed had a physician diagnosis of AR, with 65% of respondents stating that their allergies were  intermittent in nature. An otolaryngologist or allergist diagnosed the majority of the individuals surveyed. Runny nose, nasal and throat itching, postnasal drip, and nasal congestion or stuffed up nose were the most common and bothersome symptoms of AR. The majority of survey participants  (58% of the overall survey population) with AR reported that the condition had an impact on their daily private and professional life. Seventy-two percent of adults reported that their AR symptoms limited their work/school activities and 35% reported that their AR interfered with and caused  them to miss work or school within the past 12 months. One factor, in addition to the outward AR symptoms, that could have contributed to these function impairments may have been sleep disturbances. Although a secondary symptom to AR, sleep disturbances (difficulty getting to sleep, waking  up during the night or lack of a good night's sleep) were shown in this survey to be extremely troubling in ∼15% of AR sufferers. In the past year >90% of patients reported taking a medication of any type for their AR, with nearly a 4:1 ratio of patients taking a prescription medication  versus an over-the-counter (OTC) medication in the past 4 weeks. Over 75% of survey respondents reported taking an intranasal corticosteroid (INCS) in the last 4 weeks and the satisfaction rate of INCS medications was similar to that reported for OTC medications. The most common reasons cited  for dissatisfaction with INCS medications were inadequate effectiveness, bothersome side effects (e.g., unpleasant taste and retrograde drainage into the pharynx), decreased effectiveness with chronic use, and failure to provide 24-hour relief.
  
  
  CONCLUSIONS
  These  data show that AR is common in the Middle East region as elsewhere in the world. Many patients with AR in Middle East region suffer from their symptoms (e.g., runny nose, nasal itching, nasal congestion, postnasal drip, and other symptoms) on all or most days during the times of the  year that their allergies are worst. These symptoms have been shown to reduce QOL and performance at work/school to a significant degree. Additionally, the survey data underscore a considerable treatment gap with current therapies for AR and that many AR patients still have not found adequate  effectiveness with currently available medications. Thus, through identification of disease impact on the Middle East population and highlighting treatment gaps, clinicians in the Middle East may better understand and treat AR, leading to improvements in overall patient satisfaction and QOL.
authors.affiliation: Ear, Nose, and Throat Department, Dubai Hospital, Dubai, United Arab Emirates. hmabdulrahman@dohms.gov.ae
authors.forename: Hussain
authors.initials: H
authors.lastname: Abdulrahman
authors.forename: Usamah
authors.initials: U
authors.lastname: Hadi
authors.forename: Hisham
authors.initials: H
authors.lastname: Tarraf
authors.forename: Mohammad
authors.initials: M
authors.lastname: Gharagozlou
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kamel
authors.forename: Alaa
authors.initials: A
authors.lastname: Soliman
authors.forename: Walid Abou
authors.initials: WA
authors.lastname: Hamad
authors.forename: Kamal Maurice
authors.initials: KM
authors.lastname: Hanna
authors.forename: Badr Eldin
authors.initials: BE
authors.lastname: Mostafa
authors.forename: Mohammádreza
authors.initials: M
authors.lastname: Omrani
authors.forename: Abdelfatah
authors.initials: A
authors.lastname: Abdelmotal
authors.forename: Nabil
authors.initials: N
authors.lastname: Moukarzel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D012221:Rhinitis, Allergic, Perennial / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D006255:Rhinitis, Allergic, Seasonal / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy