title: Specialist-based treatment reduces the severity of allergic rhinitis.
abstract: BACKGROUND
  Although the treatment of allergic rhinitis (AR) is now well established, its impact on severity has not yet been evaluated.
  
  
  OBJECTIVE
  The aim was to analyse specialist-based treatment on AR severity, nasal symptoms and quality of life.
  
  
  METHODS
  A longitudinal observational, prospective, multi-centre study with 4 weeks of follow-up was carried out by 141 allergologists and ENT specialists in Spain. Selection criteria were adult patients with AR, clinically diagnosed at least 2 years before, with a total nasal symptom score (TNSS) ≥5, not receiving either antihistamines within the previous week or nasal corticosteroids during the 2 previous weeks. Disease severity using both original Allergic Rhinitis and its Impact on Asthma (o-ARIA) and modified (m-ARIA) classifications, nasal symptoms, and Quality of Life (ESPRINT-15), were measured at baseline and after 4 weeks of treatment.
  
  
  RESULTS
  Among the recruited AR patients (n = 707, 58% women), 39.3% were intermittent and 60.7% persistent, 40.2% had asthma and 61.4% conjunctivitis. Most patients were treated with second generation antihistamines in monotherapy (63.2%) or in combination with intranasal corticosteroids (31.5%). While using o-ARIA, 96.9% of patients had 'moderate/severe' AR, the m-ARIA discriminated between 'moderate' (55.4%) and severe (41.5%) AR, at baseline. After 4 weeks of treatment, improvement was found on disease severity (P < 0.0001), TNSS (8.2 ± 1.8 vs. 3.5 ± 2.3, P < 0.0001) and Quality of Life (ESPRINT-15 global score: 3.0 ± 1.2 vs. 1.1 ± 1.0, P < 0.0001).
  
  
  CONCLUSIONS
  Specialist-based treatment reduces AR severity, evaluated using the m-ARIA classification for the first time, in addition to the improvement of nasal symptoms and quality of life.
  
  
  CONCLUSIONS
  Specialist-based treatment improves AR severity, in addition to nasal symptoms and quality of life. However, no matter the treatment option some AR patients remain severe and need further follow-up.
authors.affiliation: Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain. jmullol@clinic.ub.es
authors.forename: J
authors.initials: J
authors.lastname: Mullol
authors.forename: J
authors.initials: J
authors.lastname: Bartra
authors.forename: A
authors.initials: A
authors.lastname: del Cuvillo
authors.forename: I
authors.initials: I
authors.lastname: Izquierdo
authors.forename: R
authors.initials: R
authors.lastname: Muñoz-Cano
authors.forename: A
authors.initials: A
authors.lastname: Valero
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D001249:Asthma / Q000145:classification / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D039563:Histamine H1 Antagonists, Non-Sedating / Q000008:administration & dosage*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D065631:Rhinitis, Allergic; D012221:Rhinitis, Allergic, Perennial / Q000145:classification / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D039563:Histamine H1 Antagonists, Non-Sedating