title: The hidden burden of adult allergic rhinitis: UK healthcare resource utilisation survey.
abstract: BACKGROUND
  The affliction of allergic rhinitis (AR) has been trivialised in the past. Recent initiatives by the European Academy of Allergy & Clinical Immunology and by the EU parliament seek to rectify that situation. The aim of this study was to provide a comprehensive picture of the burden and unmet need of AR patients.
  
  
  METHODS
  This was a cross-sectional, online, questionnaire-based study (June-July 2011) including symptomatic seasonal AR (SAR) patients (≥18 years) from a panel. SAR episode pattern, severity, medication/co-medication usage, residual symptoms on treatment, number of healthcare visits, absenteeism and presenteeism were collected.
  
  
  RESULTS
  One thousand patients were recruited (mild: n = 254; moderate/severe: n = 746). Patients with moderate/severe disease had significantly more symptomatic episodes/year (8.0 vs 6.0/year; p = 0.025) with longer episode-duration (12.5 vs 9.8 days; p = 0.0041) and more commonly used ≥2 AR therapies (70.5 vs 56.1 %; OR 1.87; p = 0.0001), looking for better and faster nasal and ocular symptom relief. The reported symptom burden was high irrespective of treatment, and significantly (p < 0.0001) higher in the moderate/severe group. Patients with moderate/severe AR were more likely to visit their GP (1.61 vs 1.19 times/year; OR: 1.49; p = 0.0061); due to dissatisfaction with therapy in 35.4 % of cases. Patients reported SAR-related absenteeism from work on 4.1 days/year (total cost to UK: £1.25 billion/year) and noted presenteeism for a mean of 37.7 days/year (vs 21.0 days/year; OR 1.71; p = 0.0048). Asthma co-morbid patients reported the need to increase their reliever- (1 in 2 patients) and controller-medication (1 in 5 patients) if they did not take their rhinitis medication.
  
  
  CONCLUSIONS
  This study differentiated between patients with mild and moderate/severe AR, demonstrating a burden of poorly controlled symptoms and high co-medication use. The deficiency in obtaining symptom control with what are currently considered firstline treatments suggests the need for a novel therapeutic approach.
authors.affiliation: University of Aberdeen, Aberdeen, UK.
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.affiliation: The Royal National Throat, Nose and Ear Hospital, London, UK.
authors.forename: Glenis
authors.initials: G
authors.lastname: Scadding
authors.affiliation: Woodbrook Medical Centre, Loughborough, UK ; University of Edinburgh, Edinburgh, UK.
authors.forename: Dermot
authors.initials: D
authors.lastname: Ryan
authors.affiliation: Upper Airways Research Laboratory, Ghent University Hospital, Ghent, Belgium.
authors.forename: Claus
authors.initials: C
authors.lastname: Bachert
authors.affiliation: Allergy and Respiratory Clinic, IRCCS AOU S. Martino, Genoa, Italy.
authors.forename: G Walter
authors.initials: GW
authors.lastname: Canonica
authors.affiliation: Hospital Clínic, IDIBAPS, CIBERES, Barcelona, Catalonia Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Mullol
authors.affiliation: Center for Rhinology and Allergology, Wiesbaden, Germany.
authors.forename: Ludger
authors.initials: L
authors.lastname: Klimek
authors.affiliation: ICON, Oxford, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Pitman
authors.affiliation: Acaster Consulting, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Acaster
authors.affiliation: Medscript Ltd, Dundalk, Ireland.
authors.forename: Ruth
authors.initials: R
authors.lastname: Murray
authors.affiliation: University Hospital, Montpellier, France ; MACVIA-LR, Contre les Maladies Chronique spour un Vieillissement Actif en Languedoc Roussilon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France ; INSERM, VIMA : Ageing and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, Paris, France ; UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Versailles, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Bousquet
keywords: Absenteeism; Allergic rhinitis; Co-medication; Presenteeism; Symptom episode; UK