title: Comparison of six disease severity scores for allergic rhinitis against pollen counts a prospective analysis at population and individual level.
abstract: Many different symptom (medication) scores are nowadays used as measures of allergic rhinoconjunctivitis severity in individual patients and in clinical trials. Their differences contribute to the heterogeneity of the primary end-point in meta-analyses, so that calls for symptom (medication) score harmonization have been launched.
  
  
  
  To prospectively compare six different severity scores for allergic rhinitis (AR) against pollen counts at both population and individual levels.
  
  
  
  Two groups of children with seasonal AR and grass pollen sensitization were recruited in Ascoli, Italy (n = 76) and Berlin, Germany (n = 29). Symptoms and drug intake were monitored daily for 40 and 30 days of the grass pollen season in 2011 (Ascoli) and 2013 (Berlin), respectively, through an Internet-based platform (AllergyMonitor(™) , TPS Production srl, Rome, Italy). From the gathered data, the informatics platform automatically generated one symptom score (RTSS) and five symptom-medication scores (RC-ACS(©) , ACS, RTSS[LOCF], RTSS[WC] and AdSS). Values were then statistically normalized for reciprocal comparison and matched against the daily variations of local grass pollen counts (Spearman's rank correlation).
  
  
  
  The grass pollen counts were higher in Ascoli than in Berlin (peak values 194 vs. 59 grains/m(3) ). At population level, the trajectories of the normalized average values of the six scores differed only slightly in both studies and correlated well with the pollen counts (ranges r(2) : 0.38-0.50 in Ascoli, 0.41-0.56 in Berlin). By contrast, in individual patients, trajectories of different scores were often quite heterogeneous. The RTSS[WC] had a very low discriminatory power and generated in many patients long, flat horizontal segments.
  
  
  
  Disease severity scores for seasonal AR, as evaluated via an Internet-based platform, tend to provide similar results at population level but can often produce heterogeneous slopes in individual patients. The choice of the disease severity score might have only a low impact on the outcome of a very large clinical trial, but it may be crucial in the management of individual patients.
authors.affiliation: Department of Paediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany.
authors.forename: Jakob
authors.initials: J
authors.lastname: Florack
authors.affiliation: Department of Biology, University of Rome 'Tor Vergata', Rome, Italy.
authors.forename: Maria Antonia
authors.initials: MA
authors.lastname: Brighetti
authors.affiliation: Department of Paediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany.|Statistics Institute, University 'La Sapienza', Rome, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Perna
authors.affiliation: Department of Paediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany.|Pediatric Allergy and Pulmonology HC Practice, Berlin, Germany.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pizzulli
authors.affiliation: Pediatric Allergy and Pulmonology HC Practice, Berlin, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Pizzulli
authors.affiliation: Pediatric Department and Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy.|TPS Production srl, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tripodi
authors.affiliation: Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria (CREA), Unità di ricerca per l'ingegneria agraria, Monterotondo, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Costa
authors.affiliation: Department of Biology, University of Rome 'Tor Vergata', Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Travaglini
authors.affiliation: TPS Production srl, Rome, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Pelosi
authors.affiliation: Operative Complex Unit of Pediatrics, San Camillo-Forlanini Hospital, Rome, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Bianchi
authors.affiliation: Department of Paediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany.
authors.forename: Olympia
authors.initials: O
authors.lastname: Tsilochristou
authors.affiliation: ARPAM, Marche Aerobiological Monitoring Service, Castel di Lama, Ascoli Piceno, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gabrielli
authors.affiliation: Department of Paediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany.
authors.forename: Paolo Maria
authors.initials: PM
authors.lastname: Matricardi
mesh_terms: D000293:Adolescent; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D005858:Germany; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D020407:Internet; D007558:Italy; D008297:Male; D006109:Poaceae / Q000276:immunology*; D011058:Pollen / Q000276:immunology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018926:Anti-Allergic Agents
keywords: allergic rhinitis; e-Health; grass pollen; hay fever; symptom-medication score