This cross-sectional, multicenter survey was the first to evaluate the severity, impact on everyday life activities, symptom perception, and concomitant asthma frequency in allergic rhinitis patients in all counties of Hungary. Conducted among 933 patients with AR presenting to their specialist, the study found that AR was mostly confirmed with diagnostic tests in Hungary. A marked proportion of patients had moderate or severe disease (57.34%), persistent symptoms (98.0%) and comorbidities such as asthma (53.32% in the mild, while 57.52% in the moderate to severe AR). Underrepresentation of patients with intermittent disease might be the consequence of over-the-counter freely available antihistamine tablets available for intermittent AR patients for 4 weeks without medical prescription.
As reflected in this and other surveys, AR imposes a substantial burden on patients regarding everyday life limitations and work performance[12, 13]. Nearly 60% of AR patients had moderate to severe disease, and these patients – although treated – showed marked nasal and ocular allergic rhinitis symptoms and hence suffered from sleep- and concentration disturbances, limitations on everyday life activities, and poor work/school productivity. Majority of moderate to severe patients in this survey considered that they had remarkable difficulties because of AR. However, patients with mild AR did not show limitations regarding any aspects of everyday life.
Our results confirm higher rate of seasonal AR and are similar to those of AILA study (Allergies in Latin America), revealing that 62% of Latin American AR patients are seasonally affected, with the remaining 38% suffering year-long symptoms. In the study of Navarro et al. 46% of cases were intermittent, 54% persistent, 43% mild, and 57% moderate-severe. Pereira et al., whose study included 3225 subjects attending the allergy clinics, found that 36% had intermittent rhinitis, 64% persistent rhinitis, 59% mild rhinitis, and 41% moderate-severe rhinitis. Bachert et al. assessed the data of 554 subjects recruited from the general population with rhinitis symptoms. They found that 59% had intermittent rhinitis, 41% persistent rhinitis, 25% mild rhinitis, and 75% moderate-persistent rhinitis. Bousquet et al. reported that 46% of 3,052 subjects had intermittent rhinitis, 54% persistent rhinitis, 19% mild rhinitis, and 81% moderate-severe disease. Consistent with findings from previous surveys, it can be concluded that the prevalence of moderate to severe AR is higher among women than among men. Likewise previous data, also this survey found high symptom burden among moderate to severe-, and a very good symptom control in mild AR patients who presented to their physician[13, 16]. The most frequent patient-reported symptoms were: nasal congestion and obstruction as well as rhinorrhoea and ocular symptoms; in agreement with the results of Asia-Pacific Survey of Katelaris et al..
Overall, there was only a poor correlation between the AR severity evaluated by physicians and that based on patients’ opinion. In good agreement with previous results of Canonica et al. it can be concluded that physicians underrate the severity of AR in many cases. The underestimation of the severity may partially lead to adherence problems. Non-adherence to the prescribed therapeutic regimen is a worldwide problem. Reviews about various diseases conducted across countries are consistent in estimating non-compliance between 30 and 50%. However, it is clear that adequate management of AR, including the patient’s adherence, is essential to achieve optimal therapeutic outcome. In our survey the compliance with tablet-taking and nasal spray use was found to be between 50 and 65%; mostly depending on the dosage form (higher for tablet-taking) and being fast independent from the severity of AR.
Several studies have confirmed the importance of rhinitis symptoms in the future development of asthma. The severity of rhinitis may also affect the development of asthma. In the present study the prevalence of asthma was found to be 53.32% in the mild, while 57.52% in the moderate-severe AR group. Other authors have found disparate results according to the population studied. Marogna et al., in an epidemiologic study carried out in 832 subjects with intermittent rhinitis, found that 11.6% developed asthma when AR was mild and 22.2% when the condition was moderate-severe, whereas in 968 subjects who had persistent AR, 30.1% and 35.4% developed asthma when AR was mild and moderate-severe, respectively.
This is the only multicenter study ever conducted in Hungary to describe the symptoms, impact on everyday life and concomitant asthma frequency of AR; however as a real-life investigation it has many limitations. The bias on symptom severity caused by a possible not proper AR diagnosis or treatment non-adherence cannot be excluded in some cases. There were 74 surveys which were not included in the analysis due to missing data. Furthermore, some local and oral antihistamines, nasal decongestants may be purchased over-the-counter in pharmacies, therefore their use is completely unknown in this survey.