Skip to main content
Log in

Impact of Allergic Rhinitis Treatment on Quality of Life

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Allergic rhinitis is a chronic inflammatory disorder of the nasal passages. It affects approximately 20% of the population, is a significant health and economic burden, and severely impairs quality of life.

Two main instruments, Medical Outcomes Study 36-Item Short Form health survey (SF-36) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) have been used to assess quality of life in patients with allergic rhinitis. Antihistamines, corticosteroids, anticholinergic agents, decongestants, cromoglycates, and immunotherapy are used to treat patients with allergic rhinitis.

Of these, antihistamines and intranasal corticosteroids are the most efficacious and frequently utilised medications. Studies have demonstrated improvements in quality of life with both of these medications in patients with allergic rhinitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I

Similar content being viewed by others

References

  1. Druce HM. Allergic and nonallergic rhinitis. In: Middleton EJ, Reed CE, Ellis EF, et al., editors. Allergy principles and practice. 5th ed. St. Louis: Mosby Year Book Inc., 1998: 1005–16

    Google Scholar 

  2. Emmanuel EB. Hayfever, a post-industrial revolution epidemic: a history of its growth during the 19th century. Clin Allergy 1988; 18: 295–304

    Article  Google Scholar 

  3. Aberg N. Asthma and allergic rhinitis in Swedish conscripts. Clin Exp Allergy 1989; 19: 59–63

    Article  PubMed  CAS  Google Scholar 

  4. Barbee R, Kaltenborn W, Lebowitz M, et al. Longitudinal changes in skin test reactivity in a community population sample. J Allergy Clin Immunol 1987; 79: 16–24

    Article  PubMed  CAS  Google Scholar 

  5. Upton MN, McConnachie A, McSharry C, et al. Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring. BMJ 2000; 321 (7253): 88–92

    Article  PubMed  CAS  Google Scholar 

  6. Ciprandi G, Vizzaccaro A, Cirillo I, et al. Increase of asthma and allergic rhinitis prevalence in young Italian men. Int Arch All Immunol 1996; 111 (3): 278–83

    Article  CAS  Google Scholar 

  7. Dykewicz MS, Fineman S, Skoner DP, et al. Diagnosis and management of rhinitis: Complete Guidelines of the Joint Task Force on practice parameters in allergy, asthma, and immunology. Ann Allergy Asthma Immunol 1998; 81: 478–518

    Article  PubMed  CAS  Google Scholar 

  8. Malone DC, Battista C, Arrighi HM, et al. A cost of illness study of allergic rhinitis in the United States. J Allergy Clin Immunol 1997; 99: 22–7

    PubMed  CAS  Google Scholar 

  9. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey. Med Care 1992; 30: 473–83

    Article  PubMed  Google Scholar 

  10. Gilson BS, Gilson JS, Bergner M, et al. The sickness impact profile: development of an outcome measure for health care. Am J Public Health 1975; 65: 1304

    Article  PubMed  CAS  Google Scholar 

  11. Bousquet J, Bullinger M, Fayol C, et al. Assessment of quality of life in patients with perennial allergic rhinitis with the French version of the SF-36 Health Status Questionnaire. J Allergy Clin Immunol 1994; 94: 182–8

    Article  PubMed  CAS  Google Scholar 

  12. Juniper EF, Guyatt GH. Development and testing of a new measure of health status for clinical trials in rhinoconjunctivitis. Clin Exp Allergy 1991; 21: 77–83

    Article  PubMed  CAS  Google Scholar 

  13. Juniper EF, Guyatt GH, Dolovich J. Assessment of quality of life in adolescents with allergic rhinoconjuncitivitis: development and testing of a questionnaire for clinical trials. J Allergy Clin Immunol 1994; 93: 413–23

    Article  PubMed  CAS  Google Scholar 

  14. Meltzer EO, Nathan RA, Selner JC, et al. Quality of life and rhinitic symptoms: results of a nationwide survey with the SF-36 and RQLQ questionnaires. J Allergy Clin Immunol 1997; 99 (Pt 2): S815–9

    Article  Google Scholar 

  15. Guill MF, Buckley RH, Rocha W, et al. Multicenter, double-blind, placebo-controlled trial of terfenadine suspension in the treatment of fall-allergic rhinitis in children. J Allergy Clin Immunol 1986; 78: 4–9

    Article  PubMed  CAS  Google Scholar 

  16. Georgitis JW, Shen D. Nasal pharmacodynamics of brompheniramine in perennial rhinitis. Arch Otolaryngol Head Neck Surg 1988; 114: 63–7

    Article  PubMed  CAS  Google Scholar 

  17. Dockhorn RJ, Bergner A, Connell JT, et al. Safety and efficacy of loratidine (Sch-29851): a new non-sedating antihistamine in seasonal allergic rhinitis. Ann Allergy 1987; 58: 407–11

    PubMed  CAS  Google Scholar 

  18. Backhouse CI, Renton R, Fidler C, et al. Multicentre double-blind comparison of terfenadine and cetirizine in patientswith seasonal allergic rhinitis. Br J Clin Pract 1990; 44: 88–91

    PubMed  CAS  Google Scholar 

  19. Meltzer EO. Performance effects of antihistamines. J Allergy Clin Immunol 1990; 86: 613–9

    Article  PubMed  CAS  Google Scholar 

  20. Druce H. Impairment of function by antihistamines. Ann Allergy 1990; 64: 403–5

    PubMed  CAS  Google Scholar 

  21. O’Hanlon JF. Antihistamines and driving performance: The Netherlands. J Respir Dis 1988; 9: 12–7

    Google Scholar 

  22. Roth T, Roehrs T, Koshorek G, et al. Sedative effects of antihistamines. J Allergy Clin Immunol 1987; 80: 94–8

    Article  PubMed  CAS  Google Scholar 

  23. Nolan TM. Sedative effects of antihistamines: safety, performance, learning, and quality of life. Clin Ther 1997; 19 (1): 39–55

    Article  Google Scholar 

  24. Vuurman EFPM, van Veggel LMA, Uiterwijk MMC, et al. Seasonal allergic rhinitis and antihistamine effects on children’s learning. Ann Allergy 1993; 71: 121–6

    PubMed  CAS  Google Scholar 

  25. Zyrtec® (cetirizine hydrochloride) tablets. Physicians’ Desk Reference. Montvale (NJ): Medical Economics Co, Inc., 2000: 2405

  26. Ramaekers JG, Uiterwijk MMC, O’Hanlon JF. Effects of loratidine and cetirizine on actual driving a psychometric test performance, and EEG during driving. Eur J Clin Pharmacol 1992; 42: 363–9

    PubMed  CAS  Google Scholar 

  27. Patat A, Stubbs D, Dunmore C, et al. Lack of interaction between two antihistamines, mizolastine and cetirizine, and ethanol in psychomotor and driving performance in healthy subjects. Eur J Clin Pharmacol 1995; 48: 143–50

    Article  PubMed  CAS  Google Scholar 

  28. Volkerts ER, van Willigenburg PP, van Laar MW, et al. Does cetirizine belong to the new generation of antihistamines? An investigation into its acute and subchronic effects of highway driving, psychometric test performance and daytime sleepiness. Hum Psychopharmacol 1992; 7: 227–38

    Article  CAS  Google Scholar 

  29. Kemp JP. Antihistamines: is there anything safe to prescribe? Ann Allergy 1992; 69: 276–80

    PubMed  CAS  Google Scholar 

  30. Hindmarch I, Shamsi Z, Stanley N, et al. A double-blind, placebo-controlled investigation of the effects of fexofenadine, loratidine and promethazine on cognitive and psychomotor function. Br J Clin Pharm 1999; 48 (2): 200–6

    Article  CAS  Google Scholar 

  31. Honig PK, Worthoun DC, Zamani K, et al. Terfenadine-ketoconazole interaction. JAMA 1993; 269: 1513–8

    Article  PubMed  CAS  Google Scholar 

  32. Tobin JR, Doyle TP, Ackerman AD, et al. Astemizole-induced cardiac conduction disturbances in a child. JAMA 1991; 266: 2737–40

    Article  PubMed  CAS  Google Scholar 

  33. Brannan MD, Reidenberg P, Radwanski E, et al. Loratidine administered concomitantly with erythromycin: pharmacokinetic and electrocardiographic evaluations. Clin Pharmcol Ther 1995; 58: 269–78

    Article  CAS  Google Scholar 

  34. Sale M, Woosley R, Thakker K, et al. Effects of cetirizine and erythromycin, alone and in combination on QT interval and pharmacokinetics in healthy subjects [abstract]. Ann Allergy Asthma Immunol 1996; 76: 93

    Google Scholar 

  35. Bernstein DI, Schoenwetter WF, Nathan RA, et al. Efficacy and safety of fexofenadine hydrochloride for treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 1997; 79: 443–8

    Article  PubMed  CAS  Google Scholar 

  36. Bousquet J, Duchateau J, Pignat JC, et al. Improvement of quality of life by treatment with cetirizine in patients with perennial allergic rhinitis as determined by a French Version of the SF-36 questionnaire. J Allergy Clin Immunol 1996; 98: 308–16

    Google Scholar 

  37. Meltzer EO, Casale TB, Nathan RA, et al. Once-daily fexofenadine HCL improves quality of life and reduces work and activity impairment in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 1999; 83: 311–7

    Article  PubMed  CAS  Google Scholar 

  38. Corren J, Harris AG, Aaronson D, et al. Efficacy and safety of loratidine plus pseudoephedrine in patients with seasonal allergic rhinitis and mild asthma. J Allergy Clin Immunol 1997; 100: 781–8

    Article  PubMed  CAS  Google Scholar 

  39. Janssens MML, Bussche GV. Levocarbastine: an effective topical treatment of allergic rhinoconjunctivitis. Clin Exp Allergy 1991; 21 Suppl. 2: 29–36

    Article  PubMed  Google Scholar 

  40. Ratner PH, Findlay SR, Hampel Jr F, et al. A double-blind controlled trial to assess the safety and efficacy of azelastine nasal spray in seasonal allergic rhinitis. J Allergy Clin Immunol 1994; 94: 818–25

    Article  PubMed  CAS  Google Scholar 

  41. Astelin® (azelastine hydrochloride) nasal spray. Physicians’ Desk Reference. Montvale (NJ): Medical Economics Co., Inc., 2000: 3148

  42. Busse W, Randley B, Sedgwick J, et al. The effect of azelastine on neutrophil and eosinophil generation of superoxide. J Allergy Clin Immunol 1989; 83: 400–5

    Article  PubMed  CAS  Google Scholar 

  43. Ciprandi G, Pronzati C, Passalacqua G, et al. Topical azelastine reduces eosinophil activation and intercellular adhesion molecule-1 expression on nasal epithelial cells: an antiallergic activity. J Allergy Clin Immunol 1996; 98: 1088–96

    Article  PubMed  CAS  Google Scholar 

  44. Pichler WJ, Klint T, Blaser G, et al. Clinical comparison of systemic methylprednisolone acetate versus topical budesonide in patients with seasonal allergic rhinitis. Allergy 1988; 43 (2): 87–92

    Article  PubMed  CAS  Google Scholar 

  45. Ratner P, van Bavel J, Gross G, et al. New formulation of aqueous flunisolide nasal spray in the treatment of allergic rhinitis: comparative assessment of safety, tolerability, and efficacy. Allergy Asthma Proc 1996: 17 (3): 149–56

    Article  PubMed  CAS  Google Scholar 

  46. Hillas J, Booth RJ, Somerfield S, et al. A comparative trial of intra-nasal beclomethasone dipropionate and sodium cromoglycate in patients with chronic perennial rhinitis. Clin Allergy 1980; 10: 253–8

    Article  PubMed  CAS  Google Scholar 

  47. Welsh PW, Stricker WE, Chu CP, et al. Efficacy of beclomethasone nasal solution, flunisolide, and cromolyn in relieving symptoms of ragweed allergy. Mayo Clin Proc 1987; 62: 125–34

    Article  PubMed  CAS  Google Scholar 

  48. Bernstein DI, Creticos PS, Busse WW, et al. Comparison of triamcinolone acetonide nasal inhaler with astemizole in treatment of ragweed-induced allergic rhinitis. J Allergy Clin Immunol 1996; 97: 749–55

    Article  PubMed  CAS  Google Scholar 

  49. Bronsky EA, Dockhorn RJ, Meltzer EO, et al. Fluticasone propionate aqueous nasal spray compared with terfenadine tablets in the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol 1996; 97: 749–55

    Article  Google Scholar 

  50. Gomez E, Clague JE, Gatland D, et al. Effect of topical corticosteroids on seasonally induced increases in nasal mast cells. BMJ 1988; 296: 1572–3

    Article  PubMed  CAS  Google Scholar 

  51. Rak S, Jacobson MR, Sudderick RM, et al. Influence of prolonged treatment with topical corticosteroid (fluticasone propionate) on early and late phase nasal responses and cellular infiltration in the nasal mucosa after allergen challenge. Clin Exp Allergy 1994; 24: 930–9

    Article  PubMed  CAS  Google Scholar 

  52. Laforce C. Use of nasal steroids in managing allergic rhinitis. J Allergy Clin Immunol 1999; 103 (Suppl. Pt 2): S388–94

    Article  PubMed  CAS  Google Scholar 

  53. LaForce C, Davis V. Nasal septal perforation in patients using intranasal beclomethasone propionate (BDP) [abstract]. J Allergy Clin Immunol 1985; 75 Suppl.: 186

    Article  Google Scholar 

  54. Soedber Warner ML. Nasal septal perforation associated with topical corticosteroid therapy. J Pediatr 1984; 105: 840–1

    Article  Google Scholar 

  55. Halopainen E, Mlmberg H, Binder E. Long term follow-up of intra-nasal beclomethasone treatment: a clinical and histologic study. Acta Otolaryngol 1982; 386 Suppl.: 270

    Article  Google Scholar 

  56. Sorensen H, Mygind N, Pederson CB, et al. Long term treatment of nasal polyps with beclomethasone dipropionate aerosol. III. Morphological studies and conclusions. Acta Otolaryngol 1976; 182: 260–2

    Article  Google Scholar 

  57. Orgel HA, Meltzer EO, Bierman CW, et al. Intranasal fluocortin butyl in patients with perennial rhinitis: a 12-month efficacy and safety study including nasal biopsy. J Allergy Clin Immunol 1991; 88: 257–64

    Article  PubMed  CAS  Google Scholar 

  58. Rachelefsky GS, Chervinsky P, Meltzer EO, et al. An evaluation of the effects of beclomethasone dipropionate aqueous nasal spray on long-term growth in children [abstract]. J Allergy Clin Immunol 1998; 101 (Pt 2): S236

    Google Scholar 

  59. Wolthers OD, Pedersen S. Short term growth in children with allergic rhinitis treated with oral antihistamine depot and intranasal glucocorticosteroids. Acta Pediatr 1993; 82: 635–40

    CAS  Google Scholar 

  60. Wiseman LR, Benfield P. Intranasal fluticasone propionate: a reappraisal of its pharmacology and clinical efficacy in the treatment of rhinitis. Drugs 1997; 53: 885–907

    Article  PubMed  CAS  Google Scholar 

  61. Brannan MD, Herron JM, Reidenberg P, et al. Lack of hypothalamic-pituitary-adrenal axis suppression with once-daily or twice-daily beclomethasone dipropionate aqueous nasal spray administered to patients with allergic rhinitis. Clin Ther 1995; 17 (4): 637–47

    Article  PubMed  CAS  Google Scholar 

  62. Pipkorn U, Pukander J, Suonpaa J, et al. Long-term safety of budesonide nasal aerosol: a 5.5-year follow-up study. Clin Allergy 1988; 18: 253–9

    Article  PubMed  CAS  Google Scholar 

  63. Juniper EF, Willms DG, Guyatt GH, et al. Aqueous beclomethasone dipropionate nasal spray in the treatment of seasonal (ragweed) rhinitis. CMAJ 1992; 147 (6): 887–92

    PubMed  CAS  Google Scholar 

  64. Juniper EF, Guyatt GH, O’Byrne PM, et al. Aqueous beclomethasone dipropionate nasal spray: regular versus ‘as required’ use in the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol 1990; 86: 380–6

    Article  PubMed  CAS  Google Scholar 

  65. Meltzer EO. Clinical and antiinflammatory effects of intranasal budesonide aqueous pump spray in the treatment of perennial allergic rhinitis. Ann Allergy Asthma Immunol 1998; 81: 128–34

    Article  PubMed  CAS  Google Scholar 

  66. Shapiro GG, Konig P. Cromolyn sodium: a review. Pharmacotherapy 1985; 5: 156–70

    PubMed  CAS  Google Scholar 

  67. Schulller DE, Fink JN, Fillery WV, et al. A multicenter trial of nedocromil sodium, 1% nasal solution, compared with cromolyn sodium and placebo in ragweed seasonal allergic rhinitis. J Allergy Clin Immunol 1990; 86: 554–61

    Article  Google Scholar 

  68. Juniper EF, Guyatt GH, Ferrie PJ, et al. Sodium cromoglycate eye drops: regular versus ‘as needed’ use in the treatment of seasonal allergic conjunctivitis. J Allergy Clin Immunol 1994; 94 (1): 36–43

    Article  PubMed  CAS  Google Scholar 

  69. Meltzer EO, Orgel A, Bronsky EA, et al. Ipratropium bromide aqueous nasal spray for patients with perennial allergic rhinitis: a study of its effect on their symptoms, quality of life, and nasal cytology. J Allergy Clin Immunol 1992; 90: 242–9

    Article  PubMed  CAS  Google Scholar 

  70. Grossman J, Banov C, Boggs P, et al. Use of ipratropium bromide nasal spray in chronic treatment of nonallergic perennial rhinitis, alone and in combination with other perennial rhinitis medications. J Allergy Clin Immunol 1995; 95: 1123–7

    Article  PubMed  CAS  Google Scholar 

  71. Williams BO, Hull H, McSorley P. Efficacy of acrivastine plus pseudoephedrine for symptomatic relief of seasonal allergic rhinitis due to mountain cedar. Ann AllergyAsthma Immunol 1996; 76: 432–8

    Article  CAS  Google Scholar 

  72. Bronsky E, Poggs P, Findlay S, et al. Comparative efficacy and safety of a once-daily loratidine-pseudoephedrine combination versus components alone and placebo in the management of seasonal allergic rhinitis. J Allergy Clin Immunol 1995; 96; 139–47

    Article  PubMed  CAS  Google Scholar 

  73. Durham SF, Walker SM, Varga EM, et al. Long-term clinical efficacy of grass-pollen immunotherapy. N Engl J Med 1999; 341: 468–75

    Article  PubMed  CAS  Google Scholar 

  74. Naclerio RM, Proud D, Moylan B, et al. A double-blind study of the discontinuation of ragweed immunotherapy. J Allergy Clin Immunol 1997; 100: 293–300

    Article  PubMed  CAS  Google Scholar 

  75. Mosbech H, Osterballe O. Does the effect of immunotherapy last after termination of treatment? Follow-up study in patient swith grass pollen rhinitis. Allergy 1988; 43: 523–9

    Article  PubMed  CAS  Google Scholar 

  76. Norman PS. Immunotherapy past and present. J Allergy Clin Immunol 1998; 102: 1–10

    Article  PubMed  CAS  Google Scholar 

  77. Fell WR, Mabry RL, Mabry CS. Quality of life analysis of patients undergoing immunotherapy for allergic rhinitis. Ear Nose Throat J 1997; 76 (8): 528–36

    PubMed  CAS  Google Scholar 

  78. Juniper EF, Guyatt GH, Griffith LE. First-line treatment of seasonal (ragweed) rhinoconjunctivitis: a randomized management trial comparing a nasal steroid spray and a nonsedating antihistamine. CMAJ 1997; 156 (8): 1123–31

    PubMed  CAS  Google Scholar 

  79. Ratner PH, van Bavel JH, Martin BG, et al. A comparison of the efficacy of fluticasone propionate aqueous nasal spray and loratidine, alone and in combination, for the treatment of seasonal allergic rhinitis. J Fam Pract 1998; 47 (2): 118–25

    PubMed  CAS  Google Scholar 

  80. Kozma CM, Schulz RM, Sclar DA, et al. A comparison of costs and efficacy of intranasal fluticasone propionate and terfenadine tablets for seasonal allergic rhinitis. Clin Ther 1996; 18: 334–46

    Article  PubMed  CAS  Google Scholar 

  81. Munch EP, Soborg M, Norreslet TT, et al. A comparative study of dexchlorphenirmaine maleate sustained release tablets and budesonide nasal spray in seasonal allergic thinitis. Allergy 1983; 38: 517–24

    Article  PubMed  CAS  Google Scholar 

  82. Schoenwetter W, Lim J. Comparison of intranasal triamcinolone acetonide with oral loratadine for the treatment of patients with seasonal allergic rhinitis. Clin Ther 1995; 17: 479–92

    Article  PubMed  CAS  Google Scholar 

  83. Dickson DJ, Crucickshank MJ. Comparison of flunisolide nasal spray and terfenadine tablets in hay fever. Br J Clin Pract 1984; 416–20

    Google Scholar 

  84. van Bavel J, Findlay SR, Hampel Jr FC, et al. Intranasal fluticasone propionate is nore effective than terfenadine tablets for seasonal allergic rhintis. Arch Intern Med 1994; 154: 2699–704

    Article  PubMed  Google Scholar 

  85. Gehanno P, Desfougheres J-L. Fluticasone propionate aqueous nasal spray compared with oral loratadine in patients with seasonal allergic rhinitis. Allergy 1997; 52: 445–50

    Article  PubMed  CAS  Google Scholar 

  86. Beswick KBJ, Kenyon GS, Cherry JR. A comparative study of beclomethasone dipropionate aqueous spray with terfenadine tablets in seasonal allergic rhinitis. Curr Med Res Opin 1985; 9: 560–7

    Article  PubMed  CAS  Google Scholar 

  87. Bjerrum P, Illum P. Treatment of seasonal allergic rhinitis with budesonide and disodium cromoglycate. Allergy 1985; 40: 65–9

    Article  PubMed  CAS  Google Scholar 

  88. Brooks CD, Francom SF, Peel BG, et al. Spectrum of seasonal allergic rhinitis symptom relief with topical corticoid and oral antihistamine given singly or in combination. Am J Rhinology 1996; 10: 193–9

    Article  Google Scholar 

Download references

Acknowledgements

Supported by the Ernest S. Bazley Grant to Northwestern Memorial, Hospital and Northwestern University Medical School, USA.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anju Tripathi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tripathi, A., Patterson, R. Impact of Allergic Rhinitis Treatment on Quality of Life. Pharmacoeconomics 19, 891–899 (2001). https://doi.org/10.2165/00019053-200119090-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-200119090-00001

Keywords

Navigation