apa Asia Pacific Allergy Asia Pac Allergy 2233-8276 2233-8268 Asia Pacific Association of Allergy, Asthma and Clinical Immunology 10.5415/apallergy.2018.8.e7 apa-8-e7 Original Article The International Study of the Allergic Rhinitis Survey: outcomes from 4 geographical regions PassaliDesiderio 1 * CingiCemal 2 StaffaPaola 1 PassaliFrancesco 3 MulukNuray Bayar 4 BellussiMaria Luisa 1 Department of Otorhinolaryngology – Head and Neck Surgery, University of Siena, 53100 Siena, Italy Department of Otorhinolaryngology – Head and Neck Surgery, Osmangazi University, Faculty of Medicine, 26040 Eskisehir, Turkey ENT Clinic, University of Roma Tor Vergata, 00173 Rome, Italy Department of Otorhinolaryngology – Head and Neck Surgery, Kırıkkale University, Faculty of Medicine, 71450 Kırıkkale, Turkey Correspondence to Desiderio Passali Department of Otorhinolaryngology – Head and Neck Surgery, University of Siena, Viale Bracci, 11 53100, Siena, Italy. Tel: +39-335-6102667 E-mail: d.passali@virgilio.it Cemal Cingi Department of Otorhinolaryngology – Head and Neck Surgery, Osmangazi University, Faculty of Medicine, 26040 Eskisehir, Turkey. Tel: +90-532-2676616 Fax: +90-222-224-0424 E-mail: ccingi@gmail.com 01 2018 04 01 2018 8 1 e7 10082017 08012018 Copyright © 2018 Asia Pacific Association of Allergy, Asthma and Clinical Immunology 2018 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background

Allergic rhinitis (AR) is a global health problem and is characterised by one or more symptoms, including sneezing, itching, nasal congestion and rhinorrhea.

 Objective

We investigated the features of AR and the physician's approach to the management of AR patients in four geographical regions.

 Methods

In this cross-sectional study, a questionnaire survey concerning AR was completed by Honorary and Corresponding Members of the Italian Society of Rhinology from different countries among 4 world geographical regions—Asia, Europe, the Americas, and Africa.

 Results

The prevalence of AR was reported to be 15%–25%. Children and adolescents, as well as young adults, were the age groups more affected by AR with comorbidities of asthma, sinusitis, conjunctivitis, and nasal polyposis. Nasal symptoms of AR were more intense in the spring (51.92%) and autumn (28.85%). The most common aero-allergens were pollen and mites (67.31%), animal dander and pollutants (23.08%), and fungal allergens (21.15%). Allergen-specific immunotherapy was prescribed for both perennial and seasonal allergens (32.69%) via sublingual swallow (46.15%) and subcutaneous (32.69%) routes. For the AR patients, the most prescribed drugs were intranasal corticosteroids (86.54%) and oral H1-antihistamines (82.69%).

 Conclusion

A network of experts can improve our knowledge concerning AR epidemiology, and together with guidelines, could assist practitioners and otolaryngologists in standardising the diagnosis and treatment of AR.

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Tables

Allergic rhinitis survey results

Item Number/total number (%)
1) Which is the prevalence of allergic rhinitis in your country? Answer not given: 2 (3.85)
 1. 5% 7/52 (13.46)
 2. 15% 15/52 (28.85)
 3. 25% 19/52 (45.24)
 4. 35% 5/52 (9.62)
 5. >35% 5/52 (9.62)
2) The prevalence of allergic rhinitis in your country is: Answer not given: 2 (3.85)
 1. In dubious increase 10/52 (19.23)
 2. Steady 4/52 (7.69)
 3. Decreasing 0/52 (0)
 4. Surely increasing 36/52 (69.23)
3) The increasing prevalence. can be attributed to: Answer not given: 3 (5.77)
 1. Changing in lifestyle 24/52 (46.15)
 2. Increased exposure to allergens. irritants and pollutants 37/52 (71.15)
 3. Early exposure to allergens. irritants and pollutants 12/52 (23.08)
 4. Decreasing of some viral and/or bacterial infections 7/52 (13.56)
4) Which are the age groups more often affected by allergic rhinitis? Answer not given: 1 (1.92)
 1. Children and adolescents 23/52 (44.23)
 2. Young adults 22/52 (42.31)
 3. Old age 0/52 (0)
 4. All age groups 13/52 (25.00)
5) The comorbidities more frequently reported in patients with allergic rhinitis are: Answer not given: (1.92)
 1. Asthma 41/52 (78.85)
 2. Conjunctivitis 21/52 (40.38)
 3. Sinusitis 30/52 (57.69)
 4. Otitis media 5/52 (9.62)
 5. Nasal polyposis 19/52 (36.54)
6) Which specialist would more likely be consulted by a patient with allergic rhinitis? Answer not given: 0 (0)
 1. Primary care physician 19/52 (36.54)
 2. Allergologist 20/52 (38.46)
 3. Pulmonologist 8/52 (15.38)
 4. Otorhinolaryngologist 36/52 (69.23)
 5. Ophtalmologist 1/52 (1.96)
7) In which period of the year nasal symptoms are more intense? Answer not given: 1 (1.92)
 1. Spring 27/52 (51.92)
 2. Summer 8/52 (15.38)
 3. Autumn 15/52 (28.85)
 4. Winter 7/52 (13.46)
 5. Throughout the whole year 14/50 (26.92)
8) Which are the most common aero-allergens in your country? Answer not given: 0 (0)
 1. Mites 35/52 (67.31)
 2. Pollen 35/52 (67.31)
 3. Animal danders 12/52 (23.08)
 4. Pollutants 12/52 (23.08)
 5. Insects 1/52 (1.92)
 6. Fungal allergens 11/52 (21.15)
9) Which symptoms are more often complained by patients with allergic rhinitis? Answer not given: 0 (0)
 1. Rinorrhea 47/52 (90.38)
 2. Nasal blockage 49/52 (94.23)
 3. Hypo-anosmia 15/52 (28.85)
 4. Snoring, sleep problems 9/52 (17.31)
 5. Chronic cough 7/52 (13.46)
 6. Sedation 1/52 (1.92)
 7. Asthma and conjunctivitis 14/52 (26.92)
10) Do you perform prick test?* Answer not given: 0 (0)
 1. Yes 24/52 (46.15)
 2. No 28/52 (53.85)
11) If you answered yes, which kind of pollens do you test?* Answer not given: 29/52 (55.77)
 1. Betula verucosa or Betulaceae mix 7/52 (13.46)
 2. Cupressacee 6/52 (11.54)
 3. Grass mix 17/52 (32.69)
 4. Artemisia vulgaris 8/52 (15.38)
 5. Oleacee 5/52 (9.62)
 6. Parietaria officinalis 8/52 (15.38)
 7. Platanus occidentalis 7/52 (13.46)
 8. Ambrosia eliator 8/52 (15.38)
 9. Other (specify) 2/52 (3.85) (poplar)
12) Which kind of mites do you test?* Answer not given: 25 (48.08)
 1. Dermatophagoides pteronyssimus and Dermatophagoides farinae 27/52 (52.92)
 2. Euroglyphus maynei 2/52 (3.85)
 3. Lepidoglyphus denstructor 0 (0)
 4. Blomia tropicalis and Blomia kulagini 2 (3.85)
 5. Other (specify) 0 (0)
13) Which of these animal allergens do you test?* Answer not given: 24/52 (46.15)
 1. Cat (felix domesticus) 27/52 (51.92)
 2. Dog (canis familiaris) 27/52 (51.92)
 3. Horse 5/52 (9.62)
 4. Other (specify) 3/52 (5.77)
14) Which kind of fungal allergens?* Answer not given: 27/52 (51.92)
 1. Alternaria alternata 23/52 (44.23)
 2. Cladosporium album 15/52 (28.85)
 3. Other (specify) 4/52 (7.69)
15) Do you test insect allergens too?* Answer not given: 35/52 (67.31)
 1. Cockroach (Blatella sp.) 17/52 (32.69)
 2. Other (specify) 3/52 (12.50)
16) When do you consider positive a skin prick test?* Answer not given: 27/52 (51.92)
 1. Wheal size>3 mm after 15' 19/52 (36.54)
 2. Regardless of the diameter, on comparison with the positive control 10/52 (19.23)
 3. Regardless of the diameter, on comparison with the negative control 1/52 (1.92)
 4. Other (specify) 1/52 (1.92)
17) Do you prescribe the measurement of serum total and specific IgE after skin prick test? Answer not given: 11/52 (21.15)
 1. Yes 23/52 (44.23)
 2. No 18/52 (34.62)
18) Which other diagnostic test do you prescribe in allergic rhinitis patients? Answer not given: 9/52 (17.31)
 1. Rhinomanometry 21/52 (40.38)
 2. Nasal mucociliary clearance 9/52 (17.31)
 3. Computed tomography 25/52 (48.08)
 4. Olfactory tests 11/52 (21.15)
 5. Nasal cytology 16/52 (30.77)
 6. Nasal provocation test 13/52 (25.00)
19) In your experience. nasal cytology is useful for: Answer not given: 12/52 (23.08)
 1. Differential diagnosis between allergic and non allergic or infective rhinitis 20/52 (38.46)
 2. Follow-up of the pathology and evaluation of the treatment response 6/52 (11.54)
 3. Not useful 18/52 (34.62)
20) Do you perform nasal cytology in your outpatient? Answer not given: 2/52 (3.92)
 1. Yes 16/52 (30.77)
 2. No 34/52 (65.38)
21) Do you perform nasal provocation test? Answer not given: 2/52 (3.85)
 1. Yes 14/52 (26.92)
 2. No 36/52 (69.23)
22) If you answered yes, when do you suggest nasal provocation test? Answer not given: 37/52 (71.15)
 1. Mismatch clinical history and allergy outcomes 13/52 (25.00)
 2. Occupational rhinitis 8/52 (15.38)
 3. Other (specify) 3/52 (5.77)
23) Do you prescribe allergen specific immunotherapy? Answer not given: 2/52 (3.85)
 1. Yes, for perennial allergens 6/52 (11.54)
 2. Yes, for seasonal allergens 7/52 (13.46)
 3. Yes, for both kind of allergens 17/52 (32.69)
 4. No 22/52 (42.31)
24) Which route of administration do you prefer for immunotherapy? Answer not given: 18/52 (34.62)
 1. Intranasal 7/52 (13.46)
 2. Sublingual-swallow 24/52 (46.15)
 3. Subcutaneous 17/52 (32.69)
25) Which kind of symptomatic drugs do you prescribe in allergic patients? Answer not given: 1/52 (1.92)
 1. Oral H1-antihistamines 43/52 (82.69)
 2. Intranasal corticosteroids 45/52 (86.54)
 3. Intranasal corticosteroids and intranasal antihistamine 18/52 (34.62)
 4. Systemic corticosteroids 10/52 (19.23)
 5. Antileukotrienes 21/52 (40.38)
 6. Nasal douches with hypertonic solution 11/52 (21.15)
 7. Nasal douches with isotonic solution 15/52 (28.85)
 8. Nasal douches with hyaluronic acid 1/52 (1.92)
 9. Other (specify) 3/52 (5.77)

For questions 10–16, only 24 of 52 of the participants (46.15%) performed the prick test. However, to avoid confusion, the responses related to the prick test in questions 11–16 were also rated in the 52 total participants. If the responses were rated in only the prick test performing group (24 participants), the rates would be different. Readers should consider this issue.

Territorial distribution of the ENT specialists among geographic regions

Continent Territorial distribution (%)
Africa 7.7
 Central Africa 1.9
 Southern Africa 1.9
 Northern Africa 3.8
America 13.5
 Central America 7.7
 South America 3.8
 North America 1.9
Asia 38.5
 Central Asia 1.9
 Southern Asia 9.6
 Western Asia 11.5
 Eastern Asia 9.6
 South-Eastern Asia 5.8
Europe 38.5
 Central Europe 5.8
 Europe-Asia 3.9
 Southern Europe 13.5
 Eastern Europe 11.5
 Northern Europe 3.8

ENT, ear, nose, and throat.