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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%).
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Table 1.
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.
Table 2.
Territorial distribution of the ENT specialists among geographic regions
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