Impact of pretreatment nasal symptoms on treatment outcome in allergic rhinitis

Abstract

Objective The Allergic Rhinitis and its Impact on Asthma (ARIA) classification of allergic rhinitis (AR) is based on the severity and duration of nasal symptoms. Whether nasal symptoms have an impact on treatment outcome is unclear. The aim of this study was to evaluate the correlation between pretreatment nasal symptoms and therapeutic response in AR. Study Design Case series with planned data collection. Setting Tertiary medical center. Subjects and Methods Sixty-nine AR patients were classified according to ARIA class: mild or moderate-severe intermittent AR (MIAR or MSIAR) and mild or moderate-severe persistent AR (MPAR or MSPAR). All patients were treated over 28 days with 220 μg of intranasal triamcinolone acetonide once daily. Nasal symptoms, peak expiratory flow index, and global symptom control were used to evaluate treatment outcome. Results At 28 days after treatment, MSPAR patients showed the worst global symptom control, followed by MSIAR, MPAR, and MIAR (mean global symptom controls were 76.5%, 83.8%, 87.7%, and 89.0%, respectively). Pretreatment total nasal symptom score was inversely correlated with global symptom control ( ρ = –0.405, P < 0.001), but positively correlated with percent total nasal symptom score and peak expiratory flow index improvements ( ρ = 0.271, P = 0.024; and ρ = 0.371, P = 0.002, respectively). Blocked nose had the best inverse correlation with global symptom control ( ρ = –0.389, P = 0.001). Conclusion A worse treatment outcome despite more clinical improvements during the treatment period in a higher severity score suggests the therapeutic predictive value of pretreatment nasal symptom scoring and the need for more dosing and continuing medication in higher scores, especially in blocked nose.