Persistent Allergic Rhinitis Patients Research Articles

Association of severity of allergic rhinitis with neutrophil-to-lymphocyte, eosinophil-to-neutrophil, and eosinophil-to-lymphocyte ratios in adults.

Allergic rhinitis (AR) is characterized by chronic inflammation of the nasal mucosa. T-helper 2 lymphocytes, neutrophils, and eosinophils play an active role during the late-phase immune response after exposure to allergen. We aimed to investigate the usefulness of inflammatory parameters of neutro-phil-to-lymphocyte ratio (NLR), eosinophil-to-neutrophil ratio (ENR), and eosinophil-to- lymphocyte ratio (ELR) as markers for distinction between intermittent and persistent allergic rhinitis. This was a double-center, retrospective study. Patients were enrolled after diagnosed with AR according to the Allergic Rhinitis and Its Impact on Asthma guidelines. Individuals with an active infection were excluded. A cohort of healthy subjects acted as a control group. NLR, ENR, and ELR were calculated using the results obtained from the patients' complete blood count. Descriptive statistical analysis was performed for all studied variables. In all, 205 AR patients and 49 healthy individuals were included. AR patients had significantly higher levels of absolute eosinophils, ENR, and ELR, and significantly lower levels of NLR than the healthy controls (P < 0.05). A total of 160 (78%) patients with persistent AR had significantly higher levels of absolute eosinophils, ENR, and ELR, and significantly lower levels of NLR than patients with intermittent AR (P < 0.05). Currently, classification of severity of AR is based on the patient's anamnesis. It has been shown in this study that serum eosinophil levels in persistent AR patients could be used as traceable parameters in evaluating severity of the disease by looking at the proportions of ENR and ELR. We anticipate that in the future this issue would be supported by a larger number of studies.

The effects of nasal breathing due to pediatric allergic rhinitis on dentofacial growth and its dental considerations

Allergic rhinitis is a specific IgE mediated inflammatory disease of the nasal mucosa, characterized by symptoms such as rhinorrhea, nasal congestion, nasal obstruction, nasal and eye itching, and sneezing. The prevalence of allergic rhinitis varies according to country, age, and surveying methods, but it seems to increase worldwide, also in Korea. Prolonged mouth breathing caused by allergic rhinitis can produce muscular and postural alterations, causing alterations on the morphology, position, growth direction of the jaws, and malocclusion. Also, mouth breathing leads to dryness of the mouth, causing various oral diseases; gingivitis, halitosis, inflammation of tonsil, increased risk of dental caries and dental erosion. In dental clinic, using rapid maxillary expansion to persistent allergic rhinitis patients with narrow maxilla can enlarge maxillary dental arch and nasal cavity anatomy, improving nasal breathing and reducing nasal cavity resistance. However, it is desirable to use along with otolaryngologic treatment. Dentists should be aware of the characteristics of allergic rhinitis and its effects on patients, and consider when planning dental treatment.

Effectiveness of Additional Intranasal Phototherapy through Decrease Score of Nose Symptom and Eosinophil Mucosa on Persistent Allergic Rhinitis

Background: Allergic rhinitis (AR) is a common atopic disease but the available treatment has limited used and success rate. It has been suggested that intranasal phototherapy represents an alternative choice in the treatment of AR. Objective: This study aimed to analyze the effect of additional intranasal phototherapy to loratadine therapy compared with single loratadine therapy in order to decrease total nasal symptoms score (TNSS) and nasal mucosa eosinophil count in persistent AR patients. Method: Fifty-four persistent AR patients were divided into two treatment groups: group A and B treated with 10 mg loratadine once a day with additional intranasal phototherapy at 660 nm. 4.4 minutes 3 times a day for group B. Evaluation was based on TNSS and nasal mucosa eosinophil countpre and post 14 days of treatment. Result: The study conducted from July to August 2014 demonstrated significant average of TNSS decrease on group B compared to group A (p = 0.002). Also significant average of eosinophil mucosa nasal count decrease on group B compared to group A (p = 0.049). Both group A and B showed the smallest score of TNSS pre-therapy was 4 vs 6, however the highest score was 6 vs 12. Group A and B showed the smallest score of TNSS post-therapy was 0 vs 0, however the highest score was 8 vs 7. Conclusion: Additional intranasal phototherapy to loratadine therapy showed more effective compared with single loratadine therapy in order to decrease TNSS and nasal mucosa eosinophil count in persistent AR patients

Local Expression of Mucosal YKL-40; Correlation of YKL-40 with Clinical Manifestations and Immunopathogenesis of Moderate/Severe Persistent Allergic Rhinitis Patients

ABSTRACTYKL-40 is an important protein that plays a critical role in chronic inflammation in hypersensitivity disease. In this study, the expression of YKL-40 was investigated among patients with moderate/severe persistent allergic rhinitis (M/S PAR), patients with mild (M) PAR and healthy individuals. Moreover, the association between YKL-40 and immunopathogenesis of M/S PAR was meticulously surveyed. For this purpose, surgical samples were tested by real-time polymerase chain reaction to evaluate YKL-40 mRNA expression. The presence and location of YKL-40 protein in the tissue samples were determined by immunohistochemistry. Additionally, we measured the number of eosinophils per field in the tissue samples, blood eosinophils, total serum IgE, specific serum IgE, total nasal syndrome score (TNSS) and YKL-40 serum levels. The data indicated that production of YKL-40 in patients with M/S PAR increased significantly when compared with the control group. Furthermore, local production of YKL-40 correlated with specific IgE, nasal eosinophil count and TNSS. The results of the present study indicate that YKL-40, for its correlation with allergic clinical manifestations and symptom severity in M/S PAR patients, should be considered as a trigger factor in AR.

Add-on probiotics in patients with persistent allergic rhinitis: A randomized crossover clinical trial.

Current medications for allergic rhinitis (AR) may have undesirable side effects that could affect quality of life (QoL). Probiotics could be an alternative in these patients. The aim of this study was to assess the impact of add-on probiotics on symptoms and QoL of patients. In this randomized crossover clinical trial, patients with persistent AR were included. Each subject received budesonide with probiotic supplements (BP) or budesonide with placebo for 8 weeks (B), then vice versa for a further 8 weeks. There was an 8-week washout. The primary outcome was the change of the Short Form 36-Item Health Survey (SF-36) score. The secondary outcomes were assessed by the Sinonasal Outcome Test-22 (SNOT-22) and the Control of Allergic Rhinitis and Asthma Test (CARAT) questionnaires. A total of 152 subjects (30.1 ± 7.6 years) completed the study. The SF-36 score in both groups showed improvement compared with baseline values. Treatment BP was more effective than that of B. The Cohen's d and the number needed to treat for Physical Component Scales of SF-36 were 0.40 and 10.77, respectively. These values for Mental Component Scales were 0.33 and 12.61, respectively. Also, treatment BP showed more reduction in the score of SNOT-22 and CARAT. This study showed that the addition of probiotics to budesonide significantly improved QoL in persistent AR patients. However, the clinical situation of these patients may be not very representative of AR patients in general population. Further studies are recommended. 1b Laryngoscope, 129:1744-1750, 2019.

Spirometric evaluation in patients with allergic rhinitis- emphasising need of early diagnosis: a tertiary care experience from Central India

Background: Allergic rhinitis is predecessor of Bronchial asthma in most of the cases. Present study was aimed to understand the prevalence of the impaired spirometric changes in patients with allergic rhinitis and to find association with various demographic factors, sputum eosinophilia and eosinophil count in the blood with the impaired Spirometry of these patients.Methods: Authors conducted a cross sectional study among the patients of allergic rhinitis presented to us in our outpatient department from January 2016 to July 2017. The patient’s with allergic rhinitis either newly diagnosed or already on treatment were included in the study. Standard guidelines as given by ARIA were followed in defining a case of allergic rhinitis. The detailed clinical history was taken, and examination was performed of all the patients and documented. Spirometric evaluation was done using the standard guidelines by a desktop based Spirometry.Results: The mean age of the study subjects was 30.22±13.13 years with male: female ratio of 0.96. The mean duration of the allergic rhinitis in our study was 3.86±3.34years. The most common complaint was itching sensation of nose followed by paroxysmal sneezing and watering of eyes. About 22.15% of the study subjects have impaired Spirometry. Upon bronchodilator therapy 30% of the study subjects had significant reversibility in FEV1.Conclusions: About ¼ of present study subjects had impaired Spirometry and about 30% of them had reversibility after bronchodilator therapy. Authors also found that the higher age study subjects had significantly higher impaired Spirometry; persistent allergic rhinitis patients had higher impairment of Spirometry and the patients with higher the sputum eosinophilia had higher impairment in Spirometry.

Efficacy analysis of psychological intervention on the basis of medication for the treatment of moderate-severe persistent allergic rhinitis

Objective:To observe the effect of psychological intervention on the basis of drug therapy for moderate-severe persistent allergic rhinitis.Method:Sixty patients with moderate-severe persistent allergic rhinitis were randomly divided into two groups: control group and study group. The control group was only given pure drug therapy. The study group was given drug treatment and psychological intervention. Both groups were treated for 12 weeks. Before and after the treatment, the patients were graded by SAS, SDS and RQLQ to assess their anxiety and depression, as well as changes in the quality of life. Finally, a statistical analysis was performed.Result:After the treatment, the SAS and SDS scores of the control group and the study group were lower than those scores before treatment, and the difference was statistically significant (P<0.05). The SAS and SDS scores were lower in the study group than in the control group after treatment, and the difference was statistically significant (P<0.05).After the treatment, the scores of RQLQ in the control group and the study group were lower than those scores before treatment. and the difference was statistically significant (P<0.05). After treatment with two regimens, the scores of the sleep, the non-nose/eye symptoms, and the emotion were lower in the study group than those scores in the control group, and the difference was statistically significant (P<0.05).Conclusion:To improve the mental disorder and the quality of life of the moderate-severe persistent allergic rhinitis patients, on the basis of drug treatment along with psychological intervention is more effective than using medical treatment.

Global health fact: nasal symptom impair quality of life among persistent allergic rhinitis patients

Global health fact: nasal symptom impair quality of life among persistent allergic rhinitis patients

A study of the curative effect of endoscopic-assisted posterior nasal neurotomy on patients with moderate severe persistent allergic rhinitis

Objective:To investigate the feasibility and effect of endoscopic-assisted posterior nasal neurotomy on patients with moderate-severe persistent allergic rhinitis (AR).Method:Endoscopic-assisted posterior nasal neurotomy were operated on 32 moderate-severe persistent AR patients who were insensitive to drugs and desensitization treatment,and curative effect were evaluated by scoring according to the diagnosis and curative effect evaluation standard of AR.Result:Follow-up evaluations were perfected after one year. Among them 17 cases were markedly effective,15 cases were effective,and the rate of total effective was 100%,without complications such as nose bleeds,dry eye,etc.Conclusion:The advantages of endoscopic-assisted posterior nasal neurotomy on moderate-severe persistent allergic rhinitis patients include the localization of posterior nasal nerve is clear,easy to operate,the short-term effect is remarkable,and less complications,therefore it's worth using on the AR patients who are failing in drugs and specific immune treatment.

Clinical observation of flupentixol and melitracen combined with specific immunotherapy for treatment of allergic rhinitis patients with anxiety and depression

Objective:To explore the clinical effects of Flupentixol/Melitracencombined with specific immunotherapy in allergic rhinitis patients with anxiety and depression. Method:Totally ninetynine moderate to severe persistent allergic rhinitis patients with anxiety and depression from October 2014 to Sepetember 2015 were randomly divided into two groups: 45 patients in experimental group (Flupentixol/Melitracen 10.5 mg，QD,treatment last 4 months)and 44 patients in control group.All patients were treated with specific immunotherapy for 1 years. The nasal symptoms score, mini Rhinoconjunctivitis Quality of life questionnaire(MiniRQLQ), Medication score, SAS and SDS score and the clinical curative effect were observed before treatment, after 4 months or one year treatment. The drug reactions were also recorded. Result:The VAS scores, MiniRQLQ scores, medication scores, SAS and SDS scores of patients in two groups who were treated after 4 months and 1 year were significantly reduced than that of patients before treatment.The differences were statistically significant(P<0.05).Compared with the control group, nasal symptom scores, MiniRQLQ scores, medication scores, SAS and SDS scores in experimental group were decreased after 4 month or 1 year treatment(P<0.05).After 4 months of treatment, the total effective rate of the experimental group was 84.4%, while the control group was 56.8%.After 1 years of treatment, the experimental group excellence rate was 57.8%, while the control group was 22.7%.The differences were statistically significant(P<0.05). During the course of treatment, there were thirteen cases of mild adverse reactionsin experimental group (17.7%) and control group(11.4%). There was no significant differences(P>0.05). Conclusion:Flupentixol and melitracen combined with specific immunotherapy could sifnificantlly relieve clinical symptom, quality of life and mental depression.is a safe and reliable therapeutic regimen for further improving clinical symptoms,quality of life,mental statusand the clinical efficacy in moderate to severe persistent with anxiety anddepression.

Olfaction in patients with allergic rhinitis: an indicator of successful MP-AzeFlu therapy.

The purpose of this study was to investigate the effect of MP-AzeFlu on olfaction and the interaction between severity of allergic rhinitis and olfactory improvement after therapy. A prospective, multicenter, observational study was performed on 47 patients with persistent allergic rhinitis. Duration and severity of allergic rhinitis was diagnosed and classified using the modified Allergic Rhinitis and its Impact on Asthma (ARIA) criteria and the proof of allergen sensitization from positive skin-prick tests, specific immonoglobulin E (IgE) in serum, and nasal provocation response. Patients were treated with MP-AzeFlu (1 spray/nostril twice daily) over 3 months. Olfactory function was assessed at baseline and at 1 and 3 months of therapy using the "Sniffin' Sticks" test. In addition, a nasal symptom score was recorded on a visual analog scale (VAS) at each given time-point. MP-AzeFlu was found to be associated with a significant improvement in TDI score, from 23.7 at baseline to 34.2 at 1 month (p < 0.001) and 37.1 at 3 months (p < 0.001) of treatment. Furthermore, a highly significant improvement of symptoms over time (p < 0.001; VAS at baseline: 84.3; 1 month: 32.4; 3 months: 26.2) could be demonstrated. Most importantly, there was a highly significant interaction between the severity of allergic rhinitis and olfactory function (p < 0.001) and VAS (p < 0.001). MP-AzeFlu is associated with olfactory improvement in persistent allergic rhinitis patients. Further, the modified ARIA severity classification is an indicator of patients' olfactory function. Moreover, assessment of olfaction seems to be a reliable indicator of the clinical success of antiallergic/antiinflammatory therapy.

A proteomics analysis reveals that A2M might be regulated by STAT3 in persistent allergic rhinitis.

Proteomics tools can be used to identify the differentially expressed proteins related to allergic rhinitis (AR). However, the large numbers of proteins related to AR have not yet been explored using an advanced quantitative proteomics approach, known as isobaric tags for relative and absolute quantitation (iTRAQ). To identify differentially expressed proteins in persistent AR patients and to explore the regulatory signalling pathways involving the identified proteins. Forty-five persistent AR patients and 20 healthy controls were recruited for this study. iTRAQ was used to identify the proteins that were differentially expressed between these two groups, and a bioinformatics analysis was then conducted to identify the signalling pathways associated with the identified proteins. Immunofluorescence labelling was performed to detect alpha-2-macroglobulin (A2M), STAT3, p-STAT3 and IL17 in the nasal mucosa. A total of 133 differentially expressed proteins were identified. We then determined the top 10 regulatory pathways associated with these proteins and found that the blood coagulation pathway had the most significant association. A2M, a protein involved in the blood coagulation pathway, was found to be differentially expressed in the serum of AR patients. The bioinformatics analysis indicated that STAT3 is an upstream transcription factor that might regulate A2M expression. An immunofluorescence study further confirmed that STAT3 and A2M are co-localized in nasal mucosa cells. Additionally, A2M, STAT3, p-STAT3, and IL17 are elevated in AR patients. The expressional level of A2M is positively related to IL17 and the symptom of the congestion in AR subjects. The blood coagulation pathway may be a key regulatory network pathway contributing to the allergic inflammatory response in AR patients. A2M, which is regulated by STAT3, may be an important protein in the pathogenesis of allergic rhinitis in AR patients.

Effect of specific immunotherapy on the psychological health level and quality of life in patients with allergic rhinitis

Objective: To study the effect of specific immunotherapy on the psychological health level and quality of life in patients with allergic rhinitis(AR).Method:Selected 97 cases diagnosed as moderate to severe persistent AR patients, were treated with specific immunotherapy for one year. All patients received the evaluation with symptom check list 90(SCL-90) and rhinoconjunctivitis quality of life questionnaire(RQLQ) before specific immunotherapy, six, and 12 months after specific immunotherapy.Result:The total scores, scores of somatization, obsessive, anxiety, depression and phobia in SCL-90 of AR patients after 12 months treatment were significantly lower than that before treatment（P < 0.05）. Total score of quality of life and subitem score in RQLQ of AR patients after 12 months treatment were obviously lower than that before treatment (P < 0.05）.Conclusion:Specific immunotherapy can effectively alleviate the clinical symptoms and improve psychological health level and quality of life of AR patients.

Curative observation on allergic rhinitis treated by intranasal corticosteroids combined with nasal irrigation

Objective: To observe the effect of normal saline with intranasal corticosteroids in the treatment of allergic rhinitis(AR).Method:Two hundred and seventy-three outpatients with severe persistent allergic rhinitis were participated in this study.All patients were randomly divided into three groups, and were treated for 12 weeks using three different therapies, respectively. Symptom assessment of each patient were performed before treatment, 4 weeks, 8 weeks, and 12 weeks after treatment, respectively. The content of symptom assessment includes visual analogue scale, rhinoconjunctivitis quality of life questionnaire, symptoms scores and endoscopy examination scores.Result:Efficacy of intranasal corticosteroids combined with normal saline nasal irrigation in the treatment of AR is better than that of intranasal corticosteroids only, and is almost equivalent to intranasal corticosteroids combined with antihistamines.Conclusion:Long-term application of intranasal corticosteroids in combination with normal saline irrigation can effectively control and mitigate symptoms of severe persistent AR patients, and improve the patient's quality of life. This combination therapy is a better choice for the patient who is not satisfied with the single use of intranasal corticosteroids.

Desipramine plus levocetirizine as a treatment for persistent allergic rhinitis

Background Persistent allergic rhinitis has significant effects on the quality of life (QOL), especially on sleep and work performance, and is associated with specific psychiatric syndromes. Aim The aim of the present study was to verify the efficacy of combined desipramine and levocetirizine in the treatment of psychological stress related to persistent allergic rhinitis, and to thereby improve the QOL of the patient. Patients and methods A total of 132 psychologically stressed persistent allergic rhinitis patients (positive Kessler Psychological Distress Scale scores ≥12) were randomly divided into two groups: the control group, which received levocetirizine, and the study group, which received levocetirizine plus desipramine. QOL for all patients was assessed by using a seven-point scale after the treatment period. Results There was a highly statistically significant better QOL in the study group (6.79) compared with the control group (2.21) ( t -test=15.17 and P = 0.0001). Conclusion Desipramine and levocetirizine have a better effect on the QOL outcomes in the treatment of patients with persistent allergic rhinitis, and having psychological stress disorders. Level of evidence: 3b.

통년성 알레르기 비염의 변증 도구 개발을 위한 전문가 집단 설문조사 연구

Background : According to the rising cases of clinical researches with Traditional Korean Medicine for persistent allergic rhinitis patients, the need for developing and applying Pattern diagnosis instrument has been increasing. Objective : This study was done to investigate and pragmatize the Pattern diagnosis instrument for persistent allergic rhinitis patients launched by KFDA in 2008. Methods : Data was collected by structured survey papers from Korean Medicine doctors participate in the Conference of The Korean Oriental Medical Ophthalmology & Otolaryngology & Dermatology Society in October 2012. We investigated their representative Patterns(변증) of every questions and used the mean results for assuming agreement rates. The importance order of 8 symptom domains for considering Pattern diagnostic steps were also asked and analyzed for inducing importance rates. Finally based on above two results, we developed weight points of each questions by multiplying agrement percents with importance rates. Results : 50 Korean medicine doctors described the informed consent and survey papers. Response agreement rates of each questions of Pattern diagnosis instruments were analyzed and described in Table 2. Comparing the survey results with diagnostic references, matched percent of 肺胃熱 was the 87.9%, 肺氣虛寒 was 62.5%, 肺脾氣虛 was 62.5% and 腎元虧虛 was 50%. Mean importance rates of rhinorrhea was 7.28, otoscope diagnosis 5.12, obstruction 5.04, sneeze 4.82, symptom duration 4.63, other body condition 3.54, tongue diagnosis 3.02, nasal pruritus 2.86, accordingly. Final importance rates of each questions were assumed, and the range of them was from 1.60 to 4.72, which were listed in Table 5. Conclusion : These results might provide the rational backgrounds and practical methods for developing and utilizing methods of Pattern diagnosis questionnaire for perennial allergic rhinitis.

Assessment of Sleep Impairment in Persistent Allergic Rhinitis Patients Using Polysomnography

Background: Although questionnaires have demonstrated an association between impairment of quality of sleep and symptoms in allergic rhinitis (AR) patients, to date there is no report of an objective assessment of sleep in patients with persistent allergic rhinitis (PER) as defined by ARIA guidelines. The aim of the present study was therefore to assess sleep disturbance in PER patients by polysomnography (PSG). Methods: Ninety-eight PER patients with moderate-to-severe nasal obstruction and 30 healthy volunteers were included in the study. All patients underwent PSG during nocturnal sleep to assess the presence and severity of sleep disorders. Peak nasal inspiratory flow (PNIF) was also measured to assess nasal resistance. Results: There were statistically significant, though clinically modest, differences between PER patients and healthy controls in most PSG parameters including sleep efficiency, arousal index, average SaO₂, lowest SaO₂, time spent with a saturation below 90%, and snoring time. Although the apnea-hypopnea index (AHI) was not significantly different between the 2 groups, 17 subjects (17.3%) in the PER group but none of the control subjects had an AHI >5. Patients with higher T5SS scores (12 ≤ T5SS ≤ 15) had a greater tendency to snore than did patients with lower scores (8 ≤ T5SS ≤ 11). Finally, PNIF in the PER group was significantly lower than in the control group. Weak correlations between the arousal index and PNIF, average SaO₂, and PNIF were found. Conclusion: PSG showed modest changes in PER patients versus control subjects.

Nasal Polyps: An Independent Risk Factor for Bronchial Hyperresponsiveness in Patients with Allergic Rhinitis

Many studies were conducted to figure out the relationship between allergic rhinitis (AR) and lower airway diseases. This study was designed to elucidate the clinical parameters that could predict the coexistence of bronchial hyperresponsiveness (BHR) in AR and suggest a guideline for lower airway evaluation in these patients. One hundred seventy-three patients newly diagnosed with AR were evaluated for the lower airway with the methacholine bronchoprovocation test. BHR was more prevalent in patients with nasal polyps (p = 0.01), in patients complaining of moderate to severe symptoms (p = 0.023), with higher serum total IgE levels (p = 0.001), and with blood eosinophil count (p = 0.008). No statistically significant difference was observed between intermittent and persistent AR patients (p = 0.364). Blood eosinophil count that could predict BHR was calculated as 320 cells/μL (p = 0.004). Instead of a routine lower airway evaluation for all AR patients, we recommend lower airway evaluation for the selected patients with nasal polyps, moderate to severe symptoms, and high blood eosinophil count.

Dose-related effect of intranasal corticosteroids on treatment outcome of persistent allergic rhinitis

To evaluate the efficacy of the self-adjustable dosing regimen and explore potential dose-response relationships of intranasal corticosteroids in persistent allergic rhinitis. Prospective cohort study. Sixty-nine persistent allergic rhinitis patients were treated with 220 mcg of intranasal triamcinolone acetonide for 28 days. Patients with mild, intermittent symptoms were instructed to use the medication only after symptoms occurred once a day. Patients with symptoms that lasted more than 1 day and/or interrupted daily activities/sleep were instructed to continue the morning daily dose until they were symptom-free for 24 hours before stopping usage. All nasal symptom scores and peak expiratory flow index (PEFI) showed statistically significant improvements after treatment. At 28 days after treatment, the number of puffs and weight of steroids used were positively correlated with percentages of improvement in total symptoms score (TSS) and PEFI (rho = 0.529, r = 0.571 and rho = 0.350, r = 0.509 respectively). When at least 1400 mcg or 44 puffs were used, 60% TSS and 10% PEFI improvement were achieved. A self-adjustable dosing approach proved to be an efficacious approach to controlling allergic rhinitis.

Long-Term Treatment of Persistent Allergic Rhinitis with Levocetirizine

Background: The impact of treatment on specific aspects of health-related quality of life (HRQOL), including limitations in particular activities and quality of sleep, has not been clarified in persistent allergic rhinitis. Our objective was to determine the effect of long-term treatment with levocetirizine on the five most affected daily activities and all sleep parameters of the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) in persistent allergic rhinitis patients. Methods/Data base: This was a randomized, multicenter, double-blind, parallel group study comparing the effect of treatment with levocetirizine 5mg versus placebo once daily for 6 months on HRQOL and symptoms in 551 adults with persistent allergic rhinitis. HRQOL was assessed using the RQLQ. Repeated measures analyses were performed on RQLQ scores for the five most affected daily activities and three sleep items. Results: Levocetirizine provided significant and clinically relevant improvements in baseline RQLQ scores for the five activities most important to patients (doing housework, playing sport, driving, outdoor activities, activities at work) and three sleep items (difficulty getting to sleep, wake up during the night, lack of a good night's sleep), compared to placebo, over the 6-month treatment period. All improvements were pronounced and significantly greater for levocetirizine at each time point over 6 months. Conclusions: Levocetirizine provides clinically relevant improvements in the most affected daily activities and sleep parameters in patients with persistent allergic rhinitis. The improvements are sustained over long periods and should therefore substantially improve the overall quality of life of these patients year round.