Burden of allergic rhinitis: Results from the Pediatric Allergies in America survey

      Allergic rhinitis (AR), a chronic inflammatory disease of the upper airway, is one of the most common chronic diseases in the United States and is estimated to affect up to 60 million people. Pediatric Allergies in America is the largest and most comprehensive survey to date of pediatric patients and parents of patients with allergy, as well as health care providers (HCPs), regarding AR in children and its treatment. The goals of the survey were to determine the prevalence of AR in the US pediatric population and to collect information on what effect the condition has on patients in terms of symptom burden, quality of life, productivity, disease management, and pharmacologic treatment. This national survey screened 35,757 households to identify 500 children with HCP-diagnosed nasal allergies and 504 children without nasal allergies who were between the ages of 4 and 17 years. Parents of young children, as well as children 10 to 17 years of age, were questioned about the condition and its treatment. In parallel, 501 HCPs were interviewed. This survey has captured previously unavailable data on the prevalence of nasal allergies and their most common and most bothersome symptoms, on the effect of nasal allergies on the quality of life of children, and on medication use, including both over-the-counter and prescription medications, and has identified factors affecting satisfaction with treatment. The Pediatric Allergies in America survey also identifies distinct areas for improvement in the management of AR in children. In fact, based on the results of this survey, it appears that HCPs overestimate patients' and parents' satisfaction with disease management and the benefit of medications used for the treatment of nasal allergies in children. Findings from this national survey have identified important challenges to the management of AR, suggesting that its burden on children in the United States has been significantly underestimated.

      Key words

      Abbreviations used:

      AR (Allergic rhinitis), HCP (Health care provider), INCS (Intranasal corticosteroid), ISAAC (International Study of Asthma and Allergies in Childhood), NHANES (National Health and Nutrition Examination Survey), NP (Nurse practitioner), OTC (Over the counter), PA (Physician assistant), QoL (Quality of life), URI (Upper respiratory tract infection)
      To read this article in full you will need to make a payment


      Subscribe to Journal of Allergy and Clinical Immunology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bloebaum R.
        Managing allergic rhinitis: the role of pharmacotherapy; sound treatment can improve your patient's quality of life.
        J Respir Dis. 2002; 23: 370-376
        • Nathan R.A.
        The burden of allergic rhinitis.
        Allergy Asthma Proc. 2007; 28: 3-9
        • Settipane R.A.
        Rhinitis: a dose of epidemiological reality.
        Allergy Asthma Proc. 2003; 24: 147-154
        • Berger W.E.
        Allergic rhinitis in children: diagnosis and management strategies.
        Paediatr Drugs. 2004; 6: 233-250
        • McCrory D.C.
        • Williams J.W.
        • Dolor R.J.
        • Gray R.N.
        • Kolimaga J.T.
        • Reed S.
        • et al.
        Management of allergic rhinitis in the working-age population.
        Evid Rep Technol Assess (Summ). 2003; 67: 1-4
        • Wright A.L.
        • Holberg C.J.
        • Martinez F.D.
        • Halonen M.
        • Morgan W.
        • Taussig L.M.
        Epidemiology of physician-diagnosed allergic rhinitis in childhood.
        Pediatrics. 1994; 94: 895-901
      1. HealthStar Communications, Inc, in partnership with Schulman, Ronca and Bucuvalas, Inc. Allergies in America: a landmark survey of nasal allergy sufferers. Executive summary.
        Altana Pharma US, Inc, Florham Park, NJ2006
        • Meltzer E.
        • Blaiss M.
        • Derebery M.
        • Boyle J.
        • Naclerio R.
        • Hadley J.
        • et al.
        Perspectives on allergic rhinitis and its treatment.
        Allergy Asthma Proc. 2007; 28: S1-S32
        • Skoner D.P.
        Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis.
        J Allergy Clin Immunol. 2001; 108: S2-S8
        • Dykewicz M.S.
        • Fineman S.
        • Skoner D.P.
        • Nicklas R.
        • Lee R.
        • Blessing-Moore J.
        • et al.
        Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology.
        Ann Allergy Asthma Immunol. 1998; 81: 478-518
        • Trangsrud A.J.
        • Whitaker A.L.
        • Small R.E.
        Intranasal corticosteroids for allergic rhinitis.
        Pharmacotherapy. 2002; 22: 1458-1467
        • Waddell A.N.
        • Patel S.K.
        • Toma A.G.
        • Maw A.R.
        Intranasal steroid sprays in the treatment of rhinitis: is one better than another?.
        J Laryngol Otol. 2003; 117: 843-845
        • Skoner D.P.
        • Gentile D.
        • Angelini B.
        • Kane R.
        • Birdsall D.
        • Banerji D.
        The effects of intranasal triamcinolone acetonide and intranasal fluticasone propionate on short-term bone growth and HPA axis in children with allergic rhinitis.
        Ann Allergy Asthma Immunol. 2003; 90: 56-62
        • Skoner D.P.
        • Rachelefsky G.S.
        • Meltzer E.O.
        • Chervinsky P.
        • Morris R.M.
        • Seltzer J.M.
        • et al.
        Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate.
        Pediatrics. 2000; 105: e23
        • Wihl J.A.
        • Andersson K.E.
        • Johansson S.A.
        Systemic effects of two nasally administered glucocorticosteroids.
        Allergy. 1997; 52: 620-626
        • Wilson A.M.
        • McFarlane L.C.
        • Lipworth B.J.
        Effects of repeated once daily dosing of three intranasal corticosteroids on basal and dynamic measures of hypothalamic-pituitary-adrenal-axis activity.
        J Allergy Clin Immunol. 1998; 101: 470-474
        • Spector S.L.
        Overview of comorbid associations of allergic rhinitis.
        J Allergy Clin Immunol. 1997; 99: S773-S780
        • Wallace D.V.
        • Dykewicz M.S.
        • Bernstein D.I.
        • Blessing-Moore J.
        • Cox L.
        • Khan D.A.
        • et al.
        The diagnosis and management of rhinitis: an updated practice parameter.
        J Allergy Clin Immunol. 2008; 122: S1-S84
        • Bousquet J.
        • Van Cauwenberge P.
        • Khaltaev N.
        Allergic rhinitis and its impact on asthma.
        J Allergy Clin Immunol. 2001; 108: S147-S334
        • Douglass J.A.
        • O'Hehir R.E.
        1. Diagnosis, treatment and prevention of allergic disease: the basics.
        Med J Aust. 2006; 185: 228-233
        • Jeffery P.K.
        • Haahtela T.
        Allergic rhinitis and asthma: inflammation in a one-airway condition.
        BMC Pulm Med. 2006; 6: S5
        • Lai L.
        • Casale T.B.
        • Stokes J.
        Pediatric allergic rhinitis: treatment.
        Immunol Allergy Clin North Am. 2005; 25 (vi): 283-299
        • Bielory L.
        • Katelaris C.H.
        • Lightman S.
        • Naclerio R.M.
        Treating the ocular component of allergic rhinoconjunctivitis and related eye disorders.
        MedGenMed. 2007; 9: 35
        • Meltzer E.O.
        Evaluation of the optimal oral antihistamine for patients with allergic rhinitis.
        Mayo Clin Proc. 2005; 80: 1170-1176
        • Ogden C.L.
        • Carroll M.D.
        • Flegal K.M.
        High body mass index for age among US children and adolescents, 2003-2006.
        JAMA. 2008; 299: 2401-2405
        • Craig T.J.
        • McCann J.L.
        • Gurevich F.
        • Davies M.J.
        The correlation between allergic rhinitis and sleep disturbance.
        J Allergy Clin Immunol. 2004; 114: S139-S145
        • Young T.
        • Finn L.
        • Kim H.
        Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group.
        J Allergy Clin Immunol. 1997; 99: S757-S762
        • Golbin A.
        • Bernales R.
        • Lim D.
        Perennial allergic rhinitis (PAR), and sleep disorders.
        Ann Allergy. 1992; 68 ([abstract]): 85
      2. Juniper E. Measurement of health-related quality of life: adult rhinoconjunctivitis. 2005. Available at: Accessed May 6, 2008.

        • Klossek J.M.
        • Gohler C.
        • Vervloet D.
        • Deslandes B.
        • Dufour X.
        • Neukirch F.
        [Epidemiology of seasonal spring-time allergic rhinitis in adults in France].
        Presse Med. 2005; 34: 348-352
        • Lavie P.
        • Gertner R.
        • Zomer J.
        • Podoshin L.
        Breathing disorders in sleep associated with “microarousals” in patients with allergic rhinitis.
        Acta Otolaryngol. 1981; 92: 529-533
        • Spaeth J.
        • Klimek L.
        • Mosges R.
        Sedation in allergic rhinitis is caused by the condition and not by antihistamine treatment.
        Allergy. 1996; 51: 893-906
        • Stuck B.A.
        • Czajkowski J.
        • Hagner A.E.
        • Klimek L.
        • Verse T.
        • Hormann K.
        • et al.
        Changes in daytime sleepiness, quality of life, and objective sleep patterns in seasonal allergic rhinitis: a controlled clinical trial.
        J Allergy Clin Immunol. 2004; 113: 663-668
        • Gozal D.
        Sleep-disordered breathing and school performance in children.
        Pediatrics. 1998; 102: 616-620
        • Owens J.
        • Opipari L.
        • Nobile C.
        • Spirito A.
        Sleep and daytime behavior in children with obstructive sleep apnea and behavioral sleep disorders.
        Pediatrics. 1998; 102: 1178-1184
        • Vuurman E.F.
        • van Veggel L.M.
        • Uiterwijk M.M.
        • Leutner D.
        • O'Hanlon J.F.
        Seasonal allergic rhinitis and antihistamine effects on children's learning.
        Ann Allergy. 1993; 71: 121-126
        • Bresolin D.
        • Shapiro P.A.
        • Shapiro G.G.
        • Chapko M.K.
        • Dassel S.
        Mouth breathing in allergic children: its relationship to dentofacial development.
        Am J Orthod. 1983; 83: 334-340
        • Slavin R.G.
        Complications of allergic rhinitis: implications for sinusitis and asthma.
        J Allergy Clin Immunol. 1998; 101: S357-S360
        • Bernstein J.M.
        • Lee J.
        • Conboy K.
        • Ellis E.
        • Li P.
        Further observations on the role of IgE-mediated hypersensitivity in recurrent otitis media with effusion.
        Otolaryngol Head Neck Surg. 1985; 93: 611-615
        • Tomonaga K.
        • Kurono Y.
        • Mogi G.
        The role of nasal allergy in otitis media with effusion. A clinical study.
        Acta Otolaryngol Suppl. 1988; 458: 41-47
        • Bernstein J.M.
        The role of IgE-mediated hypersensitivity in the development of otitis media with effusion.
        Otolaryngol Clin North Am. 1992; 25: 197-211
        • Meltzer E.O.
        • Szwarcberg J.
        • Pill M.W.
        Allergic rhinitis, asthma, and rhinosinusitis: diseases of the integrated airway.
        J Manag Care Pharm. 2004; 10: 310-317
        • Nayak A.S.
        The asthma and allergic rhinitis link.
        Allergy Asthma Proc. 2003; 24: 395-402
        • Casale T.B.
        • Dykewicz M.S.
        Clinical implications of the allergic rhinitis-asthma link.
        Am J Med Sci. 2004; 327: 127-138
        • Leynaert B.
        • Neukirch C.
        • Liard R.
        • Bousquet J.
        • Neukirch F.
        Quality of life in allergic rhinitis and asthma. A population-based study of young adults.
        Am J Respir Crit Care Med. 2000; 162: 1391-1396
        • Anderson H.R.
        • Pottier A.C.
        • Strachan D.P.
        Asthma from birth to age 23: incidence and relation to prior and concurrent atopic disease.
        Thorax. 1992; 47: 537-542
        • Behbehani N.A.
        • Abal A.
        • Syabbalo N.C.
        • Abd Azeem A.
        • Shareef E.
        • Al-Momen J.
        Prevalence of asthma, allergic rhinitis, and eczema in 13- to 14-year-old children in Kuwait: an ISAAC study. International Study of Asthma and Allergies in Childhood.
        Ann Allergy Asthma Immunol. 2000; 85: 58-63
        • Kalyoncu A.F.
        • Selcuk Z.T.
        • Enunlu T.
        • Demir A.U.
        • Coplu L.
        • Sahin A.A.
        • et al.
        Prevalence of asthma and allergic diseases in primary school children in Ankara, Turkey: two cross-sectional studies, five years apart.
        Pediatr Allergy Immunol. 1999; 10: 261-265
        • Sears M.R.
        • Burrows B.
        • Flannery E.M.
        • Herbison G.P.
        • Holdaway M.D.
        Atopy in childhood. I. Gender and allergen related risks for development of hay fever and asthma.
        Clin Exp Allergy. 1993; 23: 941-948
        • Selnes A.
        • Nystad W.
        • Bolle R.
        • Lund E.
        Diverging prevalence trends of atopic disorders in Norwegian children. Results from three cross-sectional studies.
        Allergy. 2005; 60: 894-899
        • Werneck G.
        • Ruiz S.
        • Hart R.
        • White M.
        • Romieu I.
        Prevalence of asthma and other childhood allergies in Brazilian schoolchildren.
        J Asthma. 1999; 36: 677-690
        • Corren J.
        • Adinoff A.D.
        • Buchmeier A.D.
        • Irvin C.G.
        Nasal beclomethasone prevents the seasonal increase in bronchial responsiveness in patients with allergic rhinitis and asthma.
        J Allergy Clin Immunol. 1992; 90: 250-256
        • Crystal-Peters J.
        • Neslusan C.
        • Crown W.H.
        • Torres A.
        Treating allergic rhinitis in patients with comorbid asthma: the risk of asthma-related hospitalizations and emergency department visits.
        J Allergy Clin Immunol. 2002; 109: 57-62
        • Foresi A.
        • Pelucchi A.
        • Gherson G.
        • Mastropasqua B.
        • Chiapparino A.
        • Testi R.
        Once daily intranasal fluticasone propionate (200 micrograms) reduces nasal symptoms and inflammation but also attenuates the increase in bronchial responsiveness during the pollen season in allergic rhinitis.
        J Allergy Clin Immunol. 1996; 98: 274-282
        • Watson W.T.
        • Becker A.B.
        • Simons F.E.
        Treatment of allergic rhinitis with intranasal corticosteroids in patients with mild asthma: effect on lower airway responsiveness.
        J Allergy Clin Immunol. 1993; 91: 97-101
        • Welsh P.W.
        • Stricker W.E.
        • Chu C.P.
        • Naessens J.M.
        • Reese M.E.
        • Reed C.E.
        • et al.
        Efficacy of beclomethasone nasal solution, flunisolide, and cromolyn in relieving symptoms of ragweed allergy.
        Mayo Clin Proc. 1987; 62: 125-134
      3. New survey suggests patients want fast, long relief of allergy symptoms. PRN Newswire. March 20, 2006.

        • Eggleston P.A.
        Improving indoor environments: reducing allergen exposures.
        J Allergy Clin Immunol. 2005; 116: 122-126
        • Ferguson B.J.
        Environmental controls of allergies.
        Otolaryngol Clin North Am. 2008; 41: 411-417
        • Meltzer E.O.
        Allergic rhinitis: managing the pediatric spectrum.
        Allergy Asthma Proc. 2006; 27: 2-8
        • Belliveau P.P.
        Omalizumab: a monoclonal anti-IgE antibody.
        MedGenMed. 2005; 7: 27
        • Bello C.E.
        • Garrett S.D.
        Therapeutic issues in oral glucocorticoid use.
        Lippincotts Prim Care Pract. 1999; 3: 333-342
        • Naclerio R.
        • Hadley J.
        • Stoloff S.
        • Nelson H.
        Patient and physician perspectives on the attributes of nasal allergy medications.
        Allergy Asthma Proc. 2007; 28: S11-S17
        • Blaiss M.S.
        Important aspects in management of allergic rhinitis: compliance, cost, and quality of life.
        Allergy Asthma Proc. 2003; 24: 231-238
        • Cochrane G.M.
        Compliance and outcomes in patients with asthma.
        Drugs. 1996; 52: 12-19
        • Shusterman D.
        • Murphy M.A.
        Nasal hyperreactivity in allergic and non-allergic rhinitis: a potential risk factor for non-specific building-related illness.
        Indoor Air. 2007; 17: 328-333
        • Settipane R.A.
        • Charnock D.R.
        Epidemiology of rhinitis: allergic and nonallergic.
        Clin Allergy Immunol. 2007; 19: 23-34