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Treatment Guidelines For Seasonal Allergic Rhinitis Lead To Significant Improvement In Symptoms, Quality Of Life

Patients with seasonal allergic rhinitis show significantly greater improvement when treated according to the guidelines of the International Consensus on Rhinitis, researchers report.

Seasonal allergic rhinitis is a common disease worldwide, and the treatment is now well established. However, recent studies suggest that many patients are using treatment inappropriately, leading to insufficient control of symptoms.

Furthermore, national and international guidelines for the treatment of seasonal allergic rhinitis have been published, but their implementation at the patient's level has never been established.

Jean Bousquet, MD, PhD, with the Hopital Arnaud de Villeneuve, Montpellier, France, and colleagues have performed a study to assess the benefit of implementing the guidelines of the International Consensus on Rhinitis (ICR) in the treatment of this disease.

General practitioners were randomised into two groups and enrolled a maximum of two patients only. Physicians in the first group enrolled 225 patients (mean age = 33.1 years, males = 52%) and followed a treatment strategy based on the ICR guidelines. Physicians in the second group enrolled 244 patients (mean age = 31.7 years, males = 48%) and had a free choice of treatment.

At baseline, the patients were categorised into different levels of severity for seasonal allergic rhinitis using the visual analog scales. Depending on the severity category, patients in the guidelines group received an oral antihistamine (20 mg ebastine) and/or an intranasal corticosteroid (220 micrograms triamcinolone acetonide). Those with moderate/severe conjunctivitis also received a cromone (2% nedocromil sodium eye drops). Physicians in the free-choice group were not instructed to use the results of the VAS.

Patients recorded daily symptoms, drug intake and adverse events in an electronic diary over a 3-week treatment period. Quality of life was also assessed in the diary at baseline, day 7, and end of treatment (day 21) using the disease-specific rhinoconjunctivitis quality of life questionnaire (RQLQ).

The guidelines group showed significantly greater improvements in symptoms and quality of life compared to the free choice group (P=0.0001), according to Dr. Bousquet. The difference in RQLQ scores between the two groups was 0.48 at day 7 and 0.53 at day 21. In addition, 69.1% of patients in the guidelines group had compliance of over 90%, compared with only 50.4% of patients in the free-choice treatment group.

The proportion of patients in the free-choice group who received a nasal corticosteroid either alone or in combination was 32%, compared with 84% in the guidelines group. Only 20% of patients in the free-choice group received treatment that followed the guidelines strategy.

"Our study suggests that doctors are not able to assess adequately the severity of seasonal allergic rhinitis and/or to administer the appropriate treatment without guidelines," the researchers conclude.

The benefits of applying the ICR guidelines "have been clearly demonstrated and the treatment of seasonal allergic rhinitis according to guidelines has therefore been validated," they add.
Allergy 2003 Aug;58:8:733-741. "Implementation of guidelines for seasonal allergic rhinitis: a randomized controlled trial"

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