Allergic rhinitis_ Clinical manifestations, epidemiology, and diagnosis.pdf
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17/2/2015 Allergic rhinitis: Clinical manifestations, epidemiology, and diagnosis http://www.bidi.uam.mx:5667/contents/allergic-rhinitis-clinical-manifestations-epidemiology-and-diagnosis?topicK ey=ALLRG%2F7525&ela psedTime… 1/21 Official r eprint from UpToDate www.uptodate.com ©2015 UpToDate Authors Richard D deShazo, MD Stephen F Kemp, MD Section Editor Jonathan Corren, MD Deputy Editor Anna M Feldweg, MD Allergic rhinitis: Clinical manifestations, epidemiology, and diagnosis All topics are updated as new evidence be comes available and our peer review process is complete. Literature review current through: Jan 2015. | This topic last updated: Oct 22, 2014. INTRODUCTION AND TERMINOLOGY — Allergic rhinitis, or allergic rhinosinusitis, is characterized by paroxysms of sneezing, rhinorrhea, and nasal obstruction, often accompanied by itching of the eyes, nose, and palate. Postnasal drip, cough, irritability, and fatigue are other common symptoms [ 1-3 ]. Some investigators prefer the term "rhinosinusitis" to the separate terms "rhinitis" and "sinusitis." This is because the nose and sinus mucosa are contiguous, rhinitis and sinusitis frequently occur tog ether, rhinitis commonly leads to sinusitis, and nasal symptoms are common with sin usitis. However, within this topic review, rhinitis and sinusitis are referred to separately, given that management issues may differ for each condition, and detailed reviews of acute and chronic sinusitis are presented elsewhere. (See "Acute sinusitis and rhinosinusitis in adults: Clinical manifestations and diagnosis" and "Chronic rhinosinusitis: Clinical manifestations, pathophysiology, and diagnosis" and "Acute sinusitis and rhinosinusitis in adults: Treatment".) The clinical manifestations, epidemiology, and diagnosis of allergic rhinitis are presented in this topic review. The pathogenesis and treatment of this condition are discussed separately. (See "Pathogenesis of allergic rhinitis (rhinosinusitis)" and "Pharmacotherapy of allergic rhinitis".) EPIDEMIOLOGY — Allergic rhinitis is common, affecting 10 to 30 percent of childre n and adults in the United States and other industrialized countries [4-9 ]. It may be less common in some parts of the world, although even developing countries report significant rates [10-16]. The prevalence of asthma, rhinoconjuncti vitis, and eczema were systematically evaluated in approximately 1.2 million children in 98 countries in the International Study of Asthma a nd Allergies in Childhood (ISAAC) [ 17]. The overall prevalence of rhinoconjunctivitis in children aged 6 to 7 years and 13 to 14 years was 8.5 and 14.6 percent, respectively. The prevalence in the industrialized world is increasing, particularly in u rban areas [18-20]. Theories about the reasons for increasing prevalence are reviewed separately. (See "Increasing prevalence of asthma and allergic rhinitis".) Economic burden — Allergic rhinitis is associated with significant morbidity and expense [21-24]: There is evidence that the economic burden is increasing, at least in the United States. Medical spending to treat allergic rhinitis almost doubled from 2000 to 2005 (USD $6.1 to $11.2 billion dollars) [28 ]. In addition to costs directly attributable to allergic rhinitis, the disorder is highly associated with asthma and sinusitis, further expanding its economic impact. RISK FACTORS — The following are proposed or identified risk factors for allergic rhinitis [ 29-32]: ® ® It accounts for at least 2.5 percent of all clinician visits, 2 million lost school days per year, 6 million lost work days, and 28 million restricted work days per year. ● The average number of annual prescriptions for patients with allergic rhinitis is nearly double that for patients without allergic rhiniti s (19 versus 10) [24]. ● Studies performed in the years around 2000 reported 2.4 billion American dollars spent on prescription and over-the-counter medications and USD $1.1 billion in clinician billings, causing a total indirect and direct cost of several billion dollars per year [ 25-27]. ●
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