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Cover of Management of Allergic Rhinitis in the Working-Age Population

Management of Allergic Rhinitis in the Working-Age Population

Evidence Reports/Technology Assessments, No. 67

, MD, MHSc, , MD, , MD, MHS, , MA, , PhD, , MD, PhD, and , MD.

Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 03-E015ISBN-10: 1-58763-077-X

Structured Abstract


This report assesses the evidence on how allergic rhinitis affects costs and work performance in working-age populations; the effectiveness of environmental measures, immunotherapy, and combination pharmacologic therapies; differences in treatment approaches and outcomes by clinician specialty; and variability in prevalence, treatment patterns, and outcomes by patient race and ethnicity.

Search Strategy:

Nearly 1,600 English-language articles were identified principally from searches of MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, DARE, International Pharmaceutical Abstracts, EconLit, and EMBASE.

Selection Criteria:

Studies were included if the study population had allergic rhinitis, and if the study provided data on one of the key research questions and met minimal level-of-evidence criteria. We required patient-assessed symptom outcomes for efficacy questions.

Data Collection and Analysis:

We summarized descriptive data in evidence tables and evaluated each study for methodological quality. Meta-analysis was considered when multiple studies on the same topic provided quantitative outcome data.

Main Results:

Estimates of the effect of allergic rhinitis on work performance are variable. Patient-reported level of work impairment associated with allergic rhinitis ranged from 33 to 41 percent using a standardized validated instrument, with demonstrable improvement by seven to nine percentage points after treatment. Studies that directly measure work performance generally show lower degrees of impairment.

A few trials of environmental control measures in highly selected patients suggest that dust mite control measures decrease rhinitis symptoms. There is no strong evidence that air filtration systems decrease rhinitis symptoms.

Multiple trials of specific injection immunotherapy show improvement in symptoms compared with placebo. No serious adverse events were reported, and immunotherapy was well tolerated. Primary quality concerns are small trial size, lack of standardized clinical outcome assessments, and issues related to randomization procedures and concealment of allocation.

Combination symptomatic pharmacotherapy with antihistamines plus decongestants shows positive effects compared to monotherapy with either antihistamines or decongestants alone. Combination treatment with antihistamines plus nasal glucocorticoids shows positive effects compared to antihistamine alone, but no difference when compared to monotherapy with nasal glucocorticoids.

Little is described in the literature regarding patterns of allergic rhinitis care by clinician specialty. Several studies point to less-than-adequate knowledge regarding allergy treatment among patients in general medical practice. Two studies suggest that specialist clinician-delivered patient education results in improved allergic rhinitis symptoms.

Allergic rhinitis occurs in similar proportions across racial and ethnic groups in epidemiological studies, but there are essentially no data describing variation in treatment or outcomes by race or ethnicity.


Allergic rhinitis clearly has a negative impact on work performance, but the magnitude of this impact differs depending on the methodology used to measure it. Estimates of the effect of allergic rhinitis on healthcare costs appear to be unreliable. Environmental measures to reduce allergen exposure have not been definitively shown to be effective, with the possible exception of house dust mite controls. Specific immunotherapy is more effective than placebo, and combination pharmacotherapy is generally more effective than monotherapy for symptom control. There are insufficient data from which to draw conclusions about differences in treatment approaches between generalist and specialist physicians and in treatment patterns or outcomes by patient race or ethnicity.


Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-97-0014. Prepared by: Duke Evidence-based Practice Center.

Suggested citation:

McCrory DC, Williams JW, Dolor RJ, et al. Management of Allergic Rhinitis in the Working-Age Population. Evidence Report/Technology Assessment Number 67. (Prepared by Duke Evidence-based Practice Center under Contract No. 290-97-0014.) AHRQ Publication No. 03-E015. Rockville, MD: Agency for Healthcare Research and Quality. March 2003.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. Endorsement by the Agency for Healthcare Research and Quality (AHRQ) or the U.S. Department of Health and Human Services (DHHS) of such derivative products may not be stated or implied.

AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps heath care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.

The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.

Bookshelf ID: NBK36745


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