Dissonance Between Patients’ and Physicians’ Perceptions of Allergic Rhinitis and Effects of Medications

In registered trials for intranasal steroid sprays, about 66% of patients have excellent relief but 33% do not. This survey showed the same results, but this was not a clinical trial, Dr. Naclerio said.

Fifty-eight percent of 919 patients said that their nasal spray worked within an hour, but Dr. Naclerio said this is strange, because the known mechanism of action does not suggest that a nasal spray would work this rapidly.

The perception is that relief is fast, but this defies the known mechanism of action. Patients’ opinions differ from reality, he commented.

Even when prescription nasal sprays provide relief, 48% of patients said effectiveness waned. Among those who said this, 70% said the nasal sprays lost effectiveness within 12 hours. This is different than one would expect. Most sprays show effectiveness 24 hours after the last dose. Patients’ perceptions differ from what studies have shown, Dr. Naclerio commented.

All Respondents

One third of all respondents said that they had asked their doctor at some point in time to change their allergy medication. About two-thirds of patients change their prescription medications every few years; reasons included suboptimal efficacy (37%), doctor wanted to try other medication (23%), patient wanted to try another medication (11%), and patient had bothersome side effects (8%).

For all respondents, side effects of medications included dryness (50%), drowsiness (40%), post-nasal drip (40%); bad taste (30+%); burning (19%), and headache (15%). When asked why patients did not follow their physicians’ instructions regarding prescribed medications, 41% said lack of symptom relief, 37% said the medications lacked effectiveness over time, 35% noted that their symptoms disappeared, and 27% said troublesome side effects.

These findings imply that although we prescribe medications, we really don’t follow through to find out whether patients are satisfied or are taking their medications. A lot of patients don’t tell you they are unhappy; they just stop taking their medications. Prescribing medications is not enough. We need to follow our patients and find out if they are adherent. We need to determine if the medications are helping, or whether it is time to switch to a different medication. Also, the diagnosis may not be correct if the medications aren’t effective, Dr. Naclerio commented.

Patients were asked to list attributes that were important to them in an allergy medication. Thirty-nine percent said fast relief, 62% said long-lasting relief, and 52% said complete relief of symptoms. The following answers were unexpected: only 6% said easy to take, 19% said few side effects, and 18% said low cost.