Upward Trend: What’s to account for the increased prevalence of allergic rhinitis?

Impact at Home

In the U.S., it is difficult to determine whether the steep rise in allergic rhinitis over the past 30 years has leveled off. But there is no question that a large number of patients have the disease: It is estimated that allergic rhinitis affects at least 60 million people (see sidebar, “Allergic Rhinitis by the Numbers,” p. 13).

William Reisacher, MD, FACS, FAAOA, assistant professor of otorhinolaryngology at Weill Cornell Medical Center-New York Presbyterian Hospital in New York City, said the prevalence of allergic rhinitis in the U.S. may be even higher. “It affects about 15 percent to 20 percent of the adult population and 20 percent to 25 percent of the pediatric population,” he said.

The toll the disease takes on quality of life is considerable. One survey of 2,500 allergic rhinitis patients and 400 healthcare providers, released in 2006 and endorsed by the ACAAI, found that 59 percent of patients had missed work due to their allergy symptoms. In 2007, a survey of 447 patients with allergic rhinitis by researchers at Kaiser Permanente’s San Diego Medical Center found that about two-thirds of patients with intermittent disease “had some impairment of their professional or daily life as a result of allergic rhinitis” (Allergy. 2007;62 Suppl 85:9-16).

Two other surveys, the Burden of Rhinitis Survey 2004 and the Allergies in America Survey 2006, linked allergic rhinitis to a variety of debilitating co-morbidities, including depression, migraine and asthma.

Treatment and Prevention

Clearly, the stakes are high. Dr. Reisacher said that in most cases, treatment regimens should focus on two primary areas: environmental control and pharmacologic therapy. And, given the large role that people’s increasingly indoor lifestyles play in their disease, limiting the allergenic “load” in the home is crucial.

Granted, getting patients to comply with recommendations to address environmental factors that may be contributing to their symptoms “can be a huge challenge,” said Berrylin J. Ferguson, MD, FACS, FAAOA, associate professor of otolaryngology and director of the Division of Sino-Nasal Disorders and Allergy at the University of Pittsburgh School of Medicine in Pittsburgh, Pa.

Environmental controls, therefore, should be directed at things that are “reasonable and practical,” Dr. Ferguson said. For most people with dust mite allergies, for example, the significant exposure is in the bed and pillow. Dr. Ferguson advises patients to purchase breathable mattress and pillowcase covers that are impermeable to dust mites, to wash bedding in hot water once a week and to change pillowcases every three days. “If a patient follows these recommendations, they will reduce their exposure to dust mites by 90 percent, and you avoid the horrendous work of taking every stuffed animal, carpet and drapery out of the room,” she added. (See “Treating Allergic Rhinitis: A Patient Experiment.”)