xRead - September 2022

Wise et al.

Page 51

Also included are recent studies, published after the noted systematic reviews and meta-analyses. If systematic reviews and meta-analyses are not available, individual studies are listed.

Author Manuscript Author Manuscript Author Manuscript Author Manuscript

VII. Disease burden VII A. Individual burden

VII.A.1. Effect on quality of life— Two systematic reviews have evaluated the effect of AR on QOL, with both concluding that AR patients suffer from significantly decreased general and disease-specific QOL due to the impact of physical and mental health. Furthermore, both studies demonstrated that treatment of AR leads to improvement in QOL 667,668 (Table VII.A.1). While the impact of AR on QOL has been suggested in the literature for decades, only recently has the effect of AR on QOL been rigorously studied. This is in part due to the development of validated general and disease-specific QOL instruments, and their use in clinical investigations and trials. The most commonly used general QOL instruments in the AR literature appear to be the Short Form 12 and 36 (SF-12/36), 669,670 which measure generic physical and mental health-related QOL. The most commonly used AR disease-specific QOL tool is the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), or 1 of its variations (ie, mini-RQLQ, nocturnal RQLQ). 671 However, despite the availability of these instruments, many studies in the published literature rely upon nonvalidated methods to assess QOL, leading to difficulty comparing outcomes between some studies. Several high-quality studies have evaluated the impact of AR on overall and disease-specific QOL (Table VII.A.1). Most level 1b evidence includes RCTs evaluating the effect of topical nasal corticosteroids, 671-673 antihistamines, 672,674-677 or AIT. 678,679 The general consensus of these studies is that AR has a significant negative impact on general and disease-specific QOL, and that the successful treatment of AR by any of the aforementioned therapies leads to the improvement of symptoms and QOL. One RCT that examined monotherapy vs poly therapy showed that the combination of mometasone with either levocetirizine or montelukast led to greater symptom and QOL improvement than mometasone alone, but there was no difference between the levocetirizine and montelukast groups. 672 Additionally, a RCT of acupuncture vs medical therapy showed that the improvement in QOL occurred in both groups, but the degree of improvement was larger in the acupuncture group. 680 While the remaining evidence is of lower quality, it includes important and interesting findings in addition to the conclusions reached by the RCTs and systematic reviews. For example, extranasal symptoms, particularly ocular symptoms, have a significant impact on QOL and should not be ignored in the evaluation and management of AR. 681-684 Furthermore, the productivity, practical/activity, emotional, social, and memory function of patients appear to be significantly impacted by AR. 685-689 No high-quality studies have explicitly attempted to establish variations of QOL in AR patients over time, and most have short follow-up periods or only a single follow-up. However, some observations regarding the natural variation in QOL in AR can be extracted from the placebo arms of level 1 studies. Two RCTs have studied the effect of levocetirizine

Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.