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Wise et al.

Page 59

a patient reports their own symptoms could very well be the best predictor of disease control.

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Validated clinical surveys for AR often include questions about congestion, rhinorrhea and/or sneezing and may either be instantaneous or reflective over a period of days or weeks. The TNSS is typically administered as an instantaneous daily survey comprised of only 4 questions about runny nose, nasal itching, sneezing, and congestion. Some studies have used the TNSS as a reflective score calculated as the average of both the 12-hour nighttime and 12-hour daytime average (rTNSS). The TNSS score can be combined with questions about rescue medication use to yield the Daily Combined Score (DCS) and the Total Combined Rhinitis Score (TCRS). Both have been used in many therapeutic intervention studies. 803 The RQLQ is a more comprehensive survey that asks the patient to reflect upon the past week and includes global QOL questions. While this test can suffer somewhat from potential recall bias, it can be administered on site and avoids the possibility that self-administered daily scores could be missed periodically when the patient is home. The Control of Allergic Rhinitis and Asthma Test (CARAT10) evaluates rhinoconjunctivitis and asthma symptoms over the past 4 weeks giving a broader evaluation of seasonal symptom control. 804 The Respiratory Allergy Prediction (RAP) test is a 9-question survey incorporating upper and lower respiratory queries as well as a question about medication use. If conjunctivitis is to be assessed simultaneously with rhinitis symptoms, then the Rhinitis Total Symptom Score (RTSS) can be combined with Rescue Medication Score (RMS) to yield the combined score (CS). 805 Table VIII.D-1 lists several validated clinical survey tools. 696,804,806-813 for referral and further testing, then the RAP test may be used because it has been scrutinized in this setting. 814 The mini-RQLQ and DCS have been used extensively in clinical trials to evaluate the effectiveness of drugs and immunotherapies, 797-801 and therefore may be helpful in selecting the right medication for a given population. It is important to note that some tools use a higher score to indicate severe disease whereas other tools use a higher score to indicate better control of symptoms. For example, a high score on the RCAT, ARCT, and CARAT10 indicate good control of allergic symptoms. Unfortunately, not all studies use consistent terminology and interpretation of the scoring systems. 801 Inconsistent use of questionnaires can weaken the conclusions drawn in certain therapeutic intervention studies. However, a well-executed and validated survey can be essential in research settings and help clinicians screen patients for AR and further render specific diagnostic decisions. Overall, validated clinical survey instruments may be used as a tool to assist with the diagnosis of AR and determine the success of various therapies. This conclusion is based on review of more than 30 studies of which 9 of these reports range from level 1a to 2b (overall Grade A evidence) (Table VIII.D-2). An example approach using specific validated survey instruments is as follows. The TNSS may be used for daily symptom monitoring to determine the effectiveness of therapies and control of AR. The TNSS should be combined with a daily medication score to account for the effects of pharmaceuticals on The choice of which validated survey to use depends on which aspect of clinical outcomes is being studied. For example, if the goal is for a primary care physician to determine the need

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