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Irritant index questionnaire may aid in rhinitis diagnosis

Use of a questionnaire surveying patients with chronic rhinitis on their response to nonallergic irritants may assist in the diagnosis and classification of their illness, according to recent results.

Researchers evaluated data from 404 patients aged 18 to 65 years with chronic allergic rhinitis (AR), 129 with mixed rhinitis (MR) and 123 with nonallergic rhinitis (NAR). All participants responded to an irritant index questionnaire (IIQ) rating the severity of their symptoms in response to 21 nonallergic irritants, and they were reclassified into groups based on irritant burden.

Among the AR and MR patients, 254 were reclassified with low-burden AR and 279 with high-burden AR. In the NAR group, 79 were reclassified with low-burden and 44 high-burden NAR. Investigators found that patients with high-burden AR were more prone than low-burden patients to physician-diagnosed asthma (31% compared with 21%), an increased number of self-reported rhinitis symptoms (mean 3.4 compared with 3.1) and perennial, seasonally exacerbated symptoms (65% vs. 45%) (all P<.01). The high-burden AR group also was significantly older than the low-burden group (42.5 years vs. 39.2, P<.01).

Patients with high-burden NAR were found more likely than low-burden patients to have physician-diagnosed asthma (34% vs. 13%, P<.01) and reported more perennial rhinitis symptoms with seasonal exacerbation (mean 3.2 vs. 2.5, P<.01). High-burden NAR patients also were older than low-burden patients (49.6 years vs. 45, P=.03) at enrollment.

A standardized Cronbach alpha coefficient of 0.92 was established for all IIQ scores, with a range of 0.45 to 0.75 for individual survey questions (median, 0.65). Cross-validation of the high- and low-burden subgroups indicated a P value of 0.15.

“Use of the IIQ resulted in significant reclassification of patients with physician-diagnosed rhinitis into different diagnostic categories with unique clinical characteristics,” the researchers wrote. “We believe that this patient-centric questionnaire represents a valid and consistent tool that may be used to identify AR patients with high- and low-irritant trigger burdens.”

Disclosure: See the study for a full list of relevant disclosures.