Allergic rhinitis symptoms impact academic productivity
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Key takeaways:
- Nasal symptoms have a stronger association with worse academic performance than eye and asthma symptoms.
- Comedication was associated with a significant reduction in academic productivity, while immunotherapy was associated with higher productivity.
- The study’s results spotlight the importance of good rhinitis control among students as well as the need for effective treatment.
Patients with allergic rhinitis and allergy symptoms, particularly nasal symptoms, faced challenges in academic productivity, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
However, immunotherapy was associated with higher productivity, Rafael José Vieira, MD, invited assistant in the department of community medicine, information and health decision sciences in the faculty of medicine at University of Porto in Porto, Portugal, and colleagues wrote.
The researchers analyzed 13,454 days of data from 1,970 patients aged 13 to 29 years (mean age, 20.1; standard deviation, 4.1 years; 60.3% female) from 27 countries with a self-reported diagnosis of allergic rhinitis who used the MASK-air mobile app between May 21, 2015, and Jan. 9, 2022.
MASK-air includes a daily monitoring questionnaire that assesses allergy symptoms via four mandatory VASs, determines “VAS education” by asking users how much these symptoms affect their academic performance each day, and includes an optional Work Productivity and Activity Impairment Questionnaire plus Classroom Impairment Questions: Allergy Specific (WPAI+CIQ:AS). All are measured on a 0 to 100 scale, with higher scores indicating worse symptoms or greater impact.
The median VAS education score was 17 (interquartile range [IQR], 28) overall — with scores of 50 or higher observed on 1,757 days (13.1%) — 16 (IQR, 27) for patients with a self-reported diagnosis of asthma and 17 (IQR, 27) for those without asthma.
Among the 107 users who completed 125 weeks of WPAI+CIQ:AS questions, 44 (35.2%; 95% CI, 26.2%-44.2%) reported at least some education hours lost due to allergies. The median score for allergy’s impact on academic productivity was 37 (IQR, 48).
Among all variables, VAS education had the strongest correlations with:
- the WPAI+CIQ:AS impact of allergy symptoms on education productivity (Spearman’s correlation coefficient, 0.71; 95% CI, 0.58-0.8);
- Combined Symptom-Medication Score, or CMSS (Spearman’s correlation coefficient, 0.7; 95% CI, 0.69-0.71);
- VAS global allergy symptoms (Spearman’s correlation coefficient, 0.7; 95% CI, 0.68-0.71); and
- VAS nose (Spearman’s correlation coefficient, 0.66; 95% CI, 0.65-0.68).
Also, patients with a self-reported diagnosis of asthma had consistently higher Spearman’s correlation coefficients between VAS asthma scores and variables related to education than those patients who did not have asthma
VAS scores for ocular, nasal and asthma symptoms were associated with VAS education in the main regression model, with the nasal scores having the strongest positive association (regression coefficient, 0.38; 95% CI, 0.37-0.39).
Days on single medication increased VAS education scores by 0.23 units (95% CI, –0.92 to 0.47), and days on comedication increased scores by 1.7 units (95% CI, 0.72-2.68), when adjusted for other independent variables. Days on immunotherapy, however, reduced VAS education scores by 2.32 units (95% CI, –4.04 to –0.59).
Poor control of allergic rhinitis, as indicated by CMSS, was associated with missed education hours (regression coefficient, 0.44; 95% CI, 0.25-0.63), academic productivity (regression coefficient, 0.69; 95% CI, 0.49-0.9) and worse VAS education (regression coefficient, 0.88; 95% CI, 0.88-0.92).
According to the researchers, these findings indicate the importance of good rhinitis control among students as well as the need to better inform patients about effective treatments.
Perspective
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These findings are quite consistent with what I am observing in my patient population in private practice. Poorly controlled allergic rhinitis and sinus disease can lead to poor mental focus and sleep hygiene that greatly impacts academic and career productivity. Asthma research and treatment options have made leaps and bounds, so I feel poorly controlled asthma is not as prevalent as it has been in the past.
A strong patient rapport, follow-up and monitoring of symptoms is essential, especially during high pollen season and intermittently through the academic school year. Identification of the severity of symptoms and adjusting the treatment plan in a timely manner will have a great impact on control of symptoms.
For seasonal symptoms, being proactive with treatment regimens is important as various therapies take time to reach full efficacy when initiated. Proper technique and use of medications such as inhalers and nasal sprays should be checked often to ensure compliance.
Further evaluation by an allergist to identify triggers causing symptoms and to gain access to other treatment options such as allergen immunotherapy (subcutaneous, sublingual) may ultimately decrease symptoms and medication use by close to 50% to 100%.
Next, research should examine the impact of asthma, allergic rhinitis and eye symptoms on quality of life and other comorbid conditions.
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