E-diaries show promise for collecting allergic rhinoconjunctivitis symptoms

Patients remember allergic rhinoconjunctivitis symptom frequency with less precision than they remember symptom severity, although prospective and retrospective assessments of severity are well interrelated, according to a study.

The use of e-diaries and a proposed scattergram technique may improve severity assessment, Stephanie Dramburg, MD, research fellow in the department of pediatric respiratory care, immunology and critical care medicine at Charité-Universitätsmedizin Berlin, and colleagues wrote in the study, which was published in Allergy.

Data that patients record themselves may help physicians diagnose and treat allergic rhinoconjunctivitis (AR), the researchers noted, although measures of disease severity often still rely on Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines and other retrospective questionnaires. E-diaries, however, provide prospective measures of disease severity.

This study involved 91 patients (average age, 13.7 years; standard deviation, 3.2; 64% male) living in Rome who had been diagnosed with seasonal AR. These patients used the AllergyMonitor e-diary app to record their symptoms, medication intake and quality-of-life measures. Severity measurements included the daily Symptom Score (dSS), Combined Symptom Medication Score (CSMS) and VAS.

After the pollen season was over, the researchers compared the prospective e-diary measurements with retrospective ARIA severity classifications for each patient.

Disease severity varied across the population based on data from the app, including 40 patients (44%) classified as mild, 38 (42%) classified as moderate and 13 (14%) classified as severe. According to the researchers, 46 (50%) of these classifications via the app matched the classifications based on the ARIA results, although the researchers found that only four (5%) of these differences were extreme inconsistencies.

The impact of symptoms on quality of life as prospectively measured by daily questions on sleep, work and daily activity also significantly correlated with their retrospective classifications across all three levels of severity.

But the prospective and retrospective assessments of symptom frequency were more heterogenous, the researchers found. Retrospectively, the patients who called their AR symptoms persistent said they suffered from these symptoms during more than 50% of the days recorded. However, the patients who called their AR symptoms intermittent in the retrospective analyses had a broader range of data entries that indicated symptoms, the researchers continued.

The researchers additionally noted that only 47% of the patients had matching retrospective and prospective frequency classifications. The largest group of mismatches involved symptoms classified as persistent retrospectively and intermittent when assessed via e-diary in 45% of patients.

To help physicians intuitively interpret prospectively collected data about symptom severity, the researchers proposed a bubble chart with dSS on the x-axis, CSMS on the y-axis and impact on quality of life using VAS with bubble diameter. The colors and positions of these bubbles can provide a quick overview of AR symptom severity, the researchers wrote.

Although the researchers found reciprocal consistency and cross-compatibility between prospective and retrospective assessments of AR severity, they did note that patients remember symptom frequency less precisely than symptom severity.

Further, the researchers called for more studies to develop their proposed bubble chart for assessing symptoms, which they called an observer-friendly interpretation of patient-reported severity measures.