Seasonal Specificity of Seasonal Allergens and Validation of the ARIA Classification in Korea

PURPOSE: In Korea, tree pollens are known to be prevalent in spring, grass pollens in summer and weed pollens in autumn. However, few studies have revealed their seasonal specificity for allergic rhinitis symptoms. An ARIA (Allergic Rhinitis and its Impact on Asthma) classification of allergic rhinitis was recently introduced and its clinical validation has not been well proved. The aim of this study was to evaluate the seasonal specificity of seasonal allergens and to validate the ARIA classification with the conventional seasonal and perennial allergic rhinitis (SAR/PAR) classification. METHODS: Two hundred twenty six patients with allergic rhinitis were included in this study. The patients were classified according to the sensitized allergens and the ARIA classifications. A questionnaire survey was performed and the data on the seasonal symptom score, the severity of symptoms and the SNOT (sinonasal outcome test)-20 score was obtained and the data was analyzed and compared between the conventional SAR/PAR classification and the ARIA classification. RESULTS: Seasonal pollens (tree, grass, weed) were not specific to the pollen peak season and the patients' symptoms were severe during spring and autumn regardless of the offending pollens. More than 60% of the patients with SAR showed persistent symptoms and 33% of the patients with perennial allergic rhinitis (PAR) had intermittent symptoms, showing the lack of association between the SAR/PAR/PAR+SAR classification and the ARIA classification. The ARIA classification showed better association not only with the symptomatic score, but also with the SNOT-20 score, which showed better validity than the conventional SAR/PAR classifications. CONCLUSIONS: Seasonal pollens were not specific to their season of prevalence in terms of the severity of symptoms, and the ARIA classification showed better representation of allergic symptoms and quality of life (SNOT-20 score) than did the SAR/PAR classification.

Prevalence of Allergic Rhinitis on the Basis of ARIA Classification / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Allergic rhinitis (AR) is commonly sub-classified into seasonal and perennial rhinitis. The recent "Allergic Rhinitis and its impact on Asthma (ARIA) Workshop" proposed to replace these terms by intermittent vs persistent AR. But the validity of this new classification is still largely unknown. SUBJECTS AND METHOD: Three hundred-eleven allergic rhinitis patients were included in this study. Patients were categorized into seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR) groups, according to sensitized allergens. Twenty-eight items questionnaire filled out by patients were designed for this study. Based on the questionnaire, patients were classified into either intermittent or persistent AR. Patients' information and associated factors were analysed between the groups. RESULTS: Within the population with AR, 58% of the subjects had persistent AR. About 41% of the patients were classified as moderate-severe persistent AR. There was no association between the intermittent/persistent and the SAR/PAR classifications. Subjects with persistent AR had more severe symptoms, higher rate of self-awareness and had been previously diagnosed with AR. There were no significant difference in sensitization to allergens. However, grass, tree, house dust mite allergy is more common in persistent AR than in intermittent AR. More patients in "Blockers" and "Mixed" groups had persistent AR. CONCLUSION: A statistical comparison of the two classifications showed that they cannot be used interchangeably, as they do not represent the same stratum of disease. There is also an evidence that the persistent type describes a distinct group with characteristics that differentiates them from intermittent AR. These results support the validity of the new ARIA classification as shown in other studies.