Patient perceptions of allergic rhinitis and quality of life: findings from a survey conducted in europe and the United States.

BACKGROUND: : Allergic rhinitis (AR) is a common, costly, and troublesome condition, impairing patients' quality of life (QoL), cognitive function, and productivity. Patients with AR report disturbed sleep, fatigue, irritability, and a range of practical problems. However, there is a relative lack of data on how patients with AR perceive their QoL. OBJECTIVE: : To better understand how patients perceive AR and their attitudes toward this condition (including QoL) and its treatment options. METHODS: : An online and telephone survey of 3635 people identified as having outdoor and indoor allergies, urticaria, and/or pet allergies was performed in 6 countries. RESULTS: : The survey confirmed that patients with allergies perceive their symptoms as causing significant disruptions to their daily lives. Respondents were affected for a considerable part of each day, with the most severe symptoms occurring in the morning. The most important desired effect of medication was the restoration of normal breathing, and the most highly rated attributes of the "ideal" AR drug were efficacy, safety, and freedom from undesirable side effects. CONCLUSIONS: : The information gathered from allergy sufferers who participated in this survey sheds light on the degree to which people with allergies are affected by their disease and the limitations imposed by associated symptoms.

[The diagnosis of allergic diseases]. / Diagnostic des maladies allergiques.

The diagnosis of allergic diseases IgE mediated is based on 4 criteria: questionnary on the circumstances of appearance suggesting an allergic mechanism and defining an potential allergen; confirmation through cutaneous tests (prick test, IDR); measuring out of specific IgE (check results with clinical tests); provocation tests directed on the organ-target (nasal, bronchial or oral challenges) with the offending allergen. Recent tests, like cellulary tests, have shown the release of mediators in the presence of the allergen. The dosage of tryptase gives valuable information in cases of anaphylaxisis. Atopy-patch tests are efficient to detect delayed type of hypersensitivity. One of the important goal for consultations will be to confirm the allergic mechanism mediated by specific IgE. In a nutshell, the diagnosis of allergic diseases can be made based on the following: trigger identification, evidence of an IgE-mediated sensitivity and association of this sensitivity with symptoms, which can be identified with obvious clinical history or allergen testing.

[Pharmacological and clinical evalutation of nasal obstruction: application to xylometazoline]. / Techniques d'etude pharmacologique et clinique de l'obstruction nasale: application a la xylometazoline.

Nasal obstruction, a prominent feature of rhinitis, may be quantified in humans by haemodynamic techniques (measuring local blood flux), static methods (measuring the geometry of nasal cavities) and dynamic methods (assessing the patency of nasal airways through the measure of resistance to air flow). These methods demonstrated the nasal decongestant activity of xylometazoline in healthy volunteers and rhinitis patients. Controlled double-blind studies established the clinical efficacy of xylometazoline in infectious and allergic (seasonal and perennial) rhinitis versus placebo and in comparison with various reference substances. The effects on nasal epithelium ciliary activity which are observed in vitro are modest and even less pronounced in vivo owing to dilution in situ and protective physiological processes.

Evaluation of efficacy, tolerability, and treatment satisfaction with almotriptan in 3 consecutive migraine attacks. The migraine--satisfaction with treatment: reality with Almogran study.

The objective of the open-label, multicenter Migraine--Satisfaction with Treatment: Reality with Almogran study was to assess efficacy, tolerability, and satisfaction with almotriptan 12.5 mg among migraineurs who were not achieving adequate results with their current acute therapy. Data from 434 patients (342 evaluable), were obtained for 929 attacks by 154 neurologists in France. Using a questionnaire developed by the National Agency for Accreditation and Evaluation in Health (ANAES), almotriptan was associated with an increased proportion of patients experiencing significant relief at 2 h (69.3 vs. 26.6%), tolerating the medication well (91.2 vs. 76.0%), able to resume activities (70.5 vs. 24.9%), and taking only 1 dose (59.4 vs. 28.1%) compared with previous therapies. At 2 h, headache pain had disappeared in 33.4% of attacks and was mild in 26.9%. Recurrence rate was 28.4% and rescue analgesics were used in 20.9% of attacks. The rate of adverse event-related discontinuations was 2.6%. The proportion of patients who were very satisfied/satisfied overall with almotriptan treatment was 69%. Almotriptan 12.5 mg was effective, well-tolerated and associated with a high rate of treatment satisfaction in patients whose previous acute migraine therapy was inadequate according to the ANAES recommendations.

The PROMISE study: PROphylaxis of MIgraine with SEglor (dihydroergotamine mesilate) in French primary care.

INTRODUCTION: Seglor capsules, a unique modified-release formulation of dihydroergotamine mesilate, have long been in clinical use in France for migraine prophylaxis. The aim of the PROMISE (PROphylaxis of MIgraine with SEglor) study was to establish the efficacy and tolerability of Seglor in the prevention of migraine in a general practice setting. METHODS: The PROMISE study was a double blind, placebo-controlled, parallel-group study carried out in primary care practice. It included 363 migraine patients treated with Seglor or placebo for 5 months after a 1-month placebo run-in phase. RESULTS: Migraine attack frequency (primary efficacy criterion) decreased markedly in the two treatment groups so that the difference in favour of Seglor did not reach statistical significance. However, most secondary outcome measures (duration of single attack, total duration of attacks over 1 month, consumption of mild opiate analgesics, subjective improvement) improved to a significantly greater degree in patients receiving Seglor than in those receiving placebo. In the 84.5% of patients who had impaired quality of life at entry, the percentage of reduction in attack frequency and most other efficacy measures showed significant improvement with Seglor. The safety profile for Seglor was comparable to that of placebo. CONCLUSION: These results support the effectiveness of Seglor in patients with migraine-related quality-of-life impairment. The findings of the PROMISE study also suggest that patients' quality of life should be assessed systematically before initiating a preventive treatment for migraine.

Economic impact of migraine and other episodic headaches in France: data from the GRIM2000 study.

BACKGROUND: Migraine is a prevalent and incapacitating condition that affects individuals in the prime of their productive life, thus generating an economic burden for both society and healthcare systems. The direct annual healthcare costs of migraine in France were assessed over 10 years ago, and the current study updates these figures. OBJECTIVE: The objective of this study was to determine the economic cost (primarily direct costs) of migraine and other episodic headache in France based on a general population survey of headache, the GRIM2000 (Groupe de Researche Interdisciplinaire sur la Migraine). DESIGN: From a representative general population sample of 10,585 individuals aged > or = 15 years in France in 1999, 1486 individuals experiencing headaches were identified and interviewed regarding healthcare resource consumption in the previous 6 months. By applying unit costs to the resource data, costings (in 1999 values) were determined for physician consultations, hospitalisation, medication use and diagnostic/laboratory tests, and evaluated from a healthcare system perspective. Information on absenteeism and lost productivity was derived from the Migraine Disability Assessment Score (MIDAS) questionnaire. RESULTS: The prevalence of migraine (including migrainous disorder) was determined to be 17%. Total annual direct healthcare costs were estimated to be Euros 128 per individual with migraine in 1999, corresponding to Euros 1044 million when extrapolated to all individuals experiencing migraine and aged > or = 15 years. Around two-thirds of this cost accrued to the social security system (Euros 698 million; Euros 85 per individual). The total annual direct cost of other forms of episodic headache was much lower at Euros 28 per individual (social security cost Euros 18); with a prevalence of 9.2%, the annual national direct cost for other forms of episodic headache totalled Euros 124 million. The principal cost element was physician consultations. However, it was found that many individuals had never consulted a physician for their headaches, and self-medication contributed substantially to the medication costs (the second greatest cost factor for migraine). The cost per individual rose steeply with increasing severity of headache. CONCLUSIONS: The direct healthcare costs of migraine do not seem to have risen significantly over the past decade. A small minority of individuals with more severe headaches consume most of the healthcare resources devoted to migraine, while most individuals generate relatively low direct costs. The total annual direct costs in France for migraine are almost 10-fold higher than those of other episodic headache.

Impact of headache on quality of life in a general population survey in France (GRIM2000 Study).

OBJECTIVES: The objectives of this study were to determine the impact of headache on health-related quality of life in a nationwide sample of the French general population using a disease-specific measure, the Qualité de Vie et Migraine (QVM), to compare quality of life in subjects reporting different headache to types, and to evaluate the relationship between quality of life and severity, frequency, associated disability, and treatment responsiveness of headaches. METHODS: The QVM questionnaire was included within a large epidemiological survey of 1486 headache sufferers. Diagnosis was assigned retrospectively using an algorithm based on the International Headache Society classification. Headache severity was assessed with the MIGSEV scale and disability with the MIDAS scale. RESULTS: The mean global QVM score in the sample was 80.2. Quality of life was poorer in subjects with chronic daily headache (QVM score: 66.2) than in those with migraine (QVM score: 76.7), while those with other forms of episodic headache had the best quality of life (QVM score: 91.7). Quality-of-life scores were correlated with frequency, severity, disability, and treatment resistance of headaches (P <.001). CONCLUSION: The QVM scale is a sensitive tool to measure health-related quality of life in headache sufferers in the general population.

[Management of intractable migraine in adults]. / Prise en charge d'une crise migraineuse rebelle chez l'adulte.

The management of intractable migraine is not yet standardised. The first point in the emergency department is to eliminate severe cephalalgic non-migrainous disease, then to confirm the diagnosis of migraine. The second point is to determine trigger factors responsible for the refractory migraine--principally inadequate therapy, such as too low a dosage, inadequate treatment compared with intensity, and delayed treatment. Examples of inadequate classical treatments are presented for the following four main oral therapies: a nonsteroidal anti-inflammatory drug (NSAID), analgesics, ergot derivatives, and triptans. When these drugs are ineffective, the following are used via injections: propacetamol, aspirin (lysine acetylsalicylate), injectable NSAIDs, and nefopam. These products differ from country-to-country. For example, morphinomimetics, phenothiazines and corticosteroids are widely prescribed in the US, while metamizole (dipyrone) is preferred in developing countries. The authors describe the different models of administration and the adverse effects of the substances. Finally, they describe the treatment of status migrainosus. Globally, triptans are underused in emergency departments. This review confirms the need for controlled trials of treatments for migraine in emergency departments in order to develop an international therapeutic consensus.

Prevalence and description of chronic daily headache in the general population in France.

The objective of this study was to describe the epidemiology, clinical presentation and consequences of chronic daily headache (CDH) in France. A representative nation-wide sample of the general population was identified using a stratified sampling method. Ten thousand five hundred and eight-five subjects were screened in face-to-face interviews, and data collected using a standard questionnaire. An overall point prevalence of CDH in the general population of 2.98% was observed. Two-thirds of these subjects presented migraine-like features. Severity, functional impact and healthcare consumption were higher than in subjects reporting episodic migraine in the same sample. Of the subjects, 28.2% reported the most severe migraine disability assessment scores (Grades 3 and 4), compared to 12% of episodic migraineurs. A qualité de vie et migraine score of 68.4 was observed, indicating severely attenuated quality of life. Only 6.6% of subjects were taking prophylactic treatment, whilst 88% were using non-specific acute headache treatments. The frequency of physician consultations and laboratory examinations was significantly higher than in individuals with episodic headache. CDH is thus a relatively prevalent condition in the general French population, associated with an important burden of suffering and with considerable expenditure in the health service. Management of this condition is generally inappropriate.