Managing impairment in patients with allergic rhinitis.
ABSTRACT Allergic rhinitis is a common medical problem in both the adult and the pediatric population. A main complication of this disease is a reduction in the patient's quality of life. Individuals with either seasonal or perennial allergic rhinitis often are impaired, adversely affecting work and/or school performance. This impairment can result from the disease itself and the treatment thereof. Oral antihistamines are the mainstay of treatment for allergic disease. First-generation antihistamines are considered sedating and frequently are impairing even when sedation is absent. Second-generation antihistamines show some class variability regarding impairment but as a group are clearly less impairing than their first-generation predecessors. Second-generation antihistamines are the preferred medication when antihistamines are necessary.
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ABSTRACT: Seasonal allergic rhinitis is common globally, and symptoms have been shown to impair learning ability in children in laboratory conditions. Critical examinations in children are often held in the summer during the peak grass pollen season. To investigate whether seasonal allergic rhinitis adversely impacts examination performance in United Kingdom teenagers. Case-control analysis of 1,834 students (age 15-17 years; 50% girls) sitting for national examinations. Cases were those who dropped 1 or more grades in any of 3 core subjects (mathematics, English, and science) between practice (winter) and final (summer) examinations; controls were those whose grades were either unchanged or improved. Associations between allergic rhinitis symptoms, clinician-diagnosed allergic rhinitis, and allergic rhinitis-related medication use, recorded on examination days immediately before the examination, were assessed using multilevel regression models. Between 38% and 43% of students reported symptoms of seasonal allergic rhinitis on any 1 of the examination days. There were 662 cases (36% of students) and 1,172 controls. After adjustment, cases were significantly more likely than controls to have had allergic rhinitis symptoms during the examination period (odds ratio [OR], 1.4; 95% CI, 1.1-1.8; P = .002), to have taken any allergic rhinitis medication (OR, 1.4; 95% CI, 1.1-1.7; P = .01), or to have taken sedating antihistamines (OR, 1.7; 95% CI, 1.1-2.8; P = .03). Current symptomatic allergic rhinitis and rhinitis medication use are associated with a significantly increased risk of unexpectedly dropping a grade in summer examinations. This is the first time the relationship between symptomatic allergic rhinitis and poor examination performance has been demonstrated, which has significant implications for clinical practice.Journal of Allergy and Clinical Immunology 09/2007; 120(2):381-7. DOI:10.1016/j.jaci.2007.03.034 · 11.25 Impact Factor