Questionnaire improves allergic rhinitis detection in asthma
By Kirsty Oswald, medwireNews Reporter
17 May 2013
Respirology 2013; Advance online publication

medwireNews: Researchers have shown that the Self Assessment of Allergic Rhinitis and Asthma (SACRA) questionnaire is effective in identifying undiagnosed allergic rhinitis among asthma patients.

"The identification of comorbid [allergic rhinitis] in some patients who did not self-report co-existent [allergic rhinitis] suggests the clinical usefulness of SACRA as a screening tool," say authors Masayuki Hojo (National Center for Global Health and Medicine, Tokyo, Japan) and colleagues.

The study, published in Respirology, included 420 patients with asthma, of whom 252 (60%) reported they had allergic rhinitis.

Among the 168 patients who reported no concomitant allergic rhinitis, 76 answered yes to some symptoms on the SACRA questionnaire, which includes 17 items assessing both asthma control and allergic rhinitis symptoms.

Consequently, 32 (19%) of these patients were diagnosed with allergic rhinitis on the basis of immunoglobulin (Ig) E testing or physician examination. Of these patients, 78% reported two or more symptoms on the SACRA questionnaire, while most patients with only one SACRA symptom did not go on to be diagnosed with allergic rhinitis.

In contrast, only seven (2.8%) patients with self-reported allergic rhinitis did not have a positive diagnosis based on SACRA, IgE testing, or physician examination.

The authors calculate that SACRA therefore had a sensitivity of 92.4% and a specificity of 65.7% for diagnosing comorbid allergic rhinitis. And, when they excluded the 175 patients who were already receiving treatment for allergic rhinitis, this increased to 96.1% and 93.0%, respectively.

The study results follow on from the nationwide SACRA study, published in 2011, in which questionnaires from the Global Initiative for Asthma (GINA) and Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines were found to have excellent sensitivity and specificity for detecting comorbid rhinitis. But, with 33 items together, they are impractical for daily clinical practice, explain the authors.

This previous study also revealed that two-thirds of asthma patients in Japan have comorbid rhinitis, and that these patients also have poorer asthma control.

"SACRA can be used in clinical practice and we believe that the diagnosis and treatment of [allergic rhinitis] using the SACRA questionnaire may contribute to improved asthma management," Hojo and colleagues conclude.

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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