Background: Non-infectious rhinitis (NIR) is often considered a trivial disease, easily controlled by currently available drugs. Recently however, adequate attention of the scientific and regulatory environment has been called on the unmet needs of the most Severe Chronic Upper airways Diseases (SCUADs, Bousquet J et al, J Allergy Clin Immunol 2009;124:428-33).
Aim: An independent observational cross-sectional survey was promoted by the Italian Federation of Allergy and Clinical Immunology Societies (IFIACI) in order to identify phenotypes of NIR and the dimension, clinical features and burden of SCUADs in Italy.
Methods: All IFIACI clinical centers answering GPC standards were invited to collect data through a common questionnaire from up to 50 consecutive cases of NIR observed from January 1 to June 30, 2011 in subjects aged over 14 years. Data management, entry and analysis was performed through a validated procedure by IBIS,Milan, in respect of privacy requirements.
Results: The duration of rhinitis was 6.8+/-6.7 years in the 2279 patients studied. Rhinitis was classified as moderate/severe in 42.9% of the 511 patients with intermittent rhinitis and in 69.5% of the 1959 patients with persistent rhinitis.81.6%of NIR had one or more positive skin tests, grass (37.2%), Dermatophagoides pteronyssinus (26.8%) and Parietaria (19.8%) being the allergens more frequently responsible for a clinically relevant sensitization. Conjunctivitis (47.3%), asthma (34.4%), sinusitis 15.5%), sleep disturbances (9.4%) and nasal polyps (6.0%) were the co-morbidities more frequently associated with rhinitis, particularly in the most severe forms. The undergoing treatment (anti-histamines in 64.4%, nasal steroids in 59.7%, anti-leukotrienes in 14.8% and oral steroids (!) in 8.1% of cases), was considered unsatisfactory in 19.1% of cases by the doctor and in 33.6% by the patients. Immunotherapy was indicated in 63.9% of subjects with a clinically relevant sensitization but it was accepted only by 51.6% of the patients, the high costs being the major cause for non- acceptance.
Conclusions: NIR is a heterogeneous entity including several different phenotypes. Allergic rhinitis patients with persisting symptoms, co-morbidities, poor response to pharmacological treatment represent a not frequent phenotype but with high social and individual costs and still unanswered health needs.