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Burden of allergic respiratory disease: a systematic review


This meta-analysis compared the health-related quality of life (HRQL) of patients with allergic rhinitis (AR) and/or allergic asthma (AA) caused by perennial house dust mite (HDM) versus AR and/or AA caused by seasonal pollen allergy. Following a systematic search, the identified studies used the disease-specific rhinitis quality of life questionnaire or generic instruments (SF-36 and SF-12). Summary estimates obtained by meta-analysis showed that HRQL in patients with perennial HDM allergy was significantly worse than that of patients with seasonal pollen allergy, when measured by both disease-specific and generic HRQL instruments, and was reflected by an impact on both physical and mental health. A systematic review of cost data on AR and AA in selected European countries demonstrated that the majority of the economic burden was indirectly caused by high levels of absenteeism and presenteeism; there was little or no evidence of increasing or decreasing cost trends. Increased awareness of the detrimental effects of AR and/or AA on patients’ HRQL and its considerable cost burden might encourage early diagnosis and treatment, in order to minimize the disease burden and ensure beneficial and cost-effective outcomes.


In Europe, approximately 23 % of the population is affected by allergic rhinitis (AR) [1]. The most common symptoms are sneezing, itchy nose, rhinorrhea, and/or nasal congestion [2], with many patients experiencing symptoms of at least moderate severity; one study estimated that 93 % of patients with AR who consulted general practitioners had symptoms that were moderate-to-severe [3]. Studies of patients consulting general practitioners for AR reported that 18–48 % had symptoms that were not controlled by pharmacotherapy [4, 5]. Despite the bothersome nature of symptoms, AR is often trivialized by the patient; less than half (45 %) seek medical advice or treatment for their condition [4], which results in under-treatment and poor control of symptoms. A UK study found that only 18 % of patients with AR had consulted their doctor about the condition in the preceding 2 years [6]. In a sample of 230 French patients with typical symptoms of AR, 19 % had never consulted their doctor about the problem, despite 90 % reporting that their nasal symptoms affected their daily lives, over half complaining of sleepiness and headaches, and 8 % reporting that they had taken time off work because of their rhinitis [7]. Allergic rhinitis is frequently accompanied by allergic asthma (AA), the prevalence of which increases from less than 2 % in individuals without AR to 10–40 % in those with AR; this combination of upper and lower respiratory symptoms increases the overall impact on the patient [810].

There is now considerable evidence that the symptoms of AR and AA negatively affect patients’ health-related quality of life (HRQL) [1120]. This is supported by evidence that successful treatment of symptoms with allergy immunotherapy (AIT) [2123] or symptomatic treatments [2431] improves the HRQL of patients with AR. These improvements generally mirror those of conventional clinical outcome measures, such as symptom and medication scores, and lung function tests [32]. Although clinical measures provide information on the affected organ systems, they do not capture the patient’s overall perception of the disease burden caused by the physical, emotional, and social impairments in everyday life [33]. The wider impact of AR on patients’ lives is now acknowledged in the allergic rhinitis and its impact on asthma (ARIA) guidelines, which recognize the impact of HRQL on AR, and classify its severity based both on symptoms and its effect on HRQL [32].

There is evidence that AR represents a considerable economic burden [34, 35], with annual costs in the US in 2003 estimated at $2–$5 billion USD [34]. Indirect costs resulting from symptoms causing under-performance or loss of productivity in the workplace were particularly high [3639]. Data published after the present study was completed show that patients with mild AR have less impact on the health economy, with costs of around a quarter of those with moderate-to-severe disease [39].

To date, there has been no systematic review of HRQL data in patients with perennial or seasonal allergies. The objective of this systematic review and meta-analysis was, therefore, to compare HRQL in individuals with AR and/or AA with perennial house dust mite (HDM) or seasonal AR caused by exposure to pollen, or both. As HRQL instruments/questionnaires are included in many clinical studies as a matter of course, HRQL measurements enable comparisons with data from individual studies. In addition, data on the economic burden of AR and AA in selected European countries were systematically reviewed in order to compare direct and indirect costs in patients with perennial HDM and seasonal AR.


Search and identification of studies

To identify published articles on HRQL in individuals with AR and/or AA, and the economic burden of AR and AA, the following online databases were searched: MEDLINE and MEDLINE In-Process (1946–31 January 2014); EMBASE (1988–2014 week 04); EconLit (1886–January 2014); The Cochrane Library (Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews); Database of Abstracts of Reviews of Effects; National Institute For Health Research Health Technology Assessment Programme databases; Health Economics Evaluation Database; National Guidelines Clearing House; NHS Evidence; EUROScan; and

The search strategies and keywords used are presented in the Additional file 1. The MEDLINE, EMBASE, EconLit, Cochrane Library, Database of Abstracts of Reviews of Effects, and NIH HTA databases were searched simultaneously using OVID. Unless otherwise stated, the search covered the period from 1 January 2000–31 January 2014 (date of publication).

Study selection

Articles considered for inclusion included randomized, controlled trials, observational and ecological studies, and health economic analyses with HRQL and/or cost as a primary or secondary outcome from one or more of the eight countries of interest: Denmark, France, Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom. Eligible studies enrolled adults or children diagnosed with (based on positive skin prick tests and/or specific IgE results), and/or treated for, HDM (Dermatophagoides pteronyssinus or Dermatophagoides farinae) allergy; allergy to grass pollen (orchard, meadow, ryegrass, sweet vernal, and timothy grasses), Artemisia pollen, ragweed pollen, or birch pollen; or AA (as defined in the individual studies). Studies of AIT and symptomatic treatments were eligible for inclusion.

Titles and abstracts identified by the literature search were reviewed by NB; a second senior epidemiologist assessed 10 % of the titles and abstracts, and any disagreements were resolved through discussion. Full text versions of potentially eligible studies were obtained and reviewed. Additional relevant articles were identified from the bibliography of some articles, and a report from a clinical trial containing unpublished data was provided by the sponsor. Titles and abstracts of the 20 highest ranked Google Scholar search results were also reviewed and compared with the results of the database search to ensure that no articles had been missed.

Data extraction and meta-analysis

As the aim of this study was to gather information on the HRQL of patients before any intervention, baseline measurements of HRQL (prior to any intervention) in patients with AR and/or AA were extracted from the selected studies. Means and standard deviations (SD) were collected, or where this was not possible, were imputed from available statistics, according to the methods described in [40]. Where data were presented as p < 0.05 or p < 0.01, values used for imputations were p = 0.049 and p = 0.009, respectively. Six studies presented data graphically, and values were obtained using a ruler.

Meta-analyses were performed in Microsoft Excel, and heterogeneity was assessed using Q-tables [41]. Differences between subgroups were assessed by ANOVA [42]. Due to the expected differences in study design, random effects models were used to estimate the overall measure of HRQL and the error of the estimate. Pooled mean estimates were presented with standard errors and 95 % Confidence Intervals (CI).

Where possible, HRQL data were grouped by allergen (perennial or seasonal); if the allergen was not stated, data were included in a ‘Mixed’ group. Some older articles did not specify the sensitizing allergen but categorized patients as suffering from seasonal AR (SAR) or perennial AR (PAR); in these cases PAR was grouped with HDM allergy, and SAR with pollen allergy.

Cost data

Cost data were divided into direct costs (including physician visit, medication costs, hospital stays, comorbidity medication costs, comorbidity physician visits, emergency room visits, acute ward visits, and outpatient care) and indirect costs related to loss of productivity (including absenteeism, presenteeism, production loss, inability to perform usual daily activities, restricted usual daily activities). All costs were converted to 2013 international dollars ($), and expressed as purchasing power parities (PPP).


Search results and selected studies

The electronic search retrieved 2963 abstracts and titles; 2905 were retained for screening, and 2502 of these did not meet the inclusion criteria. Full text copies of 544 articles were screened and 50 were retained for data extraction. One additional reference was identified from the reference section of an article [43] and data were included from an unpublished study report provided by the sponsor [44]. Flow of articles through the selection process and reasons for rejection are shown in Fig. 1. Among the studies reporting HRQL data, 3 included patients with AA; two with PAR+AA, and one with SAR+AA.

Fig. 1
figure 1

Schematic diagram of the selection process. Asterisk comparator not of interest = environmental control mechanisms, such as mattress protector or humidifier

Baseline HRQL measurements: RQLQ and mini-RQLQ

The disease-specific rhinitis quality of life questionnaire (RQLQ) is a validated HRQL instrument for adults that measures functional impairments due to seasonal or perennial rhinoconjunctivitis of allergic or non-allergic origin. It comprises seven domains scored on a 7-point scale (from 0 = not impaired at all, to 6 = severely impaired), with higher scores reflecting poorer HRQL [45, 46].

Seventeen studies reported data obtained using RQLQ or mini-RQLQ measured at ‘baseline’, ‘the season before’ or on ‘a day without symptoms’ [5, 24, 43, 4760]. One study included patients with SAR/pollen allergy only (n = 83) and SAR/pollen allergy with associated AA (n = 52) [49]. Two studies [59, 60] contained data that did not correspond to the recognized RQLQ scale and were excluded from the analysis.

Pooling all the data gave a moderate degree of heterogeneity (I2 = 62 %) with an estimated summary RQLQ of 2.61 ± 0.10 (95 % CI 2.43–2.80). Grouping studies by allergy phenotype [SAR/pollen only, PAR/HDM only, or SAR/pollen and/or PAR (‘Mixed’ group)] gave I2 values of 63 % (moderate) for SAR/pollen, 33 % (low) for ‘Mixed’ group, and −17 % (none) for the PAR/HDM groups. Summary RQLQ estimates for the respective groups were 2.04 ± 0.18 (95 % CI 1.68–2.41) for the SAR/pollen patient group (673 patients in 10 groups from 5 studies); 3.06 ± 0.16 (95 % CI 2.75–3.37) for the Mixed group; and 2.73 ± 0.12 (95 % CI 2.49–2.98) for the PAR/HDM only group (1520 patients in 10 groups from 6 studies) Fig. 2.

Fig. 2
figure 2

Forest plot of overall RQLQ baseline scores by phenotype, from 30 groups in 15 studies. Higher scores indicate poorer HRQL

Baseline HRQL measurements: SF-36 and SF-12

The 36-Item Short Form Health Survey (SF-36) is a validated, non-disease-specific indicator of overall health status. It comprises 36 items in eight domains that reflect physical and mental functioning, which are scored from 0 to 100, with a lower score indicating poorer HRQL [61]. The SF-12 instrument is a short form of the SF-36 questionnaire, comprising 12 items.

Seven studies reported data using SF-36 or SF-12 [13, 14, 49, 52, 6264]. One study included patients with SAR/pollen allergy only (n = 83) and SAR/pollen allergy with associated AA (n = 52) [49], and one included PAR/HDM patients with AR (n = 85), AR + AA (n = 62) or rhinitis, asthma and atopic eczema/dermatitis syndrome (n = 31) [63]. Data from one study [64] were insufficient to calculate SDs and this study was excluded from the analysis.

Data for the two main SF-36 composite domains were analyzed, to investigate whether the effects of allergic respiratory disease on physical and mental HRQL differed. Heterogeneity was high when all SF-36 physical component score (PCS) data were pooled (I2 = 84 %). When data were grouped by phenotype, there was no heterogeneity for SAR/pollen (I2 = 13 %) or the PAR/HDM group, (I2 = −61 %), and heterogeneity was low for the Mixed group (I2 = 57 %). Summary estimates of HRQL using the SF-36 PCS for respective phenotypic groups were: SAR/pollen group 64.19 ± 7.89 (95 % CI 48.7–78.6; 201 patients in 4 groups from 2 studies); PAR/HDM group 49.06 ± 1.26 (95 % CI 46.6–51.5; 2255 patients in 6 groups from 2 studies); and ‘Mixed’ group 50.12 ± 0.52 (95 % CI 49.1–51.1; 4899 patients in 7 groups from 3 studies) Fig. 3.

Fig. 3
figure 3

Forest plot of baseline SF-36/SF-12 physical component scores from 17 groups in six studies by phenotype. 95 % confidence intervals for the Mixed and PAR summary measures are hidden by the symbols. Lower scores indicate poorer HRQL

Heterogeneity between SF-36 Mental Component Scores (MCS) was moderate/high when all studies were pooled (I2 = 73 %). When presented by phenotypic subgroups, there was no heterogeneity for the SAR/pollen group (I2 = −8 %), and heterogeneity was low both in the, ‘Mixed’ (I2 = 46 %) and PAR/HDM (I2 = 32 %) groups. Summary estimates for the MCS were: SAR/pollen group 50.38 ± 6.46 (95 % CI 37.7–63.0; 201 patients in 4 groups from 2 studies); PAR/HDM group 47.58 ± 1.28 (95 % CI 45.1–50.1; 2255 patients in 6 groups from 2 studies); and ‘Mixed’ group 44.62 ± 0.39 (95 % CI 43.9–45.4; 4899 patients in 7 groups from 3 studies) Fig. 4.

Fig. 4
figure 4

Forest plot of baseline SF-36/SF-12 mental component scores by phenotype, from 17 groups in six studies. 95 % confidence intervals for the Mixed and PAR summary measures are hidden by the symbols. Lower scores indicate poorer HRQL

Comparison of RQLQ total scores between SAR/pollen and PAR/HDM phenotypes

ANOVA indicated that the RQLQ summary estimates of all three groups were different (F = 3.53; p = 0.024), but that the Mixed and PAR/HDM groups were not different (F = 0.134; p = 0.134). RQLQ summary scores for the SAR/pollen and PAR/HDM groups were different (F = 35.9; p ≤ 0.001), with the overall HRQL of PAR/HDM patients worse than that of SAR/pollen patients (2.73 ± 0.12 vs. 2.04 ± 0.18; p ≤ 0.001) Fig. 5a.

Fig. 5
figure 5

Overall RQLQ and SF-36 physical and mental component scores for the PAR and SAR phenotypes. a RQLQ scores of the PAR and SAR phenotypes; b left quality of life (QoL) measured by PCS of PAR and SAR patients. Right QoL measured by MCS of PAR and SAR patients. Error bars represent 95 % CI. Higher RQLQ scores and lower SF-36 scores indicate lower HRQL

Comparison of SF-36 physical and mental component scores between SAR/pollen and PAR/HDM phenotypes

SF-36 PCS summary estimates were different between the three groups (F = 5.75; p = 0.017), with no difference between the Mixed and PAR/HDM group (F = 0.857; p = 0.355). The SF-36 PCS summary of the PAR/HDM and SAR/pollen groups was different (F = 9.867; p = 0.002), with lower HRQL in the patients with PAR/HDM allergy vs. SAR/pollen allergy. Figure 5b shows that the SF-36 PCS of patients in the PAR/HDM group was significantly worse than that of those in the SAR/pollen group (49.06 ± 1.26 vs. 64.19 ± 7.89; p = 0.002).

SF-36 MCS summary scores for the three groups were also different (F = 4.95; p = 0.007), with differences between the Mixed and the PAR/HDM groups (F = 8.169; p = 0.004), but not between the SAR/pollen and PAR/HDM groups (F = 0.357; p = 0.550), indicating that HRQL in both groups was equally affected (47.58 ± 1.28 vs. 50.38 ± 6.46, p = 0.550). Figure 5b.

Baseline RQLQ and SF-36 domain scores

Eight studies [5, 47, 5153, 55, 56, 58] reported RQLQ domain scores, or variants thereof. The ‘activities’ domain showed the highest heterogeneity (I2 = 76 %), with little or no heterogeneity (I2 = 9 %) in ‘non-hayfever symptoms’, or ‘emotional problems’ (I2 = 18 %), and medium heterogeneity (I2 = 31–35 %) in the remaining domains (Additional file 1: Figure S1). ‘Practical problems’ and ‘activities’ were the most affected domains, with the ‘emotional’ domain being the least affected (Fig. 6a).

Fig. 6
figure 6

RQLQ and SF-36 domain scores. a RQLQ domain scores in the combined PAR/SAR population; b SF-36 domain scores in the PAR/SAR population

Four studies [13, 14, 62, 63] reported SF-36 data by domain. The ‘role-emotional’ domain showed the highest heterogeneity (I2 = 43 %), with little or no heterogeneity in ‘physical activity’, ‘bodily pain’, ‘general health perception’, ‘vitality’ or ‘mental health’. (I2 = 0 % for all; Additional file 1: Figure S2). ‘Vitality’ was the most affected domain, with ‘physical activity’ being the least affected domain Fig. 6b. There were insufficient data to compare domain scores by allergy phenotype.

Financial burden of AR and AA

Eleven studies were included in the analysis of direct and indirect costs; nine studies reported data for countries of interest [24, 62, 6571] and two studies [72, 73] reported information for multiple countries using France and the United Kingdom as reference countries for calculating PPP costs (see Tables 1, 2). No studies that reported AR costs by severity were identified. One of the 17 studies included in the cost analysis was a randomized, controlled trial [72], and may not reflect costs in a real clinical practice setting.

Table 1 Direct costs
Table 2 Indirect costs

Direct comparison of total direct and indirect costs was complicated by differences in cost assessment in each study. Within countries, specific categories of costs (e.g. GP/specialist/visits, hospitalizations, medications) varied across studies, but we found very limited or no evidence for a trend of increasing or decreasing direct and indirect costs. The majority of the direct costs for AR were borne by the GP services; for patients with AR + AA, the AA part of the costs concerned medication and hospitalization costs. Medication costs, excluding over-the-counter medications, remained low Table 1.

The majority of the cost burden was indirect (Tables 1, 2) and caused by high absenteeism and presenteeism. Due to the lack of data, it was not possible to determine which had the higher cost; however, based on categories within each country, both were generally greater than the direct costs.


Grouping studies by seasonal or perennial symptoms gave an acceptable level of heterogeneity (I2 ≤ 63 %) that allowed summary estimates of HRQL from RQLQ and SF-36 instruments to be determined. Heterogeneity was generally higher for the SAR/pollen phenotype than for PAR/HDM, which could reflect the different types of baseline measurements in the selected studies, or the large heterogeneity of SAR. Patients with PAR/HDM allergy had poorer HRQL than those with SAR/pollen allergy when measured by RQLQ, SF-36 total score, and SF-36 PCS. The underlying reason for this difference is unclear, and could be due to differences in symptom frequency, duration, or severity. In Northern Europe, the pollen season is largely confined to the summer months, with the season for grass pollen, which is by far the most frequent cause of pollinosis, usually lasting from mid-May to July [74]; at the height of the pollen season, patients with SAR suffer symptoms approximately 50 % of the time and report an impact on their HRQL [75]. It can be hypothesized that the year-round nature of symptoms might be responsible for the observed poorer HRQL in PAR/HDM allergy; however, published studies report varying results. Bousquet found that the severity of AR was more important in determining HRQL, sleep, daily activities, and work performance than symptom duration [3]. Similar findings were reported by Delgado and colleagues, who observed that HRQL was lower in Spanish patients with olive or grass pollen allergy vs. HDM allergy. This was attributed to the greater severity of symptoms caused by the explosive nature of olive pollination, resulting in sudden and elevated pollen concentrations, in contrast to the more constant concentrations of perennial allergens that were more tolerable for patients [76]. Another study reported no significant differences in baseline RQLQ scores between patients with HDM, grass pollen, and Parietaria pollen allergy [48].

Analysis of SF-36 component scores showed that mental and physical component scores were affected in seasonal and perennial allergy, with HDM/PAR having a greater impact on physical vs. mental component scores. This supports the findings of other studies that report significant emotional problems and poor mental wellbeing in patients with AR, in addition to physical symptoms [13, 33, 77].

Meta-analyses were performed using HRQL measures from generic and disease-specific instruments. Generic questionnaires, like the SF-36, measure a wide range of physical, mental and psychosocial functions; they can be used in different health conditions and in the general population, and have the advantage of allowing comparisons of burden of illness across different disorders. Disease-specific instruments like the RQLQ more accurately reflect the patient’s inherent disease-associated problems, but scores cannot be directly compared with other populations. Both the generic and RQLQ instruments show improvements in HRQL in patients treated for AR; disease-specific questionnaires tend to show more important improvements, as they focus on the areas that are impacted by the disease [32]. Nowadays, HRQL questionnaires are used almost routinely in clinical studies of allergy treatments. Observed changes in HRQL generally reflect clinical outcomes; however, some studies report changes in HRQL that are not captured by symptom scores. Therefore, monitoring patients’ HRQL in clinical practice has been suggested as a possible strategy to improve the management of AR [78].

Our analysis does not permit comparison of the HRQL of AR patients with that of the general population; however, a Spanish cross-sectional study that investigated the overall HRQL of patients with AR using SF-12 reported that HRQL was 25 % lower than in the general population [79]. Poor HRQL in patients with AR is also supported by evidence that successful treatment of AR symptoms with AIT [2123] or symptomatic treatment [2431] improves patient’s HRQL scores. A comparison of published EQ-5D utility baseline scores indicated that perennial allergy and/or AA (13 patients with AR and 12 with AR+AA), on a typical day with allergy symptoms, had a score of 0.60 [23], indicating comparable HRQL to diabetes (0.83) [80], cardiovascular disorders (0.73), musculoskeletal disorders (0.63), and psychosomatic disorders (0.57), when measured with the same EQ-5D instrument [81]. Ranges of published EQ-5D scores for AR and/or AA and other diseases are summarized in Fig. 7, and indicate that the impact of AR and/or AA on generic HRQL on a day with allergen exposure is not trivial, with an effect that is comparable to chronic conditions, such as liver disease, epilepsy, migraine, and visual disorders [23, 8286].

Fig. 7
figure 7

Range of EQ-5D utility index scores for selected chronic conditions. Green and red circles represent the upper and lower values, respectively. Values were obtained from published studies in populations with cancer [82], psoriasis [82], cardiovascular diseases [82], visual disorders [82], type-2 diabetes mellitus [82], end stage renal disease [82], epilepsy [83], AR/HDM or AR and AA [23, 84], migraine [84] or chronic migraine [85], liver disease [82], and active psychoses [84, 86]. Lower EQ-5D values indicate lower HRQL

There were insufficient data in the present analysis to compare HRQL in patients with AR vs. those with both AR and AA. Delgado and colleagues reported that HRQL associated with AR was worse in patients diagnosed with both AR and asthma than in those with only AR [76]. Using the SF-36 instrument, Leynaert reported that patients with asthma experienced greater impairments in physical functioning that those with AR alone, but asthma did not further impair mental wellbeing of patients with AR [13].

The cost analysis shows variations in direct and indirect AR costs between countries, which may result from true differences in AR costs or from differences in the health systems, diagnostic behavior, or reporting between countries. Indirect costs make up the majority of the cost burden of AR, in line with the outcomes of the most recent European [39] and US studies [34]. A few studies have reported higher direct vs. indirect costs [35, 87]; however, many studies estimate indirect costs by multiplying patients’ salaries by the amount of time they are absent from work due to AR. Health impairments associated with AR are often not severe enough to cause absence from work, although they can interfere with cognitive functioning, resulting in fatigue and an impaired ability to learn, concentrate, and make decisions [88], all of which can affect performance in the workplace. In one study, more than a third of patients with AR (36 %) reported reduced workplace performance, or ‘presenteeism’, which was higher than among patients with asthma (19 %) [89]. In the US, where up to 60 million people are affected by AR [90], annual productivity loss associated with a diagnosis of AR was estimated at $601 million in 1995. When the use of sedating allergy medications and workers’ self-assessments of their reduction work productivity due to AR were taken into account, the estimated annual at-work productivity losses increased to $2.4–$4.6 billion [37]. In 2006, the cost of lost productivity in the workplace due to AR was $593 per employee per year, and exceeded that of stress ($518), migraine ($277), depression ($273), and arthritis/rheumatism ($269) [36]. Comorbid AA resulted in higher costs than AR alone [91], or AR with non-allergic asthma [92], indicating its importance in driving costs. The cost of productivity loss is greater than the cost of treating AR symptoms; however, many cost analysis studies do not consider the cost to the patient of over-the-counter AR medications, which could lead to an underestimation of direct costs [34].

Some limitations of the study design should be acknowledged. Search terms were chosen from the RQLQ and SF-36 questionnaires, or were based on the suspected impact of AA and AR on patients’ HRQL. The articles identified by the search were mainly safety or efficacy studies that included HRQL as a secondary endpoint. Consequently, abstracts that did not include secondary outcomes would not be identified by the search. This could introduce a bias, such that only studies reporting a change in HRQL were identified. Inclusion of patients with comorbid AA in some groups could also affect HRQL scores, although we estimate any effect to be small. Moreover, the study only included HDM, and not pet allergens, as perennial allergens for perennial allergic rhinitis/asthma. Many of the studies from which data are collated were randomized controlled interventional studies, which may tend to include patients with more severe symptoms.


This review presents summary data on HRQL levels in patients with allergic respiratory disease that may be used for comparison with assessments from individual studies. HRQL in PAR/HDM patients was significantly worse than that of SAR/pollen patients, when measured by both disease-specific and generic HRQL instruments, and was reflected by an impact on both physical and mental health. SAR/pollen and PAR/HDM affected MCS to a similar degree, despite a greater impact of PAR/HDM on PCS. A comparison of published EQ-5D utility index scores showed that the impact of PAR, with or without AA, on patients’ HRQL was comparable to other chronic diseases. The economic burden of AR is considerable, with indirect costs due to absenteeism and presenteeism making up the majority of costs. Greater awareness of the detrimental effects of AR on HRQL and its cost burden might encourage early diagnosis and treatment in order to minimize the disease burden and ensure beneficial and cost-effective outcomes.



allergic asthma


allergy immunotherapy


allergic rhinitis


allergic rhinitis and its impact on asthma


general practitioner


house dust mite


health-related quality of life


mental component score


perennial allergic rhinitis


physical component score


purchasing power parities


rhinitis quality of life questionnaire


seasonal allergic rhinitis


United States Dollars


  1. Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J. 2004;24:758–64.

    Article  CAS  PubMed  Google Scholar 

  2. Bousquet J, Van Cauwenberge P, Khaltaev N, Aria Workshop G, World Health O. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108:S147–334.

    Article  CAS  PubMed  Google Scholar 

  3. Bousquet J, Neukirch F, Bousquet PJ, Gehano P, Klossek JM, Le Gal M, Allaf B. Severity and impairment of allergic rhinitis in patients consulting in primary care. J Allergy Clin Immunol. 2006;117:158–62.

    Article  PubMed  Google Scholar 

  4. Canonica GW, Bousquet J, Mullol J, Scadding GK, Virchow JC. A survey of the burden of allergic rhinitis in Europe. Allergy. 2007;62(Suppl 85):17–25.

    Article  PubMed  Google Scholar 

  5. Bousquet PJ, Demoly P, Devillier P, Mesbah K, Bousquet J. Impact of allergic rhinitis symptoms on quality of life in primary care. Int Arch Allergy Immunol. 2013;160:393–400.

    Article  PubMed  Google Scholar 

  6. Jones NS, Smith PA, Carney AS, Davis A. The prevalence of allergic rhinitis and nasal symptoms in Nottingham. Clin Otolaryngol Allied Sci. 1998;23:547–54.

    Article  CAS  PubMed  Google Scholar 

  7. Didier A, Chanal I, Klossek JM, Mathieu J, Bousquet J. La rhinite allergique: le point de vue du patient. Revue francaise d’allergologie et d’immunologie clinique. 1999;39:171–85.

    Article  Google Scholar 

  8. Spector SL. Overview of comorbid associations of allergic rhinitis. J Allergy Clin Immunol. 1997;99:S773–80.

    Article  CAS  PubMed  Google Scholar 

  9. Ozdoganoglu T, Songu M. The burden of allergic rhinitis and asthma. Ther Adv Respir Dis. 2012;6:11–23.

    Article  PubMed  Google Scholar 

  10. Linneberg A, Henrik Nielsen N, Frolund L, Madsen F, Dirksen A, Jorgensen T, Copenhagen Allergy S. The link between allergic rhinitis and allergic asthma: a prospective population-based study. The Copenhagen Allergy Study. Allergy. 2002;57:1048–52.

    Article  CAS  PubMed  Google Scholar 

  11. Jaruvongvanich V, Mongkolpathumrat P, Chantaphakul H, Klaewsongkram J. Extranasal symptoms of allergic rhinitis are difficult to treat and affect quality of life. Allergol Int. 2016;65:199–203.

    Article  PubMed  Google Scholar 

  12. Meltzer EO. Quality of life in adults and children with allergic rhinitis. J Allergy Clin Immunol. 2001;108:S45–53.

    Article  CAS  PubMed  Google Scholar 

  13. Leynaert B, Neukirch C, Liard R, Bousquet J, Neukirch F. Quality of life in allergic rhinitis and asthma. Am J Respir Crit Care Med. 2000;162:1391–6.

    Article  CAS  PubMed  Google Scholar 

  14. Majani G, Biardini I, Giardini A, Senna GE, Minale P, D’Ulisse S, Ciprandi G, Canonica W. Health-related quality of life assessment in young adults with seasonal allergic rhinitis. Allergy. 2001;56:313–7.

    Article  CAS  PubMed  Google Scholar 

  15. Stuck BA, Czajkowski J, Hagner AE, Klimek L, Verse T, Hormann K, Maurer JT. Changes in daytime sleepiness, quality of life, and objective sleep patterns in seasonal allergic rhinitis: a controlled clinical trial. J Allergy Clin Immunol. 2004;113:663–8.

    Article  PubMed  Google Scholar 

  16. Song Y, Wang M, Xie J, Li W, Zhang X, Wang T, Tan G. Prevalence of allergic rhinitis among elementary and middle school students in Changsha city and its impact on quality of life. J Laryngol Otol. 2015;129:1108–14.

    Article  CAS  PubMed  Google Scholar 

  17. Sritipsukho P, Satdhabudha A, Nanthapisal S. Effect of allergic rhinitis and asthma on the quality of life in young Thai adolescents. Asian Pac J Allergy Immunol. 2015;33:222–6.

    PubMed  Google Scholar 

  18. Adebola SO, Abidoye B, Ologe FE, Adebola OE, Oyejola BA. Health-related quality of life and its contributory factors in allergic rhinitis patients in Nigeria. Auris Nasus Larynx. 2015;43:171–5.

    Article  PubMed  Google Scholar 

  19. Price D, Scadding G, Ryan D, Bachert C, Canonica GW, Mullol J, Klimek L, Pitman R, Acaster S, Murray R, Bousquet J. The hidden burden of adult allergic rhinitis: UK healthcare resource utilisation survey. Clin Transl Allergy. 2015;5:39.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Canonica GW, Mullol J, Pradalier A, Didier A. Patient perceptions of allergic rhinitis and quality of life: findings from a survey conducted in europe and the United States. World Allergy Organ J. 2008;1:138–44.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Katotomichelakis M, Riga M, Tripsianis G, Balatsouras D, Kourousis C, Danielides G, Giotakis E, Danielides V. Predictors of quality of life improvement in allergic rhinitis patients after sublingual immunotherapy. Ann Otol Rhinol Laryngol. 2015;124:430–6.

    Article  PubMed  Google Scholar 

  22. Durham SR, Yang WH, Pedersen MR, Johansen N, Rak S. Sublingual immunotherapy with once-daily grass allergen tablets: a randomized controlled trial in seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2006;117:802–9.

    Article  CAS  PubMed  Google Scholar 

  23. Petersen KD, Kronborg C, Larsen JN, Dahl R, Gyrd-Hansen D. Patient related outcomes in a real life prospective follow up study: allergen immunotherapy increase quality of life and reduce sick days. World Allergy Organ J. 2013;6:15.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bachert C, Bousquet J, Canonica GW, Durham SR, Klimek L, Mullol J, Van Cauwenberge PB, Van Hammee G. Levocetirizine improves quality of life and reduces costs in long-term management of persistent allergic rhinitis. J Allergy Clin Immunol. 2004;114:838–44.

    Article  CAS  PubMed  Google Scholar 

  25. Walter Canonica G, Bousquet J, Van Hammee G, Bachert C, Durham SR, Klimek L, Mullol J, Van Cauwenberge PB. Levocetirizine improves health-related quality of life and health status in persistent allergic rhinitis. Respir Med. 2006;100:1706–15.

    Article  CAS  PubMed  Google Scholar 

  26. El Hennawi DE, Ahmed MR, Farid AM. Psychological stress and its relationship with persistent allergic rhinitis. Eur Arch Otorhinolaryngol. 2015;273:899–904.

    Article  Google Scholar 

  27. Erdogan BA, Sanli A, Paksoy M, Altin G, Aydin S. Quality of life in patients with persistent allergic rhinitis treated with desloratadine monotherapy or desloratadine plus montelucast combination. Kulak Burun Bogaz Ihtis Derg. 2014;24:217–24.

    Article  PubMed  Google Scholar 

  28. Ciebiada M, Ciebiada MG, Kmiecik T, DuBuske LM, Gorski P. Quality of life in patients with persistent allergic rhinitis treated with montelukast alone or in combination with levocetirizine or desloratadine. J Investig Allergol Clin Immunol. 2008;18:343–9.

    CAS  PubMed  Google Scholar 

  29. Skoner DP, LaForce CF, Nathan RA, Urdaneta ER, Zielinski MA, Sacavage SD, Franklin KB, Wu MM. Effect of cetirizine on symptom severity and quality of life in perennial allergic rhinitis. Allergy Asthma Proc. 2014;35:338–45.

    Article  CAS  PubMed  Google Scholar 

  30. Goh BS, Ismail MI, Husain S. Quality of life assessment in patients with moderate to severe allergic rhinitis treated with montelukast and/or intranasal steroids: a randomised, double-blind, placebo-controlled study. J Laryngol Otol. 2014;128:242–8.

    Article  PubMed  Google Scholar 

  31. Amizadeh M, Safizadeh H, Bazargan N, Farrokhdoost Z. Survey on the prevalence of allergic rhinitis and its effect on the quality of high school students’ life. Iran J Otorhinolaryngol. 2013;25:79–84.

    PubMed  PubMed Central  Google Scholar 

  32. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(Suppl 86):8–160.

    Article  PubMed  Google Scholar 

  33. Juniper EF. Quality of life in adults and children with asthma and rhinitis. Allergy. 1997;52:971–7.

    Article  CAS  PubMed  Google Scholar 

  34. Reed SD, Lee TA, McCrory DC. The economic burden of allergic rhinitis: a critical evaluation of the literature. Pharmacoeconomics. 2004;22:345–61.

    Article  PubMed  Google Scholar 

  35. Schoenwetter WF, Dupclay L Jr, Appajosyula S, Botteman MF, Pashos CL. Economic impact and quality-of-life burden of allergic rhinitis. Curr Med Res Opin. 2004;20:305–17.

    Article  PubMed  Google Scholar 

  36. Lamb CE, Ratner PH, Johnson CE, Ambegaonkar AJ, Joshi AV, Day D, Sampson N, Eng B. Economic impact of workplace productivity losses due to allergic rhinitis compared with select medical conditions in the United States from an employer perspective. Curr Med Res Opin. 2006;22:1203–10.

    Article  PubMed  Google Scholar 

  37. Crystal-Peters J, Crown WH, Goetzel RZ, Schutt DC. The cost of productivity losses associated with allergic rhinitis. Am J Manag Care. 2000;6:373–8.

    CAS  PubMed  Google Scholar 

  38. Walker S, Khan-Wasti S, Fletcher M, Cullinan P, Harris J, Sheikh A. Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case-control study. J Allergy Clin Immunol. 2007;120:381–7.

    Article  PubMed  Google Scholar 

  39. Cardell LO, Olsson P, Andersson M, Welin KO, Svensson J, Tennvall GR, Hellgren J. TOTALL: high cost of allergic rhinitis-a national Swedish population-based questionnaire study. NPJ Prim Care Respir Med. 2016;26:15082.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. New York: Wiley Online Library; 2008.

    Book  Google Scholar 

  41. Neyeloff JL, Fuchs SC, Moreira LB. Meta-analyses and Forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Res Notes. 2012;5:52.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Analysis of Variance Calculator. Accessed 1 Feb 2016.

  43. Di Rienzo V, Pucci S, D’Alo S, Di Cara G, Incorvaia C, Frati F, Romano A. Effects of high-dose sublingual immunotherapy on quality of life in patients with cypress-induced rhinitis: a placebo-controlled study. Clin Exp All Rev. 2006;6:67–70.

    Article  Google Scholar 

  44. Mosbech H. A phase II–III trial assessing the efficacy and safety of three doses of the ALK house dust mite tablet in house dust mite-allergic subjects 81 centres in DE, DK, ES, FR, GB, IT, PL, SE. Copenhagen: National University Hospital; 2009. p. 199.

    Google Scholar 

  45. Juniper EF, Thompson AK, Ferrie PJ, Roberts JN. Validation of the standardized version of the rhinoconjunctivitis quality of life questionnaire. J Allergy Clin Immunol. 1999;104:364–9.

    Article  CAS  PubMed  Google Scholar 

  46. Juniper EF, Guyatt GH. Development and testing of a new measure of health status for clinical trials in rhinoconjunctivitis. Clin Exp Allergy. 1991;21:77–83.

    Article  CAS  PubMed  Google Scholar 

  47. Colas C, Monzon S, Venturini M, Lezaun A. Double-blind, placebo-controlled study with a modified therapeutic vaccine of Salsola kali (Russian thistle) administered through use of a cluster schedule. J Allergy Clin Immunol. 2006;117:810–6.

    Article  CAS  PubMed  Google Scholar 

  48. Ariano R, Amoroso S, Astarita C, Bassi M, Bonadonna P, Campi P, Di Gioacchino M, Musarra A, Quercia O, Russello M, et al. Quality of life in allergic rhinitis and impact of high-dose sublingual immunotherapy: a real-life study. Clin Exp All Rev. 2006;6:71–3.

    Article  Google Scholar 

  49. Laforest L, Bousquet J, Neukirch F, Aubier M, Pietri G, Devouassoux G, Pacheco Y, Van Ganse E. Influence of sociodemographic factors on quality of life during pollen season in seasonal allergic rhinitis patients. Ann Allergy Asthma Immunol. 2005;95:26–32.

    Article  PubMed  Google Scholar 

  50. Radcliffe MJ. Enzyme potentiated desensitisation in treatment of seasonal allergic rhinitis: double blind randomised controlled study. BMJ. 2003;327:251–4.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Petersen KD, Kronborg C, Gyrd-Hansen D, Dahl R, Larsen JN, Lowenstein H. Quality of life in rhinoconjunctivitis assessed with generic and disease-specific questionnaires. Allergy. 2008;63:284–91.

    Article  CAS  PubMed  Google Scholar 

  52. Brinkhaus B, Witt CM, Jena S, Liecker B, Wegscheider K, Willich SN. Acupuncture in patients with allergic rhinitis: a pragmatic randomized trial. Ann Allergy Asthma Immunol. 2008;101:535–43.

    Article  PubMed  Google Scholar 

  53. Ciprandi G, Klersy C, Cirillo I, Marseglia GL. Quality of life in allergic rhinitis: relationship with clinical, immunological, and functional aspects. Clin Exp Allergy. 2007;37:1528–35.

    CAS  PubMed  Google Scholar 

  54. Riechelmann H, Schmutzhard J, van der Werf JF, Distler A, Kleinjans HAJ. Efficacy and safety of a glutaraldehyde-modified house dust mite extract in allergic rhinitis. Am J Rhinol Allergy. 2010;24:104–9.

    Article  Google Scholar 

  55. Holmberg K, Tonnel AB, Dreyfus I, Olsson P, Cougnard J, Mesbah K, Devillier P. Desloratadine relieves nasal congestion and improves quality-of-life in persistent allergic rhinitis. Allergy. 2009;64:1663–70.

    Article  CAS  PubMed  Google Scholar 

  56. Anna C-B, Alfonso M, Ernesto E, Pau A, Rosario A, Joan B, Gloria PM. Quality of life after use of environmental control measures together with the application of the acaricide frontac in the environment of patients suffering from allergic respiratory pathology. J Allergy Clin Immunol. 2002;109:S122.

    Article  Google Scholar 

  57. Gerth Van Wijk R, Terreehorst IT, Mulder PGH, Garrelds IM, Blom HM, Popering S. Intranasal capsaicin is lacking therapeutic effect in perennial allergic rhinitis to house dust mite. A placebo-controlled study. Clin Exp Allergy. 2000;30:1792–8.

    Article  CAS  PubMed  Google Scholar 

  58. Ciprandi G, Cadario G, Valle C, Ridolo E, Verini M, Di Gioacchino M, Minelli M, Gangemi S, Sillano V, Colangelo C, et al. Sublingual immunotherapy in polysensitized patients: effect on quality of life. J Investig Allergol Clin Immunol. 2010;20:274–9.

    CAS  PubMed  Google Scholar 

  59. Höiby AS, Strand V, Robinson DS, Sager A, Rak S. Efficacy, safety, and immunological effects of a 2-year immunotherapy with Depigoid® birch pollen extract: a randomized, double-blind, placebo-controlled study. Clin Exp Allergy. 2010;40:1062–70.

    Article  PubMed  Google Scholar 

  60. Cadario G, Ciprandi G, Di Cara G, Fadel R, Incorvaia C, Marcucci F, Marengo F, Puccinelli P, Sensi L, Strazzeri L. Comparison between continuous or intermittent schedules of sublingual immunotherapy for house dust mites: effects on compliance, patients’ satisfaction, quality of life and safety. Int J Immunopathol Pharmacol. 2008;21:471–3.

    CAS  PubMed  Google Scholar 

  61. McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32:40–66.

    Article  CAS  PubMed  Google Scholar 

  62. Witt CM, Reinhold T, Jena S, Brinkhaus B, Willich SN. Cost-effectiveness of acupuncture in women and men with allergic rhinitis: a randomized controlled study in usual care. Am J Epidemiol. 2008;169:562–71.

    Article  Google Scholar 

  63. Terreehorst I, Duivenvoorden HJ, Tempels-Pavlica Z, Oosting AJ, Monchy JGR, Bruijnzeel-Koomen CAFM, Wijk RG. The effect of encasings on quality of life in adult house dust mite allergic patients with rhinitis, asthma and/or atopic dermatitis. Allergy. 2005;60:888–93.

    Article  CAS  PubMed  Google Scholar 

  64. Passalacqua G, Pasquali M, Ariano R, Lombardi C, Giardini A, Baiardini I, Majani G, Falagiani P, Bruno M, Canonica GW. Randomized double-blind controlled study with sublingual carbamylated allergoid immunotherapy in mild rhinitis due to mites. Allergy. 2006;61:849–54.

    Article  CAS  PubMed  Google Scholar 

  65. Bachert C, Vestenbæk U, Christensen J, Griffiths UK, Poulsen PB. Cost-effectiveness of grass allergen tablet (GRAZAX®) for the prevention of seasonal grass pollen induced rhinoconjunctivitis ? a Northern European perspective. Clin Exp Allergy. 2007;37:772–9.

    Article  CAS  PubMed  Google Scholar 

  66. Petersen KD, Gyrd-Hansen D, Dahl R. Health-Economic Analyses of subcutaneous Specific Immunotherapy for grass pollen and mite allergy. Allergol Immunopathol (Madr). 2005;33:296–302.

    Article  CAS  Google Scholar 

  67. Sullivan PW, Navaratnam P, Lorber R, Shekar T. The cost-effectiveness of treatment with desloratadine in patients with persistent allergic rhinitis. Curr Med Res Opin. 2010;26:1389–97.

    Article  CAS  PubMed  Google Scholar 

  68. Omnes L, Bousquet J, Scheinmann P, Neukirch F, Jasso-Mosqueda G, Chicoye A, Champion L, Fadel R. Pharmacoeconomic assessment of specific immunotherapy versus current symptomatic treatment for allergic rhinitis and asthma in France. Eur Ann Allergy Clin Immunol. 2007;39:148–56.

    CAS  PubMed  Google Scholar 

  69. Schädlich PK, Brecht JG. Economic evaluation of specific immunotherapy versus symptomatic treatment of allergic rhinitis in Germany. Pharmacoeconomics. 2000;17:37–52.

    Article  PubMed  Google Scholar 

  70. Dal Negro R, Piskorz P, Vives R, Guilera M, Sazonov Kocevar V, Badia X. Healthcare utilisation and costs associated with adding Montelukast to current therapy in patients with mild to moderate asthma and co-morbid allergic rhinitis. Pharmacoeconomics. 2007;25:665–76.

    Article  Google Scholar 

  71. Berto P, Bassi M, Incorvaia C, Frati F, Puccinelli P, Giaquinto C, Cantarutti L, Ortolani C. Cost effectiveness of sublingual immunotherapy in children with allergic rhinitis and asthma. Eur Ann Allergy Clin Immunol. 2005;37:303–8.

    CAS  PubMed  Google Scholar 

  72. Bousquet J, Demarteau N, Mullol J, Akker-van Marle ME, Van Ganse E, Bachert C. Costs associated with persistent allergic rhinitis are reduced by levocetirizine. Allergy. 2005;60:788–94.

    Article  CAS  PubMed  Google Scholar 

  73. Nasser S, Vestenbaek U, Beriot-Mathiot A, Poulsen PB. Cost-effectiveness of specific immunotherapy with Grazax in allergic rhinitis co-existing with asthma. Allergy. 2008;63:1624–9.

    Article  CAS  PubMed  Google Scholar 

  74. D’Amato G, Spieksma FT, Liccardi G, Jager S, Russo M, Kontou-Fili K, Nikkels H, Wuthrich B, Bonini S. Pollen-related allergy in Europe. Allergy. 1998;53:567–78.

    Article  PubMed  Google Scholar 

  75. Small M, Piercy J, Demoly P, Marsden H. Burden of illness and quality of life in patients being treated for seasonal allergic rhinitis: a cohort survey. Clin Transl Allergy. 2013;3:33.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Delgado J, Davila ID, Dominguez-Ortega J, Quirce S, Marti-Guadano E, Valero A. Quality of life in patients with respiratory allergy is influenced by the causative allergen. J Investig Allergol Clin Immunol. 2013;23:309–14.

    CAS  PubMed  Google Scholar 

  77. Valovirta E, Myrseth SE, Palkonen S. The voice of the patients: allergic rhinitis is not a trivial disease. Curr Opin Allergy Clin Immunol. 2008;8:1–9.

    Article  PubMed  Google Scholar 

  78. Gerth van Wijk R. R. Quality of life, should we bother? Allergy. 2003;58:284–6.

    Article  CAS  PubMed  Google Scholar 

  79. Navarro A, Colas C, Anton E, Conde J, Dávila I, Dordal M, Fernández-Parre B, Ibáñez M, Lluch-Bernal M, Matheu V. Epidemiology of allergic rhinitis in allergy consultations in Spain: alergologica-2005. J Investig Allergol Clin Immunol. 2009;19:7–13.

    PubMed  Google Scholar 

  80. Chancellor J, Aballea S, Lawrence A, Sheldon R, Cure S, Plun-Favreau J, Marchant N. Preferences of patients with diabetes mellitus for inhaled versus injectable insulin regimens. Pharmacoeconomics. 2008;26:217–34.

    Article  CAS  PubMed  Google Scholar 

  81. Moock J, Kohlmann T. Comparing preference-based quality-of-life measures: results from rehabilitation patients with musculoskeletal, cardiovascular, or psychosomatic disorders. Qual Life Res. 2008;17:485–95.

    Article  PubMed  Google Scholar 

  82. Moller AH, Erntoft S, Vinding GR, Jemec GB. A systematic literature review to compare quality of life in psoriasis with other chronic diseases using EQ-5D-derived utility values. Patient Relat Outcome Meas. 2015;6:167–77.

    PubMed  PubMed Central  Google Scholar 

  83. Rogers G, O’Flynn N. NICE guideline: transient loss of consciousness (blackouts) in adults and young people. Br J Gen Pract. 2011;61:40–2.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Sullivan PW, Ghushchyan V. Preference-Based EQ-5D index scores for chronic conditions in the United States. Med Decis Making. 2006;26:410–20.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Gillard PJ, Devine B, Varon SF, Liu L, Sullivan SD. Mapping from disease-specific measures to health-state utility values in individuals with migraine. Value Health. 2012;15:485–94.

    Article  PubMed  Google Scholar 

  86. Saarni SI, Viertio S, Perala J, Koskinen S, Lonnqvist J, Suvisaari J. Quality of life of people with schizophrenia, bipolar disorder and other psychotic disorders. Br J Psychiatry. 2010;197:386–94.

    Article  PubMed  Google Scholar 

  87. Malone DC, Lawson KA, Smith DH, Arrighi HM, Battista C. A cost of illness study of allergic rhinitis in the United States. J Allergy Clin Immunol. 1997;99:22–7.

    CAS  PubMed  Google Scholar 

  88. Fineman SM. The burden of allergic rhinitis: beyond dollars and cents. Ann Allergy Asthma Immunol. 2002;88:2–7.

    Article  PubMed  Google Scholar 

  89. Blanc PD, Trupin L, Eisner M, Earnest G, Katz PP, Israel L, Yelin EH. The work impact of asthma and rhinitis: findings from a population-based survey. J Clin Epidemiol. 2001;54:610–8.

    Article  CAS  PubMed  Google Scholar 

  90. Settipane RA, Schwindt C. Chapter 15: allergic rhinitis. Am J Rhinol Allergy. 2013;27(Suppl 1):S52–5.

    Article  PubMed  Google Scholar 

  91. Halpern MT, Schmier JK, Richner R, Guo C, Togias A. Allergic rhinitis: a potential cause of increased asthma medication use, costs, and morbidity. J Asthma. 2004;41:117–26.

    Article  PubMed  Google Scholar 

  92. Lafeuille MH, Gravel J, Figliomeni M, Zhang J, Lefebvre P. Burden of illness of patients with allergic asthma versus non-allergic asthma. J Asthma. 2013;50:900–7.

    Article  PubMed  Google Scholar 

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Authors’ contributions

AL, NSH and NB designed the study; NB performed the analysis; AL, NSH, JHP, and NB analyzed the data; all authors contributed to the writing of the manuscript. All authors read and approved the final manuscript.


The authors thank Dr. Ron Hogg of Copentown UK for medical writing support.

Competing interests

AL has received honorarium for lectures on the epidemiology of allergic disease; KDP declares no conflict of interest; JH-P, EH, and NS-H are employees of ALK; NB was an employee of Mapi Ltd. and is now employed by IMS Health UK.

Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.


The study was funded by ALK, Hørsholm, Denmark.

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Correspondence to A. Linneberg.

Additional file


Additional file 1: Table S1. Database search strategies; Figure S1. RQLQ domain scores by allergy phenotype. Studies are listed from the top as SAR, Mixed, and PAR; Figure S2 SF-36 domain scores by allergy phenotype. Studies are listed from the top as SAR, Mixed, and PAR.

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Linneberg, A., Dam Petersen, K., Hahn-Pedersen, J. et al. Burden of allergic respiratory disease: a systematic review. Clin Mol Allergy 14, 12 (2016).

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