Published online: April 2, 2019
The treatment of allergic rhinitis (AR) is complex. While guidelines propose long-term treatment to achieve disease control, most AR patients self-medicate and comply poorly with physician’s instructions. Observational real-life studies are therefore needed to better understand the behavior of AR patients and to improve AR control. Mobile health (mHealth) may provide novel insights into AR management.
In the latest issue of The Journal of Allergy & Clinical Immunology (JACI), Bédard and colleagues conducted a cross-sectional study among users of the Allergy Diary (now called MASK-air) mobile phone app (freely available on Google Play and Apple stores in Austria, Australia, Belgium, Brazil, Canada, Switzerland, Germany, Denmark, Spain, Finland, France, Great Britain, Greece, Italy, Lithuania, Mexico, Netherland, Poland, Portugal, Sweden, and Turkey) to bring novel information on medication use, disease control and work productivity in the everyday life of AR patients. Users were able to provide information on: 1) daily medication use using a scroll list including all prescribed and over-the-counter allergy medications and 2) daily AR control using visual analogue scales (VAS) for overall, ocular and asthma symptoms as well as work productivity.
A total of 112,054 days of VAS were recorded by 9,122 users from 22 countries in 2016 and 2017. The authors found that the overall VAS was associated with the number of medications: i.e. best control (lowest VAS level) found in days without medication, intermediate VAS level found in days with single intranasal corticosteroid (INCS) use and highest VAS level found in days with INCS used with co-medication. The same trend was found when using the other VAS for ocular symptoms and work productivity. Days without comedication were reported more often for azelastine-fluticasone as compared to INCS.
These findings suggest an inconsistency between patients’ and physicians’ behavior: patients increased their treatment when they were not controlled whereas, according to guidelines, physicians prescribe long-term treatment to achieve control. This major gap in AR treatment may explain the overall low level of satisfaction of severe AR patients reported in many studies. These findings suggest that mobile technology may provide a novel insight into the behavior of AR patients towards treatment and may bring novel concepts for the management of AR.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.