Quality of life against seasonal vs perennial allergens: ESPRINT-15 modified in the pediatric population

Introduction: Allergic rhinitis (AR) is a clinical syndrome characterized by IgE-mediated inflam-mation of the nasal mucosa. The present study investigates the quality of life (QoL) with AR among adults, using widely validated questionnaires, unlike in pediatric patients.Materials and methods: A cross-sectional descriptive observational study was conducted, analyzing the QoL of 102 children with AR aged between 10-15 years, belonging to two health centers (HC) in Zaragoza and two HC in Coruña. The comparison of means between the two groups is carried out using the Student's test or the Mann-Whitney test, considering a value of p<0.05 to be significant.Results: Around 102 children were studied, with a majority (59.8%) being male and a mean age of 12 years. Around 76.5% have a family history of atopy. It was found that AR is more prevalent in Zaragoza (p <0.005), and asthmais highly prevalent in Coruña (p <0.001). The most import-ant sensitizations are pollen in Zaragoza (p <0.05) and dust mites in A Coruña (p <0.001). More treatment needs and associated comorbidities (p<0.05) were observed in A Coruña. The results of the ESPRINT-15 show that 63% of the patients have a good QoL, 27% fair, and 8.8%, poor. Those sensitized to mites have a worse score (p = 0.02). It was found that 52% of children expe-rienced improvement during home confinement, with no notable differences between the two populations. The use of the mask favored QoL in patients from Zaragoza (p <0.0 01 (AU)

An analysis of factors associated with compliance and dropout of sublingual immunotherapy on Japanese cedar pollinosis patients.

BACKGROUND: Sublingual immunotherapy (SLIT) is safe and effective but compliance is problematic. In this study we evaluated dropout and compliance among adults (≥20 years of age) and adolescents (<20 years of age) for Japanese cedar pollen extract (JCPE), an aqueous SLIT approved in 2014 in Japan. METHODS: Administrative claims data on 1236 Japanese patients, 846 adults (mean age, 43.0 years; 41.8% female) and 249 adolescents (mean age, 14.1 years; 36.6% female), with a JCPE prescription between October 2014 and June 2016 were reviewed. Adults and adolescents were divided according to the year they started SLIT (1- and 2-year cohorts) to calculate dropout and compliance and identify associated factors using multivariate Cox and linear regression models. RESULTS: In 1- and 2-year adult cohorts, dropout rates were 13.5% and 22.1% and compliance rates were 92.8% and 88.8%, respectively. Adolescents had higher dropout and lower compliance. Patients 40-59 years of age had a lower dropout risk than patients 20-29 years of age. Dropout hazard ratios (95% confidence interval) in 1- and 2-year cohorts were 0.26 (0.12-0.58) and 0.40 (0.17-0.93) in patients 40-49 years of age and 0.32 (0.14-0.75) and 0.35 (0.13-0.92) in patients 50-59 years of age, respectively. Younger age contributed to lower compliance in 1- and 2-year adult cohorts (p = 0.001 and p = 0.02, respectively). Systemic steroidal medication history and male gender were positively associated with compliance in adults but not in adolescents. CONCLUSION: High dropout rate was associated with younger generations. Compliance in adults, but not in adolescents, was associated with age, systemic steroidal medication history, and gender.

Different Psychosocial Factors Are Associated with Seasonal and Perennial Allergies in Adults: Cross-Sectional Results of the KORA FF4 Study.

BACKGROUND: Psychosocial factors are supposed to play a central role in the development of allergic diseases. Associations with seasonal and perennial forms of allergies have not been investigated, yet. OBJECTIVES: The aim of the study was to investigate the associations of psychosocial factors (social status, depression, generalized anxiety, psychosocial stress, Type-D personality) with seasonal, perennial, and other forms of allergies in adults. METHOD: The analysis of self-reported data of the KORA FF4 study was performed with SAS 9.4. The sample consisted of 1,782 study participants in the study region of Augsburg (39-88 years, 61 years, 51.1% female). Descriptive bivariate statistics and multinomial logistic regression models were performed. Age, sex, family predisposition, and smoking status were considered possible confounders. Moreover, several sensitivity analyses were carried out to check whether missing values distorted the results. RESULTS: A positive association between generalized anxiety and seasonal allergies was found in the multivariate model. Depression was positively, and anxiety negatively, associated with perennial allergies. No association between the analyzed psychosocial factors and other forms of allergies could be found. CONCLUSION: The results support the relevance of psychosocial factors in association with allergies. Looking at the psychosocial factors, a separate consideration of seasonal and perennial allergies seems reasonable. Further longitudinal studies should investigate the direction of the associations, the underlying mechanisms, and other psychosocial factors, such as coping mechanisms, in confirmed allergies.

Efficacy of a Novel Intranasal Formulation of Azelastine Hydrochloride and Fluticasone Propionate, Delivered in a Single Spray, for the Treatment of Seasonal Allergic Rhinitis: Results from Russia.

BACKGROUND: The novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) in a single spray (MP-AzeFlu) was compared with a first-line intranasal antihistamine spray (AZE) in Russian seasonal allergic rhinitis (SAR) patients. METHODS: Moderate-to-severe SAR/rhinoconjunctivitis patients (n = 149; aged 18-65 years) were randomized to receive MP-AzeFlu (137/50 µg AZE/FP per spray) or AZE (137 µg/spray), both as 1 spray/nostril twice daily, in a multicenter, open-label, 14-day, parallel-group trial. The primary outcome was change from baseline in morning and evening reflective total nasal symptom score (rTNSS). Secondary end points included: change from baseline in reflective total ocular symptom score (rTOSS), reflective total of 7 symptom scores (rT7SS), 28-item Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) overall score, and EuroQol-5D (EQ-5D) questionnaire score. RESULTS: When compared with AZE-treated patients, those treated with MP-AzeFlu experienced significantly greater reductions in rTNSS (difference: -2.47; 95% confidence interval [CI] -3.65 to -1.30; p < 0.001), rTOSS (difference: -1.62; 95% CI -2.32 to -0.92; p < 0.001), and rT7SS (difference: -4.34; 95% CI -5.98 to -2.70; p < 0.001). Superior relief observed on day 2 with MP-AzeFlu versus AZE was sustained throughout the study. MP-AzeFlu-treated patients experienced a greater improvement in QoL than AZE-treated patients as measured by overall RQLQ score (mean ± SD 2.91 ± 1.08 vs. 2.05 ± 1.15) and EQ-5D score (mean ± SD 87.4 ± 10.3 vs. 83.0 ± 12.8). MP-AzeFlu was well tolerated. CONCLUSIONS: MP-AzeFlu was superior to AZE in reducing moderate-to-severe SAR symptoms, providing earlier and more complete symptom relief.

The burden of allergic rhinitis and allergic rhinoconjunctivitis on adolescents: A literature review.

OBJECTIVE: To evaluate the literature regarding the burden of allergic rhinitis (AR) and allergic rhinoconjunctivitis (ARC) in adolescents (aged 10-19 years). DATA SOURCES: Searches were performed in MEDLINE, Embase, Health Technology Assessment Database, and National Health Service Economic Evaluation Database for studies that evaluated concepts of symptoms, quality of life (QOL), daily activities, sleep, examination performance, school absenteeism and presenteeism, and treatment burden in adolescents with AR or ARC. STUDY SELECTIONS: English-language journal articles indexed in the last 15 years describing noninterventional, population-based studies. Records were assessed by 2 independent reviewers. RESULTS: A total of 27 articles were identified; outcomes evaluated were symptoms (n = 6 studies), QOL (n = 9), daily activities (n = 5), emotional aspects (n = 3), sleep (n = 6), education (n = 7), and treatment burden (n = 2). AR symptoms rated most bothersome were rhinorrhea, nasal congestion, and itchy eyes. QOL was worse in adolescents with AR vs controls regardless of QOL instrument used. Nasal symptoms and nasal obstruction were more likely to be associated with poor QOL in adolescents than in adults or younger children, respectively. Daily functioning and sleep were also negatively affected by AR. In addition, a detrimental effect on absenteeism, school productivity, and academic performance was reported. CONCLUSION: Although AR and ARC are sometimes perceived as trivial conditions, this review indicates that their effect on adolescent life is negative and far-reaching. It is critical that clinicians gain a greater understanding of the unique burden of AR and ARC in adolescents to ensure they receive prompt and appropriate care and treatment to improve clinical and academic outcomes.

Adherence and quality of life in adults and children during 3-years of SLIT treatment with Grazax-a real life study.

Respiratory allergic disease represents a global health problem, 30% of the population suffers from allergic rhinoconjunctivitis and 20% suffer from asthma. Allergy immunotherapy induce immunological tolerance and thereby modify the response to allergens and sublingual immunotherapy (SLIT) offers the possibility of home administration of allergen therapy, but adherence is more uncertain. The aim of the study was to investigate the adherence with GRAZAX in adults and children ≥ 5 years during three consecutive years of treatment. This was a non-interventional, prospective, observational, multi-center, open-label study to investigate adherence, quality of life, safety and tolerability of GRAZAX in adult and pediatric patients in a real-life setting. During the 3-years study period estimation of adherence was done regularly. Quality of life as well as symptom score was also assessed. In total, 399 patients (236 adults and 163 children) were included in the study. At baseline, 100% suffered from moderate-severe eyes and nose symptoms, and 31% had asthma in the grass pollen season. Overall, 55% completed a 3-years treatment period, whereas 37% stopped before end of study and 8% were lost to follow up. After 3 years, the adherence rate decreased from 98.2% (first month), 93.7% (first year), 93.2% (second year) and 88.9% (third year) and adverse events were the main reason for pre-term termination. The study suggests a good adherence to treatment in a real life setting among the patients finalizing 3-years SLIT therapy. The treatment was effective both on symptoms and HRQL.

Asthma and atopic diseases in adolescence and antidepressant medication in middle age.

This Swedish register-based cohort study examined whether asthma, hay fever and allergic dermatitis in late adolescence identified in the early 1970s are associated with antidepressant medication in middle age, between 2006 and 2009. After adjustment for childhood and adulthood sociodemographic characteristics, psychological, cognitive and physical function, and comorbidity, the magnitude of the associations diminished for asthma, while hay fever and atopic dermatitis retained associations. Hay fever and atopic dermatitis in adolescence have potentially important implications for future mental health, while asthma may already have influenced an individual's ability to cope with stress by late adolescence.

[The role of local immunotherapy in the treatment of the patients presenting with virus-associated allergic rhinitis]. / Lokal'naia immunoterapiia v lechenii patsientov s virus-assotsiirovannym allergicheskim rinitom.

The objective of the present study was to evaluate the clinical effectiveness of intranasal immunotherapy with the use of сycloferon in the patients presenting with seasonal virus-associated allergic rhinitis during the period of pollination. The results of the treatment of 50 patients with virus-associated allergic rhinitis (i.e. those allergic to the sagebrush pollen) were analyzed. The patients were divided into two groups depending on the therapeutic modality being used. Those comprising the main group (21 patients) received immunotherapy with сycloferon in addition to allergen-specific immunotherapy (by sublingual administration). A cycloferon solution in the physiological saline (2:1) at a concentration of 125 mg/ml was applied to the intranasal mucous membrane with the use of a nebulizer. The inhalation was performed every other day as a course of 10 procedures at a total cycloferon dose of 1250 mg. The control group was composed of 29 patients given sublingual allergen-specific immunotherapy alone. The study included the evaluation of the patients' quality of life in accordance with the adapted and modified RQLQ questionnaire. In addition, the demand for other relevant medications following the course of intranasal immunotherapy was determined by analyzing the data extracted from the self-monitoring diaries and questionnaires. The study has shown that the inclusion of сycloferon therapy in the scheme for the management of the patients presenting with virus-associated allergic rhinitis during the period of pollination enhanced the effectiveness of the treatment as assessed from the improvement of the patients' quality of life that correlated with the reduction in the severity of rhino-conjunctival manifestations of the disease (r= -0.4, p<0.05). It is concluded that the intranasal administration of the immunomodulator сycloferon has resulted in a significant decrease of requirements for chromones (p<0.001) and antihistamines (p<0.05) among the patients suffering from allergic rhinitis.

[The effectiveness of the combination of azelastine hydrochloride and mometasone furoate for the intranasal application in the patients presenting with seasonal allergic rhinitis]. / Éffektivnost' kombinatsii azelastina gidrokhlorida i mometazona furoata dlia intranazal'nogo primeneniia u bol'nykh sezonnym allergicheskim rinitom.

The objective of the present work was to evaluate the effectiveness of the combination of azelastine hydrochloride and mometasone furoate for the intranasal application to treat the patients presenting with seasonal allergic rhinitis. A total of 60 subjects suffering from seasonal allergic rhinitis were available for the observation. All the patients were allocated to three groups comprised of 20 individuals each. The patients of the first group received the fixed combination of azelastine hydrochloride and mometasone furoate for the intranasal application, those in the second group were given mometasone furoate administered intranasally together with an oral antihistamine preparation of the third generation, and the patients of the third group were treated with intranasal mometasone furoate alone. The effectiveness of the treatment was evaluated on days 7 and 14 after its initiation. It was found that the treatment with the use of the combination of azelastine hydrochloride and mometasone furoate resulted in a more pronounced alleviation of rhinological symptoms and improvement of the quality of life at the early stages of therapy in comparison with mometasone furoate monotherapy. It is concluded that the patients with moderate and severe seasonal allergic rhinitis can be recommended to use the combination of azelastine hydrochloride and mometasone furoate as качестве the initial treatment.

"Allergic mood" - Depressive and anxiety symptoms in patients with seasonal allergic rhinitis (SAR) and their association to inflammatory, endocrine, and allergic markers.

A growing number of studies show an association between seasonal allergic rhinitis (SAR) with depression and anxiety. The underlying mechanisms of a link between SAR and affect, however, are still unclear. The objective of the present study was to investigate depressive symptoms and anxiety in SAR patients and their association to inflammatory and endocrine parameters. SAR patients (n=41) and non-allergic, healthy controls (n=42) were assessed during (pollen season) and out of symptomatic periods (non-pollen season). Inflammatory cytokine profile (Interleukin [IL]-2, IL-4, IL-6, IL-8, IL-10, IL-17, IFN-γ, TNF-α), Immunoglobulin-E (IgE), hair cortisol concentrations (HCC), as well as sleep quality were measured. The present data show that during acute allergic inflammation SAR patients experienced a significant increase in Beck Depression Inventory (BDI-) II scores when (a) compared to the asymptomatic period and (b) when compared to the non-allergic controls, while no differences in anxiety were observed. Increased BDI-II scores in SAR patients were significantly associated with levels of IL-6 as well as IL-6/IL-10 and IFN-γ/IL-10 ratios and further, to an early age at manifestation of SAR and poor sleep quality. These findings support a close relationship between acute allergic processes and affective states, with inflammatory cytokines, sleep, and age of manifestation as potentially relevant mediators.

Memory and multitasking performance during acute allergic inflammation in seasonal allergic rhinitis.

BACKGROUND: In previous research, patients with seasonal allergic rhinitis (SAR) showed poorer school and work performance during periods of acute allergic inflammation, supporting the idea of an impact of SAR on cognitive functions. However, the specific cognitive domains particularly vulnerable to inflammatory processes are unclear. OBJECTIVE: In this study, the influence of SAR on memory and multitasking performance, as two potentially vulnerable cognitive domains essential in everyday life functioning, was investigated in patients with SAR. METHODS: Non-medicated patients with SAR (n = 41) and healthy non-allergic controls (n = 42) performed a dual-task paradigm and a verbal learning and memory test during and out of symptomatic allergy periods (pollen vs. non-pollen season). Disease-related factors (e.g. symptom severity, duration of symptoms, duration of disease) and allergy-related quality of life were evaluated as potential influences of cognitive performance. RESULTS: During the symptomatic allergy period, patients showed (1) poorer performance in word list-based learning (P = 0.028) and (2) a general slowing in processing speed (P < 0.001) and a shift in processing strategy (P < 0.001) in multitasking. Yet, typical parameters indicating specific multitasking costs were not affected. A significant negative association was found between learning performance and duration of disease (r = -0.451, P = 0.004), whereas symptom severity (r = 0.326; P = 0.037) and quality of life (r = 0.379; P = 0.015) were positively associated with multitasking strategy. CONCLUSIONS: Our findings suggest that SAR has a differentiated and complex impact on cognitive functions, which should be considered in the management of SAR symptoms. They also call attention to the importance of selecting sensitive measures and carefully interpreting cognitive outcomes.

[Comparison of PedsQL™4.0 and RQLQ scales in the assessment of the quality of life in children with allergic rhinitis].

Objective:To explore the value of PedsQL™4.0 and RQLQ scales in assessment of quality of life(QOL) in children with allergic rhinitis(AR). Method:A prospective trial was conducted to survey the QOL status of 71 AR clinical patients, 68 chronic pharyngitis(CP) clinical patients and 62 healthy individuals by generic questionnaire PedsQL™4.0 and disease specific questionnaire rhinoconjunetivitis quality of life questionnaire(RQLQ) respectively. The correlation between PedsQL™4.0 and RQLQ were analyzed．All the results were analyzed statistically. Result:①By the assessment of PedsQL™4.0 the scores of Social functioning and School functioning domains in AR clinical patients(the same as follow. the scores were 82.8±19.7，64.0±24.6 respectively) were less than those(86.2±18.58, 4.9±18.7) in healthy individuals(P<0.05);while the scores of Physical health and Emotional functioning domains in AR clinical patients(88.3±20.3，75.4±22.4 respectively) were similar with those(89.1±17.7，75.9±22.0) in CP clinical patients(P>0.05)．②By the assessment of RQLQ in AR patients, the nasal symptom and practical problem domains got the highest scores(2.54±1.37,2.70±1.29 respectively).③According to the assessment of the correlation between PedsQL™4.0 and RQLQ, the correlation was weak(r=-0.199--0.468，P<0.05)． Conclusion:Both PedsQL™4.0 and RQLQ were suitable for assessing the health status of AR clinical patients.PedsQL™4.0 and RQLQ each covers different aspects of the QOL of AR clinical patients, and the combination of the two questionnaires could improve the QOL assessment．.

[An analysis of life quality questionaires commonly used in allergic rhinitis].

SummaryAllergic rhinitis is a non-infectious disease with high risk, which seriously influenced on human health of body and mind. Therefore the life quality of patients with allergic rhinitis is worthy of attention. In this paper, the commonly used allergic rhinitis life quality questionnaires and selection principle have been introduced, and hope that the appropriate questionnaires for patients would be selected for the study of the life quality.

Satisfaction and perceived effectiveness in patients on subcutaneous immunotherapy with a high-dose hypoallergenic pollen extract.

This study was designed to determine the level of satisfaction, tolerance and perceived effectiveness by patients in the first pollen season after starting treatment with Alergovit(®). For this purpose, a nationwide, retrospective, multicentre and cross-sectional observational study was carried on 256 patients. Perceived effectiveness by the patients was measured using a visual analogue scale and was clinically significant in 92.4% of the patients. The satisfaction level was evaluated with a specific questionnaire. 32.5% of the patients were totally satisfied with Allergovit(®) and 48.8% reported a high degree of satisfaction. The treatment was well tolerated by 99.2% of the patients. Our results demonstrate that subcutaneous immunotherapy with Allergovit(®) is effective and well-tolerated in routine clinical practice.

You sneeze, you lose:: The impact of pollen exposure on cognitive performance during high-stakes high school exams.

Pollen is known to cause allergic reactions and affect cognitive performance in around 20% of the population. Although pollen season peaks when students take high-stakes exams, the effect of pollen allergies on school performance has received nearly no attention from economists. Using a student fixed effects model and administrative Norwegian data, this paper finds that increasing the ambient pollen levels by one standard deviation at the mean leads to a 2.5% standard deviation decrease in test scores, with potentially larger effects for allergic students. There also appear to be longer-run effects. The findings imply that random increases in pollen counts reduce test scores for allergic students relative to their peers, who consequently will be at a disadvantage when competing for jobs or higher education. This paper contributes to the literature by illuminating the interplay between individual health and human capital accumulation, which in turn can impact long-run economic growth.

Associations of Physical Activity and Sedentary Behavior with Atopic Disease in United States Children.

OBJECTIVES: To determine if eczema, asthma, and hay fever are associated with vigorous physical activity, television/video game usage, and sports participation and if sleep disturbance modifies such associations. STUDY DESIGN: Data were analyzed from 2 cross-sectional studies including 133 107 children age 6-17 years enrolled in the 2003-2004 and 2007-2008 National Survey of Children's Health. Bivariate and multivariate survey logistic regression models were created to calculate the odds of atopic disease and atopic disease severity on vigorous physical activity, television/video game use, and sports participation. RESULTS: In multivariate logistic regression models controlling for sociodemographic factors, lifetime history of asthma was associated with decreased odds of ≥1 days of vigorous physical activity (aOR, 0.87; 95% CI, 0.77-0.99) and decreased odds of sports participation (0.91; 95% CI, 0.84-0.99). Atopic disease accompanied by sleep disturbance had significantly higher odds of screen time and lower odds of sports participation compared with children with either atopic disease or sleep disturbance alone. Severe eczema (aOR, 0.39; 95% CI, 0.19-0.78), asthma (aOR, 0.29; 95% CI, 0.14-0.61), and hay fever (aOR, 0.48; 95% CI, 0.24-0.97) were all associated with decreased odds of ≥1 days of vigorous physical activity. Moderate (aOR, 0.76; 95% CI, 0.57-0.99) and severe eczema (aOR, 0.45; 95% CI, 0.28-0.73), severe asthma (aOR, 0.47; 95% CI, 0.25-0.89), and hay fever (aOR, 0.53; 95% CI, 0.36-0.61) were associated with decreased odds of sports participation in the past year. CONCLUSIONS: Children with severe atopic disease, accompanied by sleep disturbance, have higher risk of sedentary behaviors.

Comparison of outcome measures in allergic rhinitis in children, adolescents and adults.

BACKGROUND: Grass pollen-induced allergic rhinoconjunctivitis (AR) is very common worldwide. However, its symptoms may vary with the patient's age. The present study compared symptom profiles and quality of life (QoL) in children, adolescents and adults with grass pollen-induced AR. METHODS: This was a four-week, multicentre, observational study of children (aged 6-11), adolescents (12-17) and adults (18-65) consulting specialist physicians in France. The management of AR was at the physicians' discretion. Participants regularly rated their symptoms (the rhinoconjunctivitis total symptom score (RTSS) and a visual analogue scale (VAS)) and QoL (the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). RESULTS: A total of 806 patients (253 children, 250 adolescents and 303 adults, of whom 83.5% suffered from moderate-to-severe, persistent AR) provided data for at least the first 2 weeks of the study. Ocular pruritus (the most bothersome symptom in children (35%), adolescents (22%) and adults (16%)) was associated with poor QoL in all groups, whereas nasal obstruction and pruritus were associated with poor QoL in adolescents and children. Over 4 weeks, the weekly mean RTSS and VAS scores fell by around half. This change was associated with an improvement in the RQLQ scores. In all age groups, the VAS score was well correlated with the weekly mean RTSS score (Pearson's r: 0.79-0.88) and moderately correlated with the weekly mean RQLQ score (Pearson's r: 0.64-0.80). CONCLUSIONS: In moderate-to-severe grass pollen-induced AR, symptom perception differs in children vs. older patients. However, the assessments of treatment outcomes (using the RTSS, VAS and RQLQ) were similar in all age groups.

Measurement of health-related quality of life in adult patients with birch pollen-associated food allergy.

BACKGROUND: The "Food Allergy Quality of Life Questionnaire - Adult Form" (FAQLQ-AF) is the first freely available questionnaire for the assessment of health-related quality of life (HRQL) in adults with food allergy (FA). We present validation data for the German version as well as data on HRQL in patients with birch pollen-associated FA. PATIENTS AND METHODS: The Dutch FAQLQ-AF (scale from 1-7, no impairment - maximum impairment) was translated into German. Subsequently, 73 consecutive patients with a history of birch pollen-associated FA (52 women, median age 43 years) were surveyed using questions regarding triggers and symptoms of their FA as well as questions contained in the FAQLQ-AF. Construct validity, internal consistency, and discriminative ability were analyzed. RESULTS: The foods most frequently reported to elicit allergic reactions included apple (78%), hazelnut (75%), soy drinks (55%), and carrot (52%). Thirty percent of patients exclusively reported symptoms consistent with oral allergy syndrome (OAS). Sixty-four percent reported OAS combined with systemic symptoms, and only 6% were exclusively affected by non-OAS symptoms. The German FAQLQ-AF showed good construct validity (correlation with the food allergy-independent measure: r = 0.81; p < 0.001) and excellent internal consistency (Cronbachs α = 0.98). The mean overall FAQLQ-AF score was 3.7. Women, elderly individuals, and those with multiple relevant food allergies showed a greater impairment of HRQL. CONCLUSIONS: The German FAQLQ-AF questionnaire is a reliable and valid tool for measuring HRQL in patients with birch pollen-associated food allergy.

The effect of compound nasal surgery on obstructive sleep apnea syndrome.

BACKGROUND: Nasal surgery often fails to ameliorate the symptoms of obstructive sleep apnea syndrome (OSAS). We developed a compound nasal surgery (CNS) method that consists of septoplasty combined with submucosal inferior turbinectomy and posterior nasal neurectomy to ensure low nasal resistance during sleep. OBJECTIVE: To clarify the effect of CNS on OSAS, pre- and postoperative changes in sleep-related events were studied by using polysomnography, the Epworth sleepiness scale (ESS), the visual analog scale for snoring, and health-related quality of life (QOL). METHODS: Forty-five consecutive patients with OSAS and with nasal problems underwent CNS. Three months later, the postoperative effect on OSAS was assessed by using polysomnography findings, daytime sleepiness by the ESS, nasal allergy symptoms, and health-related QOL. Snoring was assessed by the family by using a visual analog scale. RESULTS: The indices of apnea, apnea-hypopnea, oxygen desaturation, and arousal; the ESS; allergic symptom score; health-related QOL; and snoring on a visual analog scale were all significantly improved. CONCLUSIONS: CNS improves OSAS events without any pharyngeal surgical procedure in selected patients. If high nasal resistance associated with OSAS is present, then CNS should thus be considered.