Clinical characteristics of chronic rhinitis patients with high vs low irritant trigger burdens.

BACKGROUND: Patients with chronic allergic rhinitis (AR) and nonallergic rhinitis (NAR) often experience irritant-induced symptoms. The clinical relevance of the magnitude of their symptoms in response to these nonspecific stimuli remains unclear. OBJECTIVE: To determine the internal consistency and validity of an irritant index questionnaire (IIQ) and whether reclassification of physician-diagnosed rhinitis subtypes based on IIQ scores results in rhinitis subtypes with different clinical characteristics. METHODS: Patients 18 to 65 years old with physician-diagnosed AR (n = 404), mixed rhinitis (MR; n = 129), or NAR (n = 123) completed an IIQ that rated rhinitis symptom severity in response to 21 nonallergic irritant triggers on a 1- to 10-point scale. Multistage sex-specific statistical analyses were performed using IIQ responses to reclassify physician-diagnosed AR, MR, and NAR into categories with high and low irritant burdens. RESULTS: The IIQ demonstrated good internal consistency and cross-validation. After reclassification, 48% and 52% of patients with physician-diagnosed AR patients (n = 533) were categorized as having low-burden AR and high-burden AR, respectively, whereas 64% and 36% of NAR (n = 123) patients were categorized as having low-burden NAR and high-burden NAR, respectively. Reclassified high-burden AR and high-burden NAR patients were more likely to have a physician diagnosis of asthma and a greater number of self-reported rhinitis symptoms and perennial symptoms with seasonal exacerbations than reclassified low-burden AR and low-burden NAR patients, respectively (P < .01). CONCLUSION: The IIQ resulted in significant reclassification of physician-diagnosed rhinitis patients into different diagnostic categories with unique clinical characteristics. Further studies are necessary to confirm the IIQ's utility as a tool for characterizing rhinitis patients in clinical practice and research.

Joint hypermobility syndrome: A common clinical disorder associated with migraine in women.

Preliminary studies suggested that headache disorders are more common in patients with joint hypermobility syndrome (JHS). The objectives of this study were to determine if the prevalence, frequency, and disability of migraine differ between female patients with JHS and a control population. Twenty-eight patients with JHS and 232 controls participated in the case-cohort study. Participants underwent a structured verbal interview and were assigned a diagnosis of migraine based on criteria of the International Classification of Headache Disorders, 2nd Edition. The primary outcome measures were the prevalence, frequency, and headache-related disability of migraine. Logistic regression was used for the prevalence analysis and Poisson regression for the frequency and disability analyses. Results indicated that the prevalence of migraine was 75% in JHS patients and 43% in controls. The adjusted odds ratio for the prevalence of migraine was 3.19 (95% CI 1.24, 8.21] in JHS patients. The rate ratios for migraine frequency and headache-related disability were 1.67 (95% CI 1.01, 2.76) and 2.99 (95% CI 1.66, 5.38), respectively, for JHS patients. Our study suggests that JHS is a clinical disorder strongly associated with an increased prevalence, frequency, and disability of migraine in females.