Burden of allergic respiratory disease: a systematic review

Abstract

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.

Keywords: Allergic asthma; Allergic rhinitis; Economic burden; Meta-analysis; Quality of life; Systematic review.

Fig. 1

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

Fig. 2

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

Fig. 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

Fig. 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

Fig. 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

Fig. 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

Fig. 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