The clinical burden of allergic rhinitis in five Middle Eastern countries: results of the SNAPSHOT program

Abstract

Background: The SNAPSHOT program provides current data on the allergic rhinitis burden in the adult general population of five Middle Eastern countries (Egypt, Turkey, Kuwait, Saudi Arabia and the United Arab Emirates, the latter three grouped into a Gulf cluster).

Methods: A multi-country, cross-sectional, epidemiological program conducted by telephone in a random sample of the adult general population; quotas were defined per country demographics. Subjects were screened for allergic rhinitis using the Score For Allergic Rhinitis questionnaire. Current prevalence (last 12 months) was estimated. Disease severity and control were assessed using the Allergic Rhinitis and its Impact on Asthma classification and Rhinitis Control Assessment Test respectively. Quality of sleep, impact on daily activities and quality of life were measured using the Epworth Sleepiness Scale, Sheehan Disability Scale and EuroQol Five-Dimension questionnaire respectively. Multivariate logistic regression analyses were used to investigate risk factors and co-morbidities.

Results: 1808 of 33,486 subjects enrolled in the SNAPSHOT program fulfilled the case definition for allergic rhinitis. Prevalence was 3.6% [95% CI 3.2-4.0%] in Egypt, 6.4% [95% CI 5.9-6.9%] in Turkey and 6.4% [95% CI 6.0-6.9%] in the Gulf cluster. Risk factors identified were country, co-morbid asthma and income. Subjects with allergic rhinitis reported a significantly lower quality of life compared to the general population (p < 0.0001). Overall, 55% of allergic rhinitis subjects were moderate/severe and 33% were uncontrolled. Both these groups reported impaired quality of life and quality of sleep and increased impairment of daily activities compared to mild/well-controlled subjects (p < 0.0001).

Conclusions: Although the observed prevalence of allergic rhinitis in these Middle Eastern countries is low compared to western countries, its burden is considerable. Allergic rhinitis in general, and specifically uncontrolled and severe disease, results in a negative impact on quality of life, quality of sleep and daily activities.

Keywords: Allergic rhinitis; Clinical burden; Middle East; Quality of life; SNAPSHOT.

Fig. 1

Risk factors for allergic rhinitis. Multivariate regression analysis investigating the risk factors for allergic rhinitis (AR): AR population (1679 subjects) versus non-AR population (28,351 subjects); OR [95% CI] = odds ratio [95% confidence interval]. The results presented are adjusted for age (18–34, 35–49, ≥ 50 years), gender and country (Egypt, Kuwait, Saudi Arabia, Turkey, UAE)

Fig. 2

Impact of co-morbidities on the risk of allergic rhinitis. Multivariate regression analysis investigating the impact of co-morbidities. Allergic rhinitis (AR) population (1808 subjects) versus non-AR population (31,678 subjects); OR [95% CI] = odds ratio [95% confidence interval]. The results presented are adjusted for age (18–34, 35–49, ≥ 50 years), gender and country (Egypt, Kuwait, Saudi Arabia, Turkey, UAE)

Fig. 3

Impact of allergic rhinitis on quality of life. Quality of life was assessed using the three level EuroQol Five Dimension questionnaire (EQ-5D-3L) a EQ-5D-3L utility values for the allergic rhinitis (AR) population and general population by country b EQ-VAS scores for the AR population and general population by country. For the AR population (n = 1808) the data represent the mean EQ-5D-3L utility value and EQ-VAS score with the 95% CI. For the general population (n = 33,486), the mean EQ-5D-3L utility value and EQ-VAS score is presented. The p values were calculated using the Kruskall–Wallis test. Permission to use the EQ-5D-3L was provided by the EuroQol Research Foundation (© EuroQol Research Foundation. EQ-5D™ is a trade mark of the EuroQol Research Foundation)

Fig. 4

Impact of allergic rhinitis control and disease severity on daily life. Impact of allergic rhinitis control and disease severity on activities of daily living a impact of disease severity based on the allergic rhinitis and its impact on asthma (ARIA) classification on activities of daily living, assessed using the Sheehan Disability Scale (SDS) b impact of AR control measured using the Rhinitis Control Assessment Test (RCAT) on activities of daily living measured using the SDS. The p values were calculated using the X² test

Fig. 5

Impact of allergic rhinitis control on daytime sleepiness. Impact of AR control measured using the Rhinitis Control Assessment Test (RCAT) on reported levels of daytime sleepiness, measured by the Epworth Sleepiness Scale (ESS). The p value was calculated using the X² test