Introduction

Today, virtually all physicians working in primary care will have a significant caseload of patients with allergic rhinitis (AR). Yet, many physicians still regard AR as a relatively unimportant “nuisance” illness and only treat the symptoms on an as-needed basis. Likewise, many patients do not realize that effective treatments are available that can help control their condition and assume that they just have to live with their symptoms. However, the incidence of AR has grown dramatically in recent years, and it is associated with significant morbidity.¹ For example, as well as experiencing troublesome nasal symptoms, patients with AR have an increased risk of suffering associated conditions such as asthma, rhinosinusitis, and chronic otitis media, which themselves increase morbidity and medical costs.^2,3 It is also well known that AR has a significant impact on the quality of life of the sufferer,⁴ with days lost from work or school.^5,6

Ten years ago, the Institute of Medicine published “Crossing the Quality Chasm,” which identified key weaknesses in the quality of American health care.⁷ Increasing patient-centered care was identified as one of the “six aims for improvement.” This meant that health care should respect and respond to patient preferences, needs, and values, and that patient values should guide all clinical decisions. In 2006, the Allergies in America: A Landmark Survey of Nasal Allergy Sufferers was conducted to assess how well we manage our patients who have nasal allergies.⁸ At the time, it was the largest and most comprehensive national survey of patients with AR and the health care providers who treat them. The survey revealed a number of truths. It highlighted that AR was not just a seasonal problem and that more than half of patients suffered symptoms throughout the year.⁹ It showed that, at their peak, nasal allergy symptoms left patients feeling tired, miserable, and irritable and, for most patients in the survey, decreased their performance at work. Importantly, the survey also uncovered gaps in communication between physician and patient. For example, fewer than half of patients who had seen a physician reported following his or her instructions on the management and treatment of AR.⁹

Five years after the landmark survey was conducted, we wanted to see how the treatment of nasal allergies had progressed in America. This supplement presents results from the Nasal Allergy Survey Assessing Limitations (NASAL; www.nasalsurvey.com), a study sponsored by Teva Respiratory, LLC, which included many of the same questions as the earlier survey. NASAL provided an up-to-date assessment of patient and provider perspectives concerning AR and nasal allergies in the United States (US). It included a national sample of 400 persons aged ≥18 years who had been diagnosed with AR, nasal allergies, or hay fever, and had experienced nasal allergy symptoms or taken medication for their condition in the past 12 months. To determine the burden of disease of AR, a telephone survey was conducted among a national probability sample of 522 adults sampled by random-digit dialing. This parallel survey of the general adult US population yielded a subsample of 400 persons aged ≥18 years who did not currently have nasal allergies. The comparison of the 2 samples of adults with and without nasal allergies provided a new and unique measure of the impact of nasal allergies on the health and lifestyle of patients. Finally, another parallel survey was conducted among 250 health care practitioners who saw patients with nasal allergies.

NASAL was the first survey of its kind to include the full range of health care practitioners involved in the management of nasal allergies. It included 100 physicians in adult primary care specialties (family medicine and internal medicine), 100 specialists (allergy and otolaryngology), and 50 nurse practitioners and physician assistants.

The purpose of NASAL was to describe the symptoms, burden of disease, and treatment of AR. The articles in this supplement report new data from NASAL showing the significant impact AR has on quality of life, the comorbidities associated with AR, and the oft-forgotten patient perspective. During the preparation of these articles, the most common phrase from our authors was, “Don’t get me started…” Each author has passionate views on the current treatment of nasal allergies in America, and these are shared in the roundtable discussion presented at the end of the supplement.