Diagnosis

Healthcare professional and patient 1

Seasonal allergic rhinitis (SAR) vs perennial allergic rhinitis (PAR)

Seasonal and perennial allergic rhinitis

Allergic rhinitis (AR) can be either seasonal or perennial (i.e., year-round) in duration.1

SAR and PAR can be distinguished based on the allergens that trigger symptoms, by how long the symptoms last, and by what time of year the symptoms occur at.1

There is evidence that PAR patients will require allergy medications throughout the year, while SAR patients will require allergy medications predominantly around pollen allergy seasons: April, May, and June for the spring allergy season and August, September, and October for the fall allergy season.1

Diagnostic tools

Diagnostic Tools

Total Nasal Symptom Score (TNSS) Total Ocular Symptom Score (TOSS)
The TNSS is a daily symptom severity score that rates nasal congestion, rhinorrea, nasal itching, sneezing, and postnasal drip on a 0- to 3- point scale.1 ,2 The TOSS is calculated as a sum of the patients' scoring of 4 individual ocular symptoms (itching, tearing, redness and puffiness) via visual analog scales of 0-100, where 0= no symptoms and 100 = worst symptoms.3
  • Improvement in nasal system is determined by clinical or patient assessment of symptom severity
  • TOSS measures the efficacy of a medication in relieving ocular symptoms
  • TNSS is calculated by summing the symptom scores
  • A total ocular symptom score is calculated for each patient by summing the four symptom scores
  • The maximum score for each symptom is typically 100 points - 0 is no symptoms while 100 is severe symptoms
  • The maximum TOSS possible is 400 points

Classification of AR

CLASSIFICATION OF ALLERGIC RHINITIS
PATTERN OF SYMPTOMS

Seasonal

  • Disease caused by an IgE-mediated inflammatory response to seasonal aeroallergens
  • The length of seasonal exposure to these allergens depends on geographic location and climatic conditions

Perennial

  • Disease caused by an IgE-mediated inflammatory response to year-round environmental aeroallergens
  • May include dust mites, mould, animal allergens, or certain occupational allergens
FREQUENCY OF SYMPTOMS

Intermittent: Characterised by frequency of exposure or symptoms (<4 days per week OR <4 weeks per year)

Persistent: Characterised by persistent symptoms (>4 days per week AND >4 weeks per year)

Episodic: Disease can occur if an individual is in contact with an allergen that is not normally a part of the individual's environment (a cat at a friend's house)
SEVERITY OF SYMPTOMS

Mild severity means that the person's allergy symptoms:

  • Do not cause sleep disturbance
  • Do not impair daily activities, leisure and/or sport
  • DO not impair school or work
  • Are present but not troublesome to the person

Moderate/severe means that one or more of the following are present:

  • Sleeping disturbance
  • Impairment of daily activities, leisure and/or sport
  • Impairment of school or work
  • Troublesome symptoms

Classification of allergic rhinitis

The accepted classification system for AR now goes beyond seasonal and perennial and includes a new subdivision of intermittent (IAR) or persistent (PER) disease. The severity of AR is classified as mild or moderate/severe depending on symptoms and quality of life.4

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