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Yepes-Nuñez JJ, Morales Cardenas E, Gómez-García C, Manco Sepúlveda M, Martínez LM, Valero A, McConnell MM. Classic test and generalizability theories are both useful for cross-cultural adaptation of an allergic rhinitis health-related quality of life questionnaire. World Allergy Organ J 2021; 14:100612. [PMID: 34934472 PMCID: PMC8640560 DOI: 10.1016/j.waojou.2021.100612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 09/18/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022] Open
Abstract
Background An instrument to assess Allergic Rhinitis (AR) Health-Related Quality of Life (HRQL) in adult patients was developed in Spain. No validated instrument is currently cross-culturally adapted for use in daily practice to assess HRQL in AR patients in Colombia. Purpose The aim of this study was to evaluate the measurement performance of an AR-HRQL specific questionnaire, ESPRINT-15 (Cuestionario ESPañol de Calidad de Vida en RINiTis), in Colombian adult patients with AR using the Classic Test Theory (CTT) and the Generalizability theory (G-theory) frameworks. Methods We conducted the cross-cultural adaptation in 2 stages. In stage 1, we evaluated comprehensibility, acceptability, and feasibility of ESPRINT-15 in healthy adults and adult patients with AR. In stage 2, we examined both reliability and validity of ESPRINT-15 scores using CTT and overall reliability applying the G-theory in adult patients with AR. Results For feasibility and acceptability, all items showed a higher than 95% level of understanding, and modifications in the original questionnaire were unnecessary. Reliability and validity using CTT showed a high internal consistency (Cronbach's alpha and Mc McDonald's omega = 0.95) and test-retest reliability (scores from 0.70 to 0.76). The overall reliability score using G-theory was 0.75, and G-coefficients scores associated with internal consistency and test-retest reliability measures were 0.96 and 0.61, respectively. Validity using exploratory factor analysis (EFA) identified 2 factors instead of the original ESPRINT-15 4 domains. However, confirmatory factor analysis (CFA) showed good fit regarding the original model. Conclusions The proposed cross-cultural adaptation of ESPRINT-15 showed good reliability and validity measures. Additionally, it was easy to use and administer. ESPRINT-15 can be used clinically and for research in Colombian adults' patients with AR. CTT and the G-theory can be used in epidemiological studies to adapt AR-HRQL questionnaires cross-culturally in adult patients with AR.
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Affiliation(s)
- Juan José Yepes-Nuñez
- Universidad de los Andes, School of Medicine, Carrera 7 #116-5, 110111, Bogotá, Colombia.,Pulmonology Service, Internal Medicine Section, Fundación Santa Fe de Bogotá University Hospital, Carrera 7b #123-90, 110111, Bogotá, Colombia
| | - Edison Morales Cardenas
- Unidad Alergológica, Calle 19 A #44-25, Consultorio 2405, Salud y Servicios Ciudad del Río, Medellín, Antioquia, Colombia
| | - Carolina Gómez-García
- Unidad Alergológica, Calle 19 A #44-25, Consultorio 2405, Salud y Servicios Ciudad del Río, Medellín, Antioquia, Colombia
| | - Madelen Manco Sepúlveda
- Unidad Alergológica, Calle 19 A #44-25, Consultorio 2405, Salud y Servicios Ciudad del Río, Medellín, Antioquia, Colombia
| | - Lina Marcela Martínez
- Unidad Alergológica, Calle 19 A #44-25, Consultorio 2405, Salud y Servicios Ciudad del Río, Medellín, Antioquia, Colombia
| | - Antonio Valero
- Sección de Alergología, Servicio de Neumología y Alergia, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Meghan M McConnell
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Kozlov V, Lavrenova G, Savlevich E, Bazarkina K. Evidence-based phytotherapy in allergic rhinitis. CLINICAL PHYTOSCIENCE 2018. [DOI: 10.1186/s40816-018-0080-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Braido F, Baiardini I, Balestracci S, Ghiglione V, Stagi E, Ridolo E, Nathan R, Canonica GW. Does asthma control correlate with quality of life related to upper and lower airways? A real life study. Allergy 2009; 64:937-43. [PMID: 19243359 DOI: 10.1111/j.1398-9995.2008.01932.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The goal of asthma therapy is to achieve an optimal level of disease control, but the relationship between asthma control, impact of comorbid rhinitis and health related quality of life (HRQoL) in real life remains unexplored. OBJECTIVE The aims of this real life study were to evaluate asthma control, the impact of asthma (with and without rhinitis) on HRQoL, the relationship between asthma control and HRQoL, and the role of rhinitis on asthma control and HRQoL. METHODS 122 asthma patients completed the Asthma Control Test, Rhinitis Symptoms score (T5SS) and RHINASTHMA. RESULTS Asthma control was unsatisfactory (44.27% of uncontrolled patients), as well as HRQoL. Controlled patients controlled showed significantly lower scores in all the RHINASTHMA domains compared to uncontrolled. Irrespective of their level of control, patients with rhinitis symptoms showed worse HRQoL in Upper Airways (UA) (P < 0.0001), Lower Airways (LA) (P < 0.001), and Global Summary (GS) (P < 0.0001). In patients with symptomatic rhinitis, RHINASTHMA were lower in controlled asthma patients (UA P = 0.002; LA P < 0.0001; RAI P < 0.01; GS P < 0.0001). Asthma control was associated with lower T5SS score (P = 0.034). CONCLUSION Asthma control in real life is unsatisfactory. Rhinitis and asthma influence each other in terms of control and HRQoL. The control of rhinitis in asthma patients can lead to an optimization of HRQoL related to the upper airways, while this phenomenon is not so evident in asthma. These results suggest to strengthen the ARIA recommendation that asthma patients must be evaluated for rhinitis and vice versa.
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Affiliation(s)
- F Braido
- Allergy and Respiratory Diseases, Department of Internal Medicine, Genoa University, Genoa, Italy
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Lanier BQ. Use of intranasal corticosteroids in the management of congestion and sleep disturbance in pediatric patients with allergic rhinitis. Clin Pediatr (Phila) 2008; 47:435-45. [PMID: 18192642 DOI: 10.1177/0009922807310249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Allergic rhinitis affects a large number of children and exerts a considerable socioeconomic impact. It is underdiagnosed and inadequately treated, which predisposes children to potentially serious comorbidities. Allergic rhinitis symptoms may create nighttime breathing problems and sleep disturbances and have a negative effect on a child's ability to learn in the classroom. Although antihistamines have shown efficacy in relieving many symptoms, they have little effect on nasal congestion. This article summarizes the advantages of intranasal corticosteroids, including their effectiveness against congestion and excellent safety profile. Intranasal corticosteroids with minimal systemic bioavailability provide topical drug delivery that minimizes the potential for systemic side-effects.
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Affiliation(s)
- Bob Q Lanier
- Division of Immunology, University of North Texas Health Science Center, Fort Worth, Texas 76132, USA.
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Baiardini I, Braido F, Brandi S, Canonica GW. Allergic diseases and their impact on quality of life. Ann Allergy Asthma Immunol 2006; 97:419-28; quiz 429-30, 476. [PMID: 17069092 DOI: 10.1016/s1081-1206(10)60928-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To review the results of studies that have evaluated the impact of allergic diseases on patients' health-related quality of life (HRQL). DATA SOURCES We performed a MEDLINE search of the literature published between January 1990 and May 2006 (English language only) on HRQL and allergic diseases. STUDY SELECTION Representative studies that used validated questionnaires that assessed the effect of allergic diseases on HRQL were selected for inclusion in this review. RESULTS Allergic diseases can deeply interfere with patients' HRQL, with detrimental effects on the physical, psychological, and social dimensions of life. Numerous validated questionnaires that are now available can easily be adopted; most of them are specifically developed for rhinitis and asthma. CONCLUSIONS HRQL has become an increasingly important aspect in outcome evaluation in health care research, providing a more comprehensive approach to the patient and proving that nowadays we cannot renounce this tool. Most of the studies evaluate patients with respiratory allergy. Further studies are needed to explore HRQL in other allergic conditions (urticaria, food allergy, sting allergy, drug allergy) by means of specific, validated questionnaires.
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Affiliation(s)
- Ilaria Baiardini
- Allergy and Respiratory Diseases, DIMI, Genoa University, Genoa, Italy
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Seshul M, Pillsbury H, Eby T. Use of intradermal dilutional testing and skin prick testing: clinical relevance and cost efficiency. Laryngoscope 2006; 116:1530-8. [PMID: 16954975 DOI: 10.1097/01.mlg.0000234916.43285.f8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective was to determine the agreement of the positive results from a multiple skin prick test (SPT) device with the ability to determine a definable endpoint through intradermal dilutional testing (IDT) to compare semiquantitatively the degree of positivity of SPT results with quantitative results from IDT and to analyze the cost of immunotherapy based on SPT compared with IDT guided by SPT. STUDY DESIGN Retrospective review of clinical data (random accrual). METHODS One hundred thirty-four patients underwent allergy screening using a multiple SPT device. Antigens testing positive by skin prick device were tested using IDT on a separate day. Antigens testing negative by SPT were not evaluated by IDT. Regional allergy testing practice patterns were determined, and a cost analysis using Medicare rates was performed RESULTS There was good agreement between an antigen testing positive by SPT and the determination of a definable endpoint (93.33%, n = 1,334 antigens). The degree of positivity from the SPT correlated poorly with the final endpoint concentration (r = 0.40, P < .0001). Blended testing techniques were similar in cost when compared with several commonly used allergy testing protocols. CONCLUSIONS Antigens which show reactivity to a multiple SPT device usually have a treatable endpoint that is independent of the degree of positivity of the SPT result. IDT is an important step in the determination of the strongest starting dose of immunotherapy that may be safely administered. Initiating immunotherapy in this manner may potentially create significant health care savings by shortening the time required for a patient to reach their individual maximally tolerated dose. The use of a relatively large screening panel is cost effective and does not increase the average number of antigens treated by immunotherapy. Blended allergy testing techniques that include IDT in their protocol are comparable in cost with commonly used allergy testing protocols.
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Affiliation(s)
- Merritt Seshul
- Carolina Ear, Nose and Throat Head and Neck Surgery Center, Hickory, North Carolina, USA
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Rha YH. Allergic rhinitis in children : diagnosis and treatment. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.6.593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yeong-Ho Rha
- Department of Pediatrics, College of Medicine, Kyunghee University, Seoul, Korea
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Abstract
Allergic rhinitis, an IgE-mediated disease, is the most common chronic childhood condition and is characterized by nasal sneezing, rhinorrhea, palate and eye itchiness, and congestion. Allergic rhinitis should be diagnosed as early as possible to avoid detrimental effects on the quality of life and comorbid disorders. Treatment initially involves avoidance measures and, when necessary, pharmacotherapy or immunotherapy. Pharmacotherapy generally involves antihistamines or nasal corticosteroids, but other medications such as leukotriene antagonists have demonstrated effectiveness in treating allergic rhinitis symptoms. Immunotherapy generally is reserved for patients unresponsive to therapy or unable to take medications.
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Affiliation(s)
- Lien Lai
- Department of Medicine, Creighton University Medical Center, 601 North 30th Street, Suite 5850, Omaha, NE 68131 USA
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Blaiss M. Current concepts and therapeutic strategies for allergic rhinitis in school-age children. Clin Ther 2005; 26:1876-89. [PMID: 15639699 DOI: 10.1016/j.clinthera.2004.11.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) is a common debilitating disorder that can adversely affect the quality of life and the academic performance of school-age children. Symptoms during the day can hamper concentration and lead to learning problems. Nocturnal symptoms can cause sleep loss and secondary daytime fatigue, further undermining a child's ability to function well during the school day Oral antihistamines are the foundation of pharmacologic therapy, but there are important differences between the agents. OBJECTIVE The purpose of this review is to provide an overview of the diagnostic and treatment challenges posed by AR in school-age children. The paper discusses and compares the available treatment modalities for this age group, with a focus on their beneficial and adverse effects. METHODS Pertinent articles were identified in the literature through a MEDLINE search (1990-2003). Keywords used were antihistamines cetirizine fexofenadine loratadine desloratadine intranasal corticosteroids and CNS effects. Results of numerous clinical trials of first-generation early second-generation and the newer antihistamines were identified. RESULTS This review established that the socioeconomic costs of AR are considerable. In children aged > or =12 years, direct US expenditures (eg, physician visits, medications) in 1996 amounted to $2.3 billion. Indirect costs measured by variables such as missed school days and poor performance also have an impact Major concerns include underdiagnosis and inadequate treatment, increasing the risk of serious comorbid conditions such as asthma. Advantages and drawbacks of antihistamines show that first-generation agents (eg, hydroxyzine) are effective and readily available over the counter, but are associated with sedation and the potential for suboptimal dosing. Newer agents, such as cetirizine, loratadine, desloratadine, and fexofenadine are effective and safer than the older drugs tie, no cardiotoxicity and less sedation). Of these, fexofenadine has been shown to be beneficial and nonsedating, even at higher-than-recommended doses. Other therapies reviewed include intranasal corticosteroids and leukotriene modifiers. CONCLUSIONS AR has a considerable negative impact on children in terms of their physical, social, and psychological well-being and academic performance. An appropriate treatment must be effective and tolerable. Of particular importance for enhancing treatment adherence in the school-age population are pleasant taste and ease of use of medication. A drug that has minimal or no sedative or anticholinergic effects is optimal.
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MESH Headings
- Adolescent
- Adrenal Cortex Hormones/therapeutic use
- Child
- Clinical Trials as Topic
- Histamine H1 Antagonists/therapeutic use
- Humans
- Patient Compliance
- Practice Guidelines as Topic
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/physiopathology
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/physiopathology
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Affiliation(s)
- Michael Blaiss
- Division of Clinical Immunology/Allergy, University of Tennessee Health Science Center, Memphis, TN, USA.
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Abstract
BACKGROUND Allergic rhinitis (AR) can have substantial negative impact on children. Most notably, it can impede learning during the school-age years. Other consequences include adverse behavioral and psychosocial effects, poor quality of life, and potential impact on serious comorbidities, such as asthma. CONSENSUS PANEL In February 2004, in a conference sponsored by Aventis Pharmaceuticals, a multidisciplinary group convened to review relevant clinical data for the purposes of developing consensus recommendations for the management of AR in children. The consensus panel consisted of academic, school health, and medical providers, who were identified based on previous work and publications. CONSENSUS FINDS The focus of discussions was to assess the degree of impact of AR in schoolchildren and, based on this information, to determine how to improve screening, diagnosis, prevention, and treatment, to help ensure quality of life and maximal school performance in this population. The group considered the most critical factor in successful management ot be communication and collaboration among parents, educators, and healthcare professionals. Knowledge of the common signs and symptoms of AR in children can help to ensure early diagnosis, appropriate intervention, and clinically favorable outcomes. Importantly, both uncontrolled symptoms of AR, as well as adverse effects from medications, can diminish cognitive function and learning. When choosing treatment for children with AR, consideration must be given to the side effects of medications. All first-generation and some second-generation antihistamines can be associated with adverse effects on cognitive function and learning, as a result of their sedative properties. Treatment with non-sedating second-generation antihistamine has been shown to improve learning potential and is an ideal choice for treatment in this population. CONCLUSION Existing data indicate that further studies using objective measures of impairment in children taking antihistamine medications should be conducted to evaluate the impact of disease and treatment.
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MESH Headings
- Absenteeism
- Adolescent
- Asthma/etiology
- Child
- Cognition Disorders/etiology
- Comorbidity
- Female
- Health Status
- Histamine H1 Antagonists/therapeutic use
- Humans
- Learning
- Male
- Mass Screening
- Practice Guidelines as Topic
- Quality of Life
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/drug therapy
- Students
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Affiliation(s)
- Michael S Blaiss
- University of Tennessee Health Science Center, Germantown, TN 38138, USA.
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Bender BG, Milgrom H. Comparison of the effects of fluticasone propionate aqueous nasal spray and loratadine on daytime alertness and performance in children with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2004; 92:344-9. [PMID: 15049399 DOI: 10.1016/s1081-1206(10)61573-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Concern has been directed at the relative sedating properties of lipophilic and lipophobic antihistamines, but few studies have sought to determine the comparative benefit of seasonal allergic rhinitis (SAR) treatments in controlling symptoms and consequently improving alertness. OBJECTIVE To compare the relative contributions of fluticasone propionate aqueous nasal spray and loratadine in enhancing daytime performance in 8- to 17-year-old children. METHODS All participants had a documented history of SAR, positive response to a skin prick (wheal 3-mm greater than negative control or equal to the positive control) for seasonal aeroallergens, and clinically identifiable symptoms at the time of randomization. Following confirmation during baseline of current SAR symptoms, participants were randomized to 1 of the 2 treatments and returned 2 weeks later for evaluation of symptom control, quality of life, attention, reaction time, and memory. RESULTS Children in the fluticasone propionate aqueous nasal spray group but not the loratadine group demonstrated improvement in nasal symptoms, nasal quality of life score, and composite verbal memory. No differences were identified on any scores from the Conners Continuous Performance Test. CONCLUSIONS Treatments that most effectively control SAR symptoms are also likely to provide the greatest benefit to children whose daytime functioning, including their capacity to learn at school, is compromised by their illness.
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Affiliation(s)
- Bruce G Bender
- Department of Pediatrics, National Jewish Medical and Research Center, Denver, Colorado 80206, USA.
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Vitanza JM, Pearlman DS. CORTICOSTEROIDS IN THE TREATMENT OF ALLERGIC RHINITIS. Immunol Allergy Clin North Am 1999. [DOI: 10.1016/s0889-8561(05)70122-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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