Received: 7 December 2021

DOI: 10.1002/clt2.12130

REVIEW ARTICLE
- -
Revised: 8 February 2022 Accepted: 20 February 2022

Worldwide prevalence of rhinitis in adults: A review of

definitions and temporal evolution

Marine Savouré1,2 | Jean Bousquet1,3,4,5,6 | Jouni J. K. Jaakkola7,8,9 |

7,8,9 10 1
Maritta S. Jaakkola | Bénédicte Jacquemin | Rachel Nadif
1
Université Paris‐Saclay, UVSQ, Univ. Paris‐Sud, Inserm, Equipe d’Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
2
French Environment and Energy Management Agency, Angers, France
3
Universitätsmedizin Berlin, Humboldt‐Universität zu Berlin, Berlin, Germany
4
Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin Institute of Health, Berlin, Germany
5
Centre Hospitalier Universitaire, Montpellier, France
6
MASK‐air, Montpellier, France
7
Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
8
Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland
9
Biocenter Oulu, University of Oulu, Oulu, Finland
10
Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) ‐ UMR_S 1085, Rennes, France

Correspondence
Marine Savouré, Universite Paris‐Saclay, Abstract
UVSQ, Univ. Paris‐Sud, Inserm, Equipe Introduction: Although rhinitis is among the most common diseases worldwide,
d’Epidémiologie Respiratoire Intégrative,
CESP, 16 Avenue Paul Vaillant Couturier, rhinitis prevalence in the general adult population is unclear and definitions differ
94807, Villejuif, France. widely.
Email: marine.savoure@inserm.fr
Objective: To summarize the literature on rhinitis prevalence in the general adult
Funding information population and to assess: (1) the prevalence according to different rhinitis defini-
Agence de l'Environnement et de la Maîtrise
tions overall and in different regions of the world, and (2) the evolution of rhinitis
de l'Energie; Academy of Finland, Grant/
Award Number: 310372; Université Paris‐ prevalence over time.
Saclay; Oulun Yliopisto
Methods: We conducted an extensive literature review of publications including
rhinitis prevalence using Pubmed and Scopus databases up to October 2020. We
classified the definitions into three categories: unspecified rhinitis, allergic rhinitis
(AR), and nonallergic rhinitis (NAR).
Results: Among 5878 articles screened, 184 articles were included, presenting 156
different definitions of rhinitis. Rhinitis prevalence ranged from 1% to 63%. The
overall median prevalences of unspecified rhinitis, AR and NAR were 29.4%, 18.1%
and 12.0%, and they varied according to the geographical location. Rhinitis preva-
lence tended to increase over time.
Conclusions: This review highlights the great heterogeneity of the definitions. The
majority of studies had focused on AR, while only a few epidemiological data exist

†
Bénédicte Jacquemin and Rachel Nadif are Co‐last authors.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, pro-
vided the original work is properly cited.
© 2022 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.

Clin Transl Allergy. 2022;e12130. wileyonlinelibrary.com/journal/clt2 1 of 10

https://doi.org/10.1002/clt2.12130
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on NAR. We found geographical variability in rhinitis prevalence. Most of studies

reported an increase of rhinitis prevalence over the last decades.

KEYWORDS
allergic rhinitis, epidemiology, non‐allergic rhinitis, prevalence, rhinitis

MOTS‐CLÉS
épidémiologie, prévalence, rhinite, rhinite allergique, rhinite non‐allergique

SCHLÜSSELWÖRTER
Allergische Rhinitis, Epidemiologie, Nicht‐allergische Rhinitis, Prevalenz, Rhinitis

PALABRAS CLAVE
rinitis alérgica, epidemiología, rinitis no alérgica, prevalencia, rinitis

1 | INTRODUCTION proposed in the literature that rhinitis prevalence has increased in

recent decades,4 but there is no literature review on this topic.
Rhinitis is among the most common chronic diseases in the world.1 In summary, many different definitions of rhinitis have been
Rhinitis is a generic term describing nasal symptoms resulting from applied, and the majority of the studies have focused on AR, with only
inflammation and/or dysfunction of the nasal mucosa.2 In this study, a few studies focusing on NAR. Moreover, the estimates of rhinitis
we will not consider acute infectious rhinitis that is often due to prevalence in adults in different parts of the world are still poorly
common cold or flu. The two other main phenotypes of rhinitis known.
are allergic rhinitis (AR) and nonallergic rhinitis (NAR): AR re- The objective of the present study was to conduct an extensive
fers to nasal symptoms that are triggered by Immunoglobulin E literature review on rhinitis prevalence in general adult population
(IgE)‐mediated response to exposure to allergens, while NAR refers around the world. This review describes rhinitis prevalence according
to a heterogeneous group of nasal symptoms without allergic to different definitions and worldwide. It also aims to describe the
3
sensitization. temporal evolution of rhinitis prevalence.
Several definitions of rhinitis have been used in epidemiological
studies, some of them defining rhinitis as a unified entity, while
others define AR and NAR separately. To date, literature reviews on 2 | METHODS
4–7
rhinitis prevalence have focused solely on AR. To our knowledge,
the last extensive review of the literature on the prevalence of AR The present literature review on rhinitis prevalence was performed
worldwide was conducted by the AR and its Impact on Asthma (ARIA) according to the four‐phase flow diagram presented in the PRISMA
in 2008, and at that time the identified studies were mainly con- statement as follows: identification, screening, defining eligibility, and
ducted in Europe or in the United States.4 In 2012, a literature review inclusion (Figure 1).
was conducted on the prevalence of AR outside North America and
Europe5 and two recent literature reviews reported prevalence of AR
only in China.6,7 Therefore, there is no recent literature review on 2.1 | Information sources, search strategy, selection
rhinitis prevalence worldwide. process and eligibility criteria
Regarding the worldwide prevalence of rhinitis among children,
the International Study of Asthma and Allergies in Childhood (ISAAC), The literature search used the computerized bibliographic databases
which is considered as the landmark study in this field, reported in 2004 PubMed and Scopus and included all the existing literature up to
a prevalence of self‐reported current nasal symptoms of 31.7% October 13, 2020.
8
(ranging from 11.9% to 80.6%) based on data from 97 countries. We searched for the terms “rhinitis” or “hay fever” combined
Among adult populations, the largest international multicenter study is with “epidemio*" or “preval*” in the title or abstract. The only limi-
the European Community Respiratory Heath Survey (ECRHS), and it tation we applied was that the studies had to be written in English,
estimated a median prevalence of self‐reported nasal allergies of 20.9% French, or Spanish language. Additional records from the references
9
(ranging from 9.5% to 40.9%) in 1995. That study did not estimate the of the literature reviews and of the eligible publications identified in
overall prevalence of rhinitis nor that of NAR, and even though it the search were included. The articles were first screened based on
included altogether 20 countries, they were mainly from the same their title and abstract, and then articles of interest were read
geographical area, that is from the Western Europe. It is commonly entirely to assess their eligibility.
SAVOURÉ ET AL.
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FIGURE 1 Flow diagram showing selection of articles reviewed

Articles were selected according to the following criteria: the population, (5) the study design, including cross‐sectional and/or
articles were required to (1) be an original epidemiological study, (2) longitudinal, (6) the method applied to assess the prevalence,
include prevalence data on rhinitis, AR and/or NAR, (3) be based on a including interview or self‐report, and (7) the definition applied for
general adult population or a population including all ages. As this rhinitis.
study focuses on rhinitis prevalence in general population, we When not directly reported in the article, the prevalence was
excluded studies focusing only on specific subpopulations such as calculated based on the available data, applying the following for-
children, students, farmers, exclusively in men, or women. We also mula: the number of participants with rhinitis divided by the total
excluded studies that were conducted in specific health centers or number of participants. We reported the prevalence in adults only if
allergy clinics and studies that did not contain any information on the available, otherwise we reported the prevalence of the population
definition of rhinitis, or that did not provide any calculable rhinitis including adults and children.
prevalence in the general population.

2.2.1 | Classification of the data

2.2 | Data items
We have categorized the different definitions of rhinitis into three
The following data were collected: (1) the year of publication, (2) the categories as follows: “unspecified rhinitis” refers to a definition of
country where the study was conducted, (3) the period during which rhinitis that did not specify whether it was allergic or nonallergic; AR
the study was conducted, (4) the size and age range of the studied refers to a definition that included the term “AR” and/or “hay fever”
4 of 10
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and/or included exposures known to induce an allergic inflammation questions that did not exclude explicitly common cold or flu; (b)
of the airways, such as pollen, furry animals, or house dust mites; questions that included other allergic diseases in the same item,
and/or assessment of allergic sensitization by skin tests and/or serum such as conjunctivitis or eczema; (c) questions that were limited
specific IgE; NAR refers to a definition that excluded AR and/or to the time of the survey; (d) questions that did not specify when
referred to triggers known to induce NAR, such as cold and dry air, rhinitis was or had been present, and (e) questions that focused
temperature change, airborne chemical irritants, spicy food, alcoholic solely on specific sub‐phenotypes of rhinitis such as rhino‐
beverages, exercise, use of tobacco, anti‐inflammatory drugs, stress, conjunctivitis, seasonal AR, or peri‐annual rhinitis.
and/or printer ink. In addition, we have further subcategorized un- (2) To have a more homogeneous adult population, we excluded
specified rhinitis, AR and NAR according to the method on which the studies that reported prevalences based on populations: (a) that
definition was based: “symptoms‐based definition” which refers to a combined adults and children (i.e., under the age of 16 years), and
definition that is based on a question asking from the participant (b) that included the elderly only (i.e., above the age of 60 years).
himself/herself about the presence of rhinitis or nasal symptoms;
while “doctor diagnosis‐based definition” of rhinitis was based on
asking a question referring to a previous self‐reported medical 3 | RESULTS
diagnosis of rhinitis or on a diagnosis made by a physician for the
study. Finally, “IgE/SPT‐based definition” refers to a definition based After excluding duplicates, a total of 5878 records were identified.
on either of the two previously mentioned definitions in combination Altogether 184 articles were included in the present review
with the assessment of the IgE‐mediated sensitization with mea- (Figure 1, Appendix 1 in Supporting Information S1) with 426 re-
surements of specific IgE and/or skin prick tests (SPTs). Participants ported prevalences of unspecified rhinitis, AR or NAR.
with positive SPTs and/or positive specific IgE were defined as AR
IgE/SPT‐based definition, those with negative IgE/SPT results were
defined as NAR IgE/SPT‐based definition. Finally, we subcategorized 3.1 | Rhinitis definitions and estimates for
unspecified rhinitis, AR and NAR into (1) “ever rhinitis” that refers to prevalence
the presence of rhinitis ever in the study participant's lifetime (i.e.,
lifetime prevalence), and (2) “current rhinitis” that refers to the A total of 156 different definitions of rhinitis were identified: 58 for
presence of rhinitis at the time of the study or in the last few months unspecified rhinitis, 86 for AR, and 12 for NAR (see Appendix 2 in
(i.e., point or months/1‐year period prevalence). The details of the Supporting Information S2). Table 1 describes the rhinitis preva-
definitions and their categorization are presented in Appendix 2 in lences for these three main categories and their subcategories. The
Supporting Information S2. median rhinitis prevalences were: 29.4% (ranging from 1.1% to 63.3%
based on 103 reported prevalences) for unspecified rhinitis, 18.1%
(ranging from 1.0% to 54.5% based on 310 reported prevalences) for
2.3 | Statistical methods AR, and 12.0% (ranging from 4.0% to 31.4% based on 13 reported
prevalences) for NAR. The median prevalence of current AR was
Mean prevalences were calculated for the unspecified rhinitis, AR, and 21.6% based on symptoms‐based definition and 16.4% based on IgE/
NAR applying Microsoft Excel®. For each definition, we calculated the SPT‐based definition. For NAR, the median prevalence was 16.4%
crude mean, median and confidence intervals based on binomial dis- based on symptoms‐based definition and 31.4% based on IgE/SPT‐
tribution with R 4.3. To compare rhinitis prevalence according to based definition. In adults of all ages, NAR was reported in 24.4%–
different regions of the world, prevalences were first grouped by 67.1% of participants with rhinitis.10–20
country and then the countries were stratified by continent. Using the ECRHS definition, the median current AR prevalence
To study the evolution of rhinitis prevalence over time, we was 22.7% (ranging from 7.0% to 47.5% based on 87 reported
selected studies that had repeated measures of the prevalence using prevalences). Using the ISAAC definitions, the median prevalence
the same definition and comparable populations over time. was 32.7% (ranging from 11.4% to 38.0% based on 6 reported
As a complementary analysis, we calculated the rhinitis preva- prevalences) for ever rhinitis, and 30.8% (ranging from 10.4% to
lences based solely on the ISAAC and ECRHS questions that are from 38.3% based on 15 reported prevalences) for current rhinitis.
the two largest international studies on rhinitis and that were used in Sensitivity analyses were based on 63 “reliable” definitions of
several studies included in the present literature review. rhinitis, while 333 prevalences were excluded: 284 due to the defi-
We also conducted sensitivity analyses with more restrictive nition criteria, 49 due to the age range studied. A total of 93 reported
definitions and populations to obtain less biased prevalences of un- prevalences were included, the median prevalences being 32.4%
specified rhinitis, AR and NAR in the general adult populations. We (ranging from 10.4% to 54.1% based on 27 reported prevalences) for
conducted sensitivity analyses based on the following two criteria: unspecified rhinitis, 17.1% (ranging from 1.0% to 44.2% based on 63
reported prevalences) for AR, and 16.4% (ranging from 6.5% to
(1) To include only more “reliable” definitions of rhinitis, we excluded 23.5% based on 3 reported prevalences) for NAR (Table S1 in Sup-
those studies in which the definition was/had been based on: (a) porting Information S3).
SAVOURÉ ET AL.
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T A B L E 1 Rhinitis prevalences
n Mean (%) Med (%) SD (%) CI95% Min. (%) Max. (%)
according to the different definitions
All definitions

Unspecified rhinitis 103 27.0 29.4 14.0 (24.3, 29.7) 1.1 63.3

AR 311 19.1 18.1 10.2 (18.0, 20.3) 1.0 54.5

NAR 13 14.6 12.0 8.3 (9.6, 19.6) 4.0 31.4

Symptoms‐based definitions

Unspecified rhinitis

Ever 20 28.1 30.4 12.8 (22.1, 34.0) 10.8 50.2

Current 68 30.8 32.3 12.5 (27.8, 33.8) 4.1 63.3

AR

Ever 42 21.4 20.7 10.9 (18.0, 24.8) 4.2 52.0

Current 145 23.5 21.6 9.7 (21.9, 25.1) 3.6 54.5

NAR

Ever 1 7.9

Current 6 10.0 16.4 4.4 (5.4, 14.6) 4.0 16.4

Doctor diagnosis‐based definitions

Unspecified rhinitis

Ever 14 9.0 9.1 3.3 (7.2, 10.9) 2.5 14.0

Current 1 1.1

AR

Ever 53 12.8 13.0 6.9 (10.9, 14.7) 1.0 30.9

Current 28 7.9 7.9 1.4 (7.4, 8.5) 3.9 11.4

IgE/SPT‐based definitions

AR

Ever 3 15.5 28.5 11.3 8.9 28.5

Current 39 17.4 16.4 7.3 (15.1, 19.8) 3.7 44.2

NAR

Ever 0

Current 6 20.4 31.4 8.5 (11.5, 29.3) 5.5 31.4

Abbreviations: AR, allergic rhinitis; CI, confidence interval; Current, combination of point and period
prevalences; Ever, Lifetime prevalences; Max, highest reported prevalence; Med, Median; Min,
lowest reported prevalence; n: number of reported prevalences; NAR, non‐allergic rhinitis; SD,
standard deviation.

3.2 | Rhinitis prevalences worldwide from 1.0% to 43.9% for Europe, and from 19.2% to 47.5% for Oce-
ania. Only a few prevalences of NAR have been reported, and no data
World maps showing the average prevalences for the unspecified was found from America, Africa or Oceania; for Asia, six reported
rhinitis, AR and NAR are presented in Figure 2. There was a wide prevalences were found ranging from 4.0% to 31.4%, and for Europe,
variation in the reported prevalences even within the same continent six prevalences were found ranging from 5.5% to 23.5%.
for all categories of rhinitis. Details of the reported prevalences by
country are presented in Table S2 in Supporting Information S3.
Prevalence of unspecified rhinitis ranged from 10.4% to 37.8% for 3.3 | Evolution in the rhinitis prevalence over time
Africa, from 14.0% to 63.3% for America, from 1.1% to 50.2% for
Asia, from 4.1% to 56.6% for Europe, and 13.2% for Oceania (based The evolution over time of rhinitis prevalence within the same pop-
on a single study21). Prevalence of AR ranged from 3.6% to 22.8% for ulation or similar populations and applying the same definition in the
Africa, from 3.5% to 54.5% for America, from 1.0% to 47.9% for Asia, same geographical region are presented in Figure 3. Table S3 in
6 of 10
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F I G U R E 2 Rhinitis prevalences in different regions of the world. (A) Unspecified rhinitis; (B) allergic rhinitis; (C) non‐allergic rhinitis. The
data for continents are presented as follows: median (minimum reported–maximum reported), n = number of reported prevalences. Colored
countries are those for which data are available. The darkest countries are those for which the median prevalence is the highest

Supporting Information S3 provides details of the prevalences by study, an increase from 4.8% to 7.7% was observed in rhinitis
country. defined by “Has a physician ever told you that you have hay
In the America, in Brazil a 10% decrease in the rhinitis preva- fever?”.37
lence was reported between 2011 and 2018.22 In the United States, For Oceania, one study in Australia showed that between 1981
the National Health and Nutrition Examination Survey (NHANES) and 1990 the hay fever prevalence increased from 21.9% to 46.7%.38
reported that episodes of hay fever in the past 12 months increased No studies were found on the evolution of rhinitis prevalence over
from 11.8% to 13.6% between 2007 and 2012. In the National Health time from the African continent.
Interview Survey (NHIS), the prevalence of AR decreased from 9.3%
in 1997 to 7.3% in 2018.
In Asia, the Korean National Health and Nutrition Examination 4 | DISCUSSION
Survey reported that the prevalence of AR increased between 1998
and 2017 from 1.0% to 17.1%.23,24 In this study, we identified a total of 184 articles that included data
25,26 27,28 29,30
In Europe, studies from Denmark, Finland, France, on the rhinitis prevalence among adults, contributing altogether
Germany,31 Italy,32 Russia,27 Scotland,33 and Sweden34–36 reported 156 different definitions of rhinitis. Depending on the definition
an increase in the prevalence of rhinitis. In Poland, the results used and the geographical area studied, rhinitis prevalence ranged
varied depending on the definition used: between 2003 and 2012 from 1% to over 60%. The median worldwide prevalences of un-
a slight decrease was observed for rhinitis based on “Problem specified rhinitis, AR and NAR were 29.4%, 18.1%, and 12.0%. A
with sneezing or a runny or blocked nose or itchy eyes in April, geographical variability was observed in the prevalences of sub-
May, June, or July” and “In last 12 months, have you had a types of rhinitis. Irrespective of the definition used, most of the
problem with sneezing or a runny or blocked nose or itchy eyes studies reported an increase in the rhinitis prevalence over the last
37
when you (your child) did not have a cold or flu?”. In the same decades.
SAVOURÉ ET AL.
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FIGURE 3 Evolution of allergic rhinitis prevalence worldwide over time

We conducted an extensive literature search using the most We found a total of 156 rhinitis definitions in the present liter-
commonly used keywords for rhinitis and AR, namely “rhinitis” and ature review, so we decided to classify them into three distinct cat-
“hay fever”. In an additional search, we also considered to use key- egories: unspecified rhinitis, AR and NAR. To our knowledge, this is
words “nose symptoms” or “nasal symptoms” as synonyms for rhinitis, the first time that such categorization of rhinitis has been applied
but the results of these searches only provided additional articles within an extensive literature review, usually all definitions of rhinitis
that referred to differential diagnoses of rhinitis, such as COVID‐19 being considered together within one term. We focused on a classi-
or nasal polyps. Therefore, these terms were not included in the main fication of rhinitis as an entity or according to its two main pheno-
search. As we have limited this review to articles published in English, types: AR or NAR. Prevalences of other sub‐phenotypes of rhinitis,
French and Spanish, it is possible that we may have omitted some such as rhino‐conjunctivitis, are also of interest per se and should be
prevalence data from articles published in other languages. assessed in more specific reviews.
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Overall, we found a median prevalence of 29% for unspecified way to define AR and NAR in the absence of IgE/SPT measurements
rhinitis, which is close to the prevalence of 31.7% reported for chil- would be to use questions referring to the main triggers of nasal
8
dren aged 13–14 years in the ISAAC phase 3 study. However, a symptoms. Specific allergens triggering rhinitis symptoms, such as
large variability was observed between the studies of rhinitis prev- pollen or animal exposure, or the presence of eye symptoms in
alence. This variability is probably partly explained by heterogeneity combination with rhinitis symptoms have been shown to have a
in the definitions used in the studies. Indeed, within the same pop- moderately high positive predictive value for AR in participants with
ulation the prevalence was found to vary greatly depending on the SPT positivity to common aeroallergens.44 These triggers as well as
definition used: for example, in the study by Bauchau et al. rhinitis associated eye symptoms emerged as important discriminative vari-
prevalence in Belgium varied by more than 30% depending on ables in a clustering analysis that was performed without any a priori
whether rhinitis was defined based on doctor diagnosis or on re- hypothesis to identify AR and NAR.45 However, an expert consensus
ported symptoms.39 Considering all the studies, we found that the and/or methodological research comparing different definitions with
average prevalence of doctor diagnosis‐based definitions was lower a clinical diagnosis of rhinitis is needed to establish the best defini-
compared to the other definitions. This could be partly explained by tions for rhinitis, AR and NAR, to be used in epidemiological studies.
the fact that rhinitis prevalence is often underestimated when based In this study, we carried out a sensitivity analysis including only
on the doctor diagnosis. Indeed, it is recognized that patients with definitions that were judged as “reliable” based on our proposed
rhinitis often tend to self‐diagnose their rhinitis and treat them- criteria for unspecified rhinitis, AR and NAR. Nevertheless, even in
selves,40 and those who consult a doctor are likely to have more this sensitivity analysis a great heterogeneity was observed between
often moderate to severe rhinitis.41 In addition, access to health the different prevalences. Moreover, using identical definitions, for
professionals may be heterogeneous according to the geographic example, ISAAC or ECRHS definitions, rhinitis prevalence still varies
location, healthcare system, or socio‐economic status of the patient. between different countries of the world.
Large variabilities in reported prevalences were also observed for AR This geographical variability in rhinitis prevalence could be partly
and NAR. The median prevalence of AR obtained in this literature explained by different environmental exposures, such as different
review based on all definitions was 18%, with a higher average species of pollen, different lifestyle factors, including dietary habits and
prevalence being detected with the symptoms‐based definitions keeping of pets indoors, or different host risk factors.5 As in this study,
compared to the IgE/SPT‐based definitions. We obtained a median we have reported rhinitis prevalences without considering these risk
prevalence of NAR of 12%, which is lower than the prevalence ob- factors, these hypotheses need to be tested in future studies. It should
tained for AR. Nevertheless, based on our literature review, be noted that these factors were rarely considered and/or investigated
compared to AR, NAR could represent 20%–80% of rhinitis cases in in the studies that were identified by this literature review.
adults. As only 13 studies had evaluated the prevalence of NAR, it is Rhinitis appears to be a common disease in the European and
rather difficult to make conclusions on the “true” prevalence of NAR. American countries, which is consistent with some previous reports.4,5
The wide variability in definitions of rhinitis detected in this In other parts of the world, far fewer studies have been reported on
extensive review makes it recommendable to try to achieve a the prevalence of different types of rhinitis, which makes it more
consensus on which definitions should be used in epidemiological difficult to calculate reliable estimates and make firm conclusions. It is
studies. However, to date, no such consensus has been reached. In our noteworthy that the global distribution of rhinitis prevalence was
opinion, it would be best to define unspecified rhinitis in epidemio- found to be similar to that of global distribution of asthma prevalence,
logical studies applying a question that is easily understandable by all for which there is more studies.46 Further studies that apply stan-
participants, that refers to the main symptoms of rhinitis, and that dardized definitions of rhinitis in different parts of the world would
does not include specific medical terms. The AR and Its Impact on throw more light on potential “true” differences in rhinitis prevalence
Asthma (ARIA) recommended to use a question including symptoms and on potential causes underlying such differences.
of “sneezing, runny nose and/or blocked nose when the patient does Our extensive review showed that most studies reported an in-
not have a cold”.3 The definitions of current and ever rhinitis should crease in rhinitis prevalence over time. One explanation could be that
not include any ambiguous terms, such as “often,” “several,” or “most the awareness of rhinitis has improved in parallel in different pop-
of the time.” Instead, it would be better to refer to clear time periods, ulations around the world due to advertising of over‐the‐counter
for example, “in the last 12 months” or “during your lifetime.” The two medicines for rhinitis, and with the development of the Internet mak-
42
questions in the ISAAC study comply with these recommendations, ing it easier to get information on rhinitis. In addition, medical exami-
and, in our opinion, are accurate questions to define current and ever nations may have become better accessible and thus, the rhinitis
unspecified rhinitis. In clinical practice, to define AR and NAR, the diagnosis may also be more easily accessible. In any case, rhinitis
measurement of specific IgE or SPTs combined with a medical history prevalence seems to have increased in many parts of the world,
by the doctor is “the gold standard.” However, as these diagnostic whatever the definition of rhinitis. Concerning the trend of increasing
tools are not always easily available in large epidemiological studies, it prevalence of different types of rhinitis, potential impact of risk factors,
could be useful to have a proxy for AR and NAR defined based on including global warming, changes in seasonal patterns, and air pollu-
questionnaire. We have recently shown that a combination of the tion, have been proposed.47 However, only few studies have investi-
ISAAC and ECRHS definitions could be a suitable proxy.43 Another gated potential impact of such factors on rhinitis prevalence over time.
SAVOURÉ ET AL.
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In conclusion, our review highlights the lack of consensus on which 2. International Rhinitis Management Working Group. International
questions the phenotypes of rhinitis should be based. This review also Consensus Report on the diagnosis and management of rhinitis. Al-
lergy. 1994;49(19 Suppl l):1‐34.
found a geographical variability of rhinitis prevalences, and pointed out
3. Bousquet J, Van Cauwenberge P, Khaltaev N, Aria Workshop Group,
the scarcity or even inexistence of data from some parts of the world. World Health Organization. Allergic rhinitis and its impact on
While these points could appear as not being novel, there is no recent asthma. J Allergy Clin Immunol. 2001;108(5 Suppl):S147‐S334.
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Impact on Asthma (ARIA) 2008*. Allergy. 2008;63(s86):8‐160.
present extensive review underlines the urgent need for a consensus
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