Editorial

Allergic rhinitis (AR) is now estimated to affect some 1.4 billion people globally and continues to be on the rise. ¹ Currently considered the most common chronic medical condition worldwide requiring therapeutic intervention, AR significantly impacts health and quality of life with poorly controlled AR shown to cause considerable patient discomfort and impairment in work productivity, school performance, social interaction, and sleep disturbances. Additionally, AR has been linked to multiple comorbid illnesses, including asthma, sinusitis, otitis media, and nasal polyps.^2,3 Although the etiology of this global increase remains unknown, developing countries around the world continue to report AR as a growing problem.^1,4,5 The manuscript within this supplement of the American Journal of Rhinology & Allergy reports the findings of the largest survey study of physician-diagnosed AR in children, adolescents, and adults undertaken in the Middle East and helps to clarify the burden of AR in this region of the world, as well as characterize AR and elucidate treatment practices in Egypt, Lebanon, Saudi Arabia, Iran, and the United Arab Emirates. ⁶

The worldwide prevalence of AR is still not fully understood and the impact is underappreciated. This study fills an important regional gap in understanding the global burden of AR. In the present article, the authors report that 10% of the Middle Eastern population surveyed had physician-diagnosed AR. This estimate is similar to previous published estimates of diagnosed AR in the United States, ⁷ Canada, ⁸ Latin America, ⁹ and the Asia-Pacific region. ¹ The majority of participants surveyed reported having intermittent symptoms (65%) with a runny nose, nasal and throat itching, and nasal congestion being among the most common and bothersome symptoms of AR. A limitation of the study includes the lack of information of allergy testing in 46% of the population, potentially including patients with rhinitis of other causes, such as sinusitis or vasomotor rhinitis. Additionally, the majority of the participants lived in urban areas because of low telephone penetration and lack of interviewing infrastructure in rural areas of the Middle East, thus limiting the generalization to the entire Middle East region. Despite these limitations, this study shows a significant burden of AR in the Middle East.

Highly concordant with other studies,^1,8,9 AR symptoms were reported to have a significant impact on quality of life in the Middle East. Fifty-eight percent of respondents stated their symptoms affected their daily and professional life, while 72% of adults reported their symptoms affected their professional performance and 35% reported symptoms resulted in missed school or work within the past 12 months. Moreover, sleep disturbance was reported to be extremely troubling in 15% of AR sufferers. This study further identified a considerable treatment gap in the Middle East with many patients, despite having been treated in the previous year by a specialist, reporting inadequate relief with the currently available medications in the Middle East. Through identification of disease impact of AR on the Middle Eastern population and highlighting treatment gaps, clinicians in the Middle East may better understand and treat AR, leading to improved disease control and quality of life.

This important study adds to the growing body of literature showing the burden of AR around the world, in particular, in developing countries, and elucidates the size of the global allergy epidemic. An improved understanding and characterization of AR in developing countries may provide information important in understanding the etiology behind the global increase in respiratory allergies. With continued research collaboration of the scientific community throughout the world, important advances can be made in understanding the pathophysiology of AR and lead to improved treatment modalities and better outcomes in patient care.