® AR is one of the most common chronic disorders in the United States. 4 One source indicates that it ranks fifth in this category.5 It is estimated that up to 30% of adults and up to 40% of children in the United States are affected.1,4,6-8 The total direct and indirect costs of AR in the United States for 2002 have been estimated to be in excess of 11 billion dollars.1 AR is the most common allergic disease in children.

^^ Despite this, the disease has historically been trivialized.

The major risk factors for AR are: a family history of allergic disorder; elevated serum IgE levels, especially before the age of 6 years; higher socioeconomic class;

positive skin test results; and emigration into a Western industrialized environment. '

Table 62-2 Categories of AR

Based on AAAAI/ACAAI Practice Parameter

Seasonal—symptoms present only during specific portions of the year Perennial—symptoms present throughout the year

Episodic—symptoms present only during intermittent exposure to allergen trigger Based on ARIA 2008 Update

Mild versus moderate-severe

Mild means no interference with sleep, daily activities, work or school function and attendance, and no troublesome symptoms Moderate-severe means the presence of any one of the following: abnormal sleep, impairment of daily activities, impairment of work or school function, troublesome symptoms Intermittent versus persistent

Intermittent means that symptoms are present for less than

4 days/week, or for less than 4 consecutive weeks Persistent means that symptoms are present for more than 4 days/week and for more than 4 consecutive weeks Any one of the four possibilities of these variables can occur: mild intermittent, mild persistent, moderate-severe intermittent, and moderate-severe persistent

Certain disorders occur commonly with AR. The most important example is asthma. Some sources consider AR and asthma as two manifestations on a spectrum within the same disease. As many as 78% of patients with asthma have AR, and up to 38% of patients with AR have asthma.4'8'10 There is evidence that AR can predispose to the development of asthma.1,4,8,10 Other conditions that can occur with AR include sinusitis, obstructive sleep apnea, otitis media with effusion, and nasal polyposis.1

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