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Allergic Rhinitis in the United States Pediatric Population

Allergic Rhinitis in the United States Pediatric Population EO Meltzer, 1 MS Blaiss, 2 MJ Derebery, 3 TA Mahr, 4 B Gordon, 5 KK Sheth, 6 AL Simmons, 7 M Wingertzahn, 8 JM Boyle 9.

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Allergic Rhinitis in the United States Pediatric Population

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  1. Allergic Rhinitis in the United States Pediatric Population EO Meltzer,1 MS Blaiss,2 MJ Derebery,3 TA Mahr,4 B Gordon,5 KK Sheth,6 AL Simmons,7 M Wingertzahn,8 JM Boyle9

  2. Patient Perspectives on the Symptoms of Allergic Rhinitis and the Effect of Allergic Rhinitis on Daily Living Michael S. Blaiss,1 John M. Boyle,2 Judith Droar3 1University of Tennessee Health Sciences Center, Memphis, TN; 2Schulman, Ronca and Bucuvalas, Inc., New York, NY; 3ALTANA Pharma US, Inc., Florham Park, NJ

  3. Allergies in America • Allergies in America: A Landmark Survey of Nasal Allergy Sufferers is a comprehensive survey of patient and healthcare-provider perspectives on nasal allergies and their treatment • This presentation focuses on patients’ perceptions of the symptoms of AR and the burden of AR on patients’ daily lives AR = Allergic rhinitis. Allergies in America: A Landmark Survey of Nasal Allergy Sufferers. Executive Summary. ALTANA Pharma US, Inc., 2006.

  4. Methods • 31,470 households in the United States were screened to obtain a national sample of nasal allergy sufferers • A total of 2,500 adults (aged ≥ 18 years) were interviewed by telephone about their condition and treatment • Diagnosed with AR, nasal allergies, or “hay fever” • Symptomatic • Received treatment for their nasal allergies within the previous 12 months Allergies in America: A Landmark Survey of Nasal Allergy Sufferers AR = Allergic rhinitis. Allergies in America: A Landmark Survey of Nasal Allergy Sufferers. Executive Summary. ALTANA Pharma US, Inc., 2006.

  5. Methods (continued) • Development of patient survey questionnaire • No existing validated, standardized, AR questionnaire • New patient questionnaire developed to collect accurate and relevant information on AR • Analysis of relevant literature • Identification of questions used to study similar diseases in accepted health surveys • Key aspects of patient questionnaire • AR symptoms • Effect of AR on quality of life • Nasal allergy medications, effectiveness, and side effects • Draft questionnaire approved by a panel of AR experts AR = Allergic rhinitis. Allergies in America: A Landmark Survey of Nasal Allergy Sufferers. Executive Summary. ALTANA Pharma US, Inc., 2006.

  6. Nasal Allergy Symptoms in Patients With Allergic Rhinitis During the worst 1-month period in the past year, did you have (symptom) every day, most days a week, a few days a week, a few days a month, less than that, or never? N = 2,500 Allergies in America: A Landmark Survey of Nasal Allergy Sufferers. Executive Summary. ALTANA Pharma US, Inc., 2006.

  7. Common Nasal Allergy Symptoms Are Bothersome When you have nasal allergy attacks, how bothersome are the following symptoms usually–extremely bothersome, moderately bothersome, slightly bothersome, or not bothersome? N = 2,500 Allergies in America: A Landmark Survey of Nasal Allergy Sufferers. Executive Summary. ALTANA Pharma US, Inc., 2006.

  8. 32% of Patients With Nasal Allergies Have Comorbid Asthma Past 12 months20% Not past12 months12% Never68% Have you ever been diagnosed with asthma? Have you had asthma in the past 12 months? N = 2,500 Allergies in America: A Landmark Survey of Nasal Allergy Sufferers. Executive Summary. ALTANA Pharma US, Inc., 2006.

  9. Nasal Allergies Contribute to Absenteeismand Interfere With Patient Performance at Work Neither48% Interferedonly22% Missed workonly 10% Both20% Have you missed work in the past 12 months due to your nasal allergies?Aside from actually missing work, have your nasal allergy symptoms in the past 12 months interfered with your performance at work? Base: Employed full time.N = 1,315 Allergies in America: A Landmark Survey of Nasal Allergy Sufferers. Executive Summary. ALTANA Pharma US, Inc., 2006.

  10. When Nasal Allergy Symptoms Are at Their Worst, Work Productivity Declines by 23% Mean productivity, % Thinking about your productivity on a scale of 0 to 100, where 100 means 100% productivity, where would you rank your productivity on days when you don’t have nasal allergy symptoms?Where would you rank your productivity on the same scale of 0 to 100 . . . when your nasal allergies are at their worst? Base: Employed full time. N = 1,315 Allergies in America: A Landmark Survey of Nasal Allergy Sufferers. Executive Summary. ALTANA Pharma US, Inc., 2006.

  11. The Majority of Patients Believe That Nasal Allergies Affect Daily Living Little19% Didn’t really impact14% Not sure1% A lot15% Some26% Moderateamount25% During allergy season, would you say the condition impacted you daily life? N = 2,500 Allergies in America: A Landmark Survey of Nasal Allergy Sufferers. Executive Summary. ALTANA Pharma US, Inc., 2006.

  12. 64% of Patients Do Not Always Adhere to Health Practitioner Advice All of the time36% Not sure1% Never, 4% Rarely, 4% Some of the time13% Most of the time 41% Would you say that you follow your health practitioner’s advice on the management and treatment of your nasal allergies—all of the time, most of the time, some of the time, rarely, or never? N = 2,500 Allergies in America: A Landmark Survey of Nasal Allergy Sufferers. Executive Summary. ALTANA Pharma US, Inc., 2006.

  13. Conclusions • Nasal allergy sufferers experience a range of symptoms • Stuffed-up nose, post-nasal drip, repeated sneezing, and runny nose are the most bothersome symptoms of nasal allergies • Approximately one third of patients with nasal allergies also suffer from asthma • Nasal allergies negatively affect patients’ daily lives • 52% of patients with AR are affected in their performance at work • Patients experience an average productivity loss of 23% when symptoms are at their worst • Only 36% of patients follow their healthcare practitioners’ advice all of the time AR = Allergic rhinitis.Allergies in America: A Landmark Survey of Nasal Allergy Sufferers. Executive Summary. ALTANA Pharma US, Inc., 2006.

  14. Allergic Rhinitis in the United States Pediatric Population EO Meltzer,1 MS Blaiss,2 MJ Derebery,3 TA Mahr,4 B Gordon,5 KK Sheth,6 AL Simmons,7 M Wingertzahn,8 JM Boyle9

  15. Pediatric Allergies in America • This comprehensive survey was designed to use a credibledata-collection approach to determine the prevalence of allergic rhinitis among children aged 4 to 17 in the US population • Random-digit dialing using both geographic and US census population estimates weights the sample to control for sample and non-sample bias • This study also collected information on what this condition means to its sufferers in terms of diagnosis, management, and treatment • 35,757 households in the United States were screened to obtaina national sample of nasal allergy sufferer perspectiveson nasal allergies and their treatment

  16. Pediatric Allergies in America • Parents of 500 children with current allergies and 504 children without nasal allergies (aged 4 - 17 years) were interviewed by telephone about their children’s condition and treatment • Children aged ≥ 10 years were also briefly queried on their condition and treatment, if parent consented • Criteria for participation in the survey • Diagnosed by healthcare practitioner with allergic rhinitis,nasal allergies, or “hay fever” • Symptomatic (yes or no) • Received treatment for their nasal allergies withinthe previous 12 months • In parallel, 501 healthcare practitioners were interviewed • Interviews were conducted between March and April 2007

  17. Pediatric Allergies in America Study Design RDD = Random digit dialing; AMA = American Medical Association; AOA = American Osteopathic Association.

  18. Prevalence of Nasal Allergies in Children: Results of a National Telephone Survey B Gordon,1 MS Blaiss,2 JM Boyle3 1Cape Cod Ear, Nose, and Throat Specialists, Hyannis, MA;2University of Tennessee Health Sciences Center, Memphis, TN; 3Schulman, Ronca and Bucuvalas, Inc., New York, NY

  19. 1 in 7 Children Has Been DiagnosedWith Nasal Allergies Not diagnosed 86% Diagnosed 14%

  20. Prevalence of Allergies 100 86% 86% Pediatric Adult* 80 60 Patients, % 40 14% 14% 20 0 Diagnosed Not diagnosed Question from Pediatric Allergies in America survey:How many children, 4 to 17 years, in this household have been diagnosed with hay fever, rhinitis, or nasal allergies and had symptoms or taken medications for their nasal allergies in the past 12 months?Question from Allergies in America survey: How many persons, 18 or older, in this household have been diagnosed with hay fever, rhinitis, or nasal allergies?*Blaiss MS, et al. Allergy Asthma Proc. 2007;28(suppl 1):S4-S10.

  21. Age of Diagnosis of AR in Pediatric Patients

  22. Age of Diagnosis of AR in Adult Patients Allergies in America: A Landmark Survey of Nasal Allergy Sufferers. Executive Summary. Altana Pharma US, Inc.; 2006.

  23. Diagnosing Physician ENT = Ear, nose, and throat; OTO = Otolaryngologist.

  24. Prevalence of Seasonal Versus Perennial Allergies in Children

  25. Time of Year for Nasal Allergy Symptoms in Children

  26. Outdoor Allergies SymptomsAre More Bothersome in Children Same52% Not sure1% Inside3% Outside44%

  27. Conclusions • The reported prevalence of nasal allergies is high (14%) among children in the United States • The majority of children were diagnosed by pediatricians • Most children were diagnosed with nasal allergiesby age 6 • Seasonal allergies are reported more commonly than perennial allergies in children • Spring is the worst season for nasal allergy symptoms in children • Outdoor allergy symptoms are worse thanindoor allergies

  28. Children With Nasal AllergiesExperience Bothersome Symptoms That Affect Daily Activities MS Blaiss,1 B Gordon,2 JM Boyle3 1University of Tennessee Health Sciences Center, Memphis, TN; 2Cape Cod Ear, Nose, and Throat Specialists,Hyannis, MA; 3Schulman, Ronca and Bucuvalas, Inc., New York, NY

  29. Every day Watering eyes 15% 19% Most days Runny nose 18% 16% 25% 21% Repeated sneezing 25% 27% Nasal congestion 0 25 50 75 100 Respondents, % Daily Symptoms During Worst Allergy Month During the worst one month period in the past year, did your [AGE] have [symptom] every day, most days a week, a few days a week, a few days a month, less than that, or never? N = 500.

  30. Most Bothersome Symptoms of Nasal Allergies

  31. Bothersome Nasal Allergy Symptoms Extremely Moderately 16% 37% Dry cough Red, itchy eyes 22% 34% 18% 41% Headache 25% 40% Runny nose 23% 47% Postnasal drip 32% 43% Nasal congestion 0 20 40 60 80 100 Respondents, %

  32. Allergists 55% 41% Degree of Discomfort During Nasal Allergy Attack: Parents and Practitioners Can't tolerate ENT specialists 26% 71% Can't ignore Family physicians 27% 70% Pediatricians 38% 56% Parents 33% 57% 0 20 40 60 80 100 Category, % ENT = Ear, nose, and throat.

  33. Conclusions • Nasal congestion is the most frequent and bothersome symptom of nasal allergies in children. • Headache and cough are frequent symptoms of children with nasal allergies • More than 80% of parents and clinicians perceive that children have significant degrees of discomfort from their symptoms • The severe symptoms of nasal allergies adversely affect children’s daily lives • Parents and physicians agree that allergy symptoms cannot be ignored or tolerated in many children with nasal allergies

  34. Nasal AllergiesAdversely Affect Sleep and Productivity in Children MJ Derebery,1 EO Meltzer,2 JM Boyle3 1House Ear Clinic, Los Angeles, CA;2Allergy and Asthma Medical Group and Research Center, San Diego, CA; 3Schulman, Ronca and Bucuvalas, Inc., New York, NY

  35. Nasal Allergies Interfere With Sleep Allergy 32% Difficulty ingetting to sleep No allergy 12% 26% Waking up duringthe night 8% 29% Lack of a goodnight’s sleep 12% 0 10 20 30 40 50 Respondents, %

  36. Children’s Productivity Suffers When Nasal Allergy Symptoms Are at Their Worst 97 100 30% decrease 80 68 60 Patient’s productivity 40 20 0 No symptomsn = 486 Symptoms at worstn = 487

  37. Nasal Allergies Decrease Productivity in Children: Reported by Health Professionals ENT = Ear, nose, and throat.

  38. Nasal Allergies Interfere at School/Daycare 50 40% 40 30 Respondents, % 20 11% 10 0 Allergy No allergy

  39. Allergy 23% No allergy 10% 23% 10% 22% 10% 21% 11% 0 10 20 30 40 50 Respondents, % Nasal Allergies Limit Activityin Children (Past 4 Weeks) Difficulty in performing Accomplished less Cut down on amount Been limited inkind of work

  40. Conclusions • Symptoms of nasal allergies negatively affect sleep patterns • Symptoms of nasal allergies negatively affect productivity of children (presenteeism) • Symptoms of nasal allergies interfere with school and limit activities • Effective control of nasal symptoms may improve sleep quality and overall daytime productivity

  41. Nasal Allergies Reduce Quality of Life in Children EO Meltzer,1 AL Simmons,2 JM Boyle3 1Allergy and Asthma Medical Group and Research Center,San Diego, CA; 2University of Arkansas Medical Center,Little Rock, AR; 3 Schulman, Ronca and Bucuvalas, Inc.,New York, NY

  42. Fewer Parents of Children With Allergies Rate Their Children’s Overall Health as Excellent

  43. Fewer Parents View Their Children’s Overall Feelings of Well-Being to Be Positive (Past 4 Weeks)

  44. Children’s Emotional Status Affected by Nasal Allergy Symptoms

  45. Children’s Social Life Is Disrupted by Nasal Allergy Symptoms Allergy N = 493 No allergy N = 432 40% Sleeping 7% 33% Organized sports or exercising 10% 31% Outdoor activities 7% 29% Going out/Playing with friends 6% 27% Having pets 4% 26% Doing well in school 8% 22% Doing things with family 5% School activities 17% 4% 12% Indoor activities 4% 0 20 30 40 50 10 Respondents, %

  46. Conclusions • Nasal allergies impair quality of life and limit activities in children • Compared to parents of children without allergies, fewer parents describe their children with nasal allergies as having excellent overall health or being positive and full of life • Parents perceive that nasal allergies made their children irritable and tired • Effective control of nasal symptoms may improve the activity level and enhance quality of lifein children with nasal allergies

  47. Parent and Physician Perspectives on Nasal Allergy Treatmentin Children AL Simmons,1 TA Mahr,2 JM Boyle3 1University of Arkansas Medical Center, Little Rock, AR; 2Gundersen Lutheran Medical Center, La Crosse, WI; 3Schulman, Ronca and Bucuvalas, Inc., New York, NY

  48. Introduction • Nasal allergies are a common childhood malady • Many treatment options exist, such as over-the-counter and prescription allergy medications, including intranasal corticosteroids • Current treatments may not be effective or are associated with side effects • This results in dissatisfaction and failure to adhere to prescribed therapy • A better understanding of parent and physician perspectives on the treatment of nasal allergies could improve patient outcomes

  49. Majority of Children With Nasal Allergies Use Medication for Symptom Relief (Past 4 Weeks) OTC = Over the counter.

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