Background Different treatments exist for allergic rhinitis (AR), including pharmacotherapy
and allergen immunotherapy (AIT), but they have not been compared using direct patient
data (i.e., "real-world data"). We aimed to compare AR pharmacological treatments
on (i) daily symptoms, (ii) frequency of use in co-medication, (iii) visual analogue
scales (VASs) on allergy symptom control considering the minimal important difference
(MID) and (iv) the effect of AIT. Methods We assessed the MASK-air (R) app data (May
2015-December 2020) by users self-reporting AR (16-90 years). We compared eight AR
medication schemes on reported VAS of allergy symptoms, clustering data by the patient
and controlling for confounding factors. We compared (i) allergy symptoms between
patients with and without AIT and (ii) different drug classes used in co-medication.
Results We analysed 269,837 days from 10,860 users. Most days (52.7%) involved medication
use. Median VAS levels were significantly higher in co-medication than in monotherapy
(including the fixed combination azelastine-fluticasone) schemes. In adjusted models,
azelastine-fluticasone was associated with lower average VAS global allergy symptoms
than all other medication schemes, while the contrary was observed for oral corticosteroids.
AIT was associated with a decrease in allergy symptoms in some medication schemes.
A difference larger than the MID compared to no treatment was observed for oral steroids.
Azelastine-fluticasone was the drug class with the lowest chance of being used in
co-medication (adjusted OR = 0.75; 95% CI = 0.71-0.80). Conclusion Median VAS levels
were higher in co-medication than in monotherapy. Patients with more severe symptoms
report a higher treatment, which is currently not reflected in guidelines.
