Title: Validating childhood symptoms with physician-diagnosed allergic rhinitis.
Authors: Kim, Haejin; Levin, Linda; LeMasters, Grace K; Villareal, Manuel; Evans, Sherry; Lockey, James E; Khurana Hershey, Gurjit K; Bernstein, David I
Published In Ann Allergy Asthma Immunol, (2012 Apr)
Abstract: BACKGROUND: Multiple population-based and high-risk cohort studies use parental questionnaire responses to define allergic rhinitis (AR) in children. Individual questionnaire items have not been validated by comparison with physician-diagnosed AR (PDAR). OBJECTIVE: To identify routine clinical questions that best agree with a physician diagnosis of AR and can be used for early case identification. METHODS: Children participating in a longitudinal birth cohort study were evaluated at ages 1 through 4 and at age 7 (n = 531) using questionnaires, physical examinations, and skin prick tests (SPT) with 15 aeroallergens (AG). Parents answered 3 stem questions pertaining to their child, including presence of nasal symptoms absent a cold/flu (ISAAC-validated question), presence of hayfever, and ocular itch. Substem questions were answered with details regarding seasonality, nasal triggers, and ocular seasonality. A global assessment of allergic diseases, including AR, was performed by a specialty-trained clinician. Percent agreement, sensitivity, specificity, and positive predictive values were assessed for individual stem and substem questions. RESULTS: Positive response to having hayfever and presence of ocular symptoms had the highest specificity (84% and 69%, respectively) and the highest percent agreement (74% and 68%) with PDAR. Identification of triggers for nasal and ocular symptoms had the highest sensitivity (89%). Positive predictive values ranged from 31 to 39%. Combining 2 responses with highest agreement increased specificity for PDAR to 91%. CONCLUSION: Responses to hayfever and ocular symptoms had better specificity and percent agreement with PDAR than the ISAAC-validated questionnaire item. Combining 2 rhinitis questions sharply increases specificity and may improve diagnostic accuracy of clinical questions.
PubMed ID: 22469440
MeSH Terms: Child; Child, Preschool; Clinical Trials as Topic; Environmental Exposure/adverse effects; Evidence-Based Medicine; Expert Testimony; Humans; Infant; Practice Guidelines as Topic; Quality Assurance, Health Care; Rhinitis, Allergic, Perennial/diagnosis*; Rhinitis, Allergic, Perennial/immunology; Rhinitis, Allergic, Perennial/physiopathology; Rhinitis, Allergic, Seasonal/diagnosis*; Rhinitis, Allergic, Seasonal/immunology; Rhinitis, Allergic, Seasonal/physiopathology; Surveys and Questionnaires*; United States